The most satisfied patients also have a 26% higher mortality rate, raising questions about whether satisfaction measures are a good proxy for health care quality, according to a study published in the Archives of Internal Medicine.

The findings show that although patient satisfaction is frequently used as a measure of care quality, researchers from the University of California-Davis say that emphasizing it could have unintended consequences.

Methodology
The researchers analyzed responses from 51,946 adults between 2000 and 2007 for the national Medical Expenditure Panel Survey, which assesses the use and costs of health care services. Respondents were questioned about their health status and experiences and asked to rate their care on a scale from zero to 10. Those responses were then linked to the national death certificate registry.

In addition to the higher death rate, the researchers found that the most satisfied patients:

• Had 9% higher medical costs;
• Spent more on drugs; and 
• Were more likely to be admitted as inpatients.

However, these patients did record lower ED utilization, researchers note.

• Regardless of this study's findings, hospitals are increasingly incented on patient satisfaction. Learn more about reimbursement for patient satisfaction and organizations' strategies to raise the bar.

Takeaways and reaction
According to the researchers, "our data suggest that we do not fully understand what drives patient satisfaction…or how these factors affect health care use and outcomes." 

The conundrum should prompt health care stakeholders to reconsider the value of patient satisfaction, they add, and whether physicians who aim to satisfy patients are not offering a full picture of the costs or risks of treatment.

However, the surprising findings are raising questions about the study's methodology. Writing on Twitter, Harvard health policy researcher Ashish K. Jha suggested that researchers may have incorrectly conflated the healthiest and sickest patients (Frier, Bloomberg, 2/13; Garza, Sacramento Bee, 2/14; McKinney, Modern Healthcare, 2/13 [subscription required]).