Patient Satisfaction and Administrative Measures as Indicators of the Quality of Mental Health Care

Veterans Administration Northeast Program Evaluation Center, West Haven, CT 06516, USA.
Psychiatric Services (Impact Factor: 2.41). 09/1999; 50(8):1053-8. DOI: 10.1176/ps.50.8.1053
Source: PubMed


Although measures of consumer satisfaction are increasingly used to supplement administrative measures in assessing quality of care, little is known about the association between these two types of indicators. This study examined the association between these measures at both an individual and a hospital level.
A satisfaction questionnaire was mailed to veterans discharged during a three-month period from 121 Veterans Administration inpatient psychiatric units; 5,542 responded, for a 37 percent response rate. These data were merged with data from administrative utilization files. Random regression analysis was used to determine the association between satisfaction and administrative measures of quality for subsequent outpatient follow-up.
At the patient level, satisfaction with several aspects of service delivery was associated with fewer readmissions and fewer days readmitted. Better alliance with inpatient staff was associated with higher administrative measures of rates of follow-up, promptness of follow-up, and continuity of outpatient care, as well as with longer stay for the initial hospitalization. At the hospital level, only one association between satisfaction and administrative measures was statistically significant. Hospitals where patients expressed greater satisfaction with their alliance with outpatient staff had higher scores on administrative measures of promptness and continuity of follow-up.
The associations between patient satisfaction and administrative measures of quality at the individual level support the idea that these measures address a common underlying construct. The attenuation of the associations at the hospital level suggests that neither type can stand alone as a measure of quality across institutions.

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    • "Mental health services are increasingly being evaluated according to levels of patient satisfaction (Ruggeri, 1994;Swanson et al., 2003). High satisfaction has been found to predict higher treatment adherence and less frequent hospital readmission (Boyer et al., 2009;Druss, Rosenheck, & Stollar, 1999). Andreasson and Skarsater (2012) conducted open-ended interviews of 12 patients with psychotic disorders about their experiences with coercive treatments. "
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    ABSTRACT: The authors reviewed and synthesized scholarly literature on the topic of involuntary confinement and treatment for severely mentally ill adults. Objectively, all facets of the issue are reported, including recurrent positive outcomes, negative outcomes, and patient experiences in common. Patient experiences are organized into related subthemes of autonomy, patient satisfaction, relationships with staff, perceived coercion, traumatization, and humiliation. The literature suggests that short-term involuntary hospitalization is sometimes necessary in order to prevent the mentally ill from psychiatrically decompensating or harming themselves or others. Understandably, hospitalization is often experienced by the mentally ill as a demoralizing violation of their rights and tends to lead them to disengage further from the professional help they need in order to recover. In turn, disengagement leads to further decompensation and resulting risk for rehospitalization. In order to intervene in this cycle and instill severely mentally ill patients with hope in the recovery process, the use of coercive tactics must be decreased in favor of cooperative engagement measures to the greatest extent possible. Patients must be empowered to make choices within the limits of their illnesses through positive interactions with staff, particularly in potentially negative, autonomy-compromising situations. Cooperative measures may help to minimize the potentially traumatic and humiliating effects of being involuntarily hospitalized and medicated. In turn, trusting patient-provider relationships may develop. Thereafter, the severely mentally ill may become more likely to seek professional help on their own volition in the future. (Bulletin of the Menninger Clinic, 79[3], 255-280).
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    • "Several studies could demonstrate a relationship between patient satisfaction and eff ectiveness of a treatment (Druss et al. 1999). Th erefore, the assessment of patient satisfaction is an important criterion in evaluation of psychiatric and psychotherapeutic services (Hansson 2001; Lasalvia and Ruggeri 2007). "
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    ABSTRACT: Objects: Patient satisfaction with psychiatric treatment has emerged as an important factor with respect to the quality of health care. Methods: Patient satisfaction using the Zurich Satisfaction Questionnaire (ZUF-8) as well as symptom severity (measured with the Hamilton Depression Scale [HRSD], Brief Psychiatric Rating Scale and Clinical Global Impression Scale) was assessed at admission and discharge of inpatient treatment in patients with a major depressive episode (MDD, N = 217) and schizophrenia (N = 75). Differences between the two diagnostic groups (using T-tests) and correlations of patient satisfaction with different social and treatment variables were calculated (Pearson product-moment correlation). Results: The mean score of patient satisfaction was 26.8 points (ZUF-8; range 8-32 points), without differences between MDD and schizophrenia (t = 0.45, p = 0.78). Patients with MDD and personality disorder showed lower satisfaction than patients with MDD without personality disorder (t = 2.31, p = 0.03). Patient satisfaction correlated negatively with severity of depressive symptoms at discharge (HRSD: r = - 0.38; p < 0.01) and number of comorbidities (r = - 0.42; p < 0.01) in MDD. Number of prescribed drugs correlated negatively with patient satisfaction in both groups (depression: r = - 0.28, p = 0.02; schizophrenia: r = - 0.24; p = 0.03). Conclusions: Patient satisfaction was high without differences between MDD and schizophrenia. Severity of disease and comorbidites in MDD and number of prescribed drugs in both groups were related with reduced patient satisfaction.
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    • "For example, mental health users who are satisfied cooperate better with their doctors and are more accepting of treatment recommendations than users who are dissatisfied with their treatment (Druss et al. 1999). In contrast, dissatisfaction of service users with various aspects of mental health treatment increases the likelihood of treatment dropout (Berghofer et al. 2002; Druss et al. 1999; Ruggeri et al. 2007; Tehrani et al. 1996; Tempier et al. 2002). Their dissatisfaction is often based on unmet treatment expectations (Berghofer et al. 2006; Wiersma and van Busschbach 2001). "

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