An Illustrated Patient Satisfaction Evaluation Tool for Ambulatory Populations
David A. Asch MD MBA
Leonard Davis Institute of Health Economics
Philadelphia, PA
Funding Period: October 1999 - September 2002

BACKGROUND/RATIONALE:
Recent studies have examined ways to measure patients’ expectations of providers and clinic visits. Few studies have linked expectations to reports of satisfaction.

OBJECTIVE(S):
Our objectives were to examine the impact of race, sex, and literacy on expressed patient expectations and the relationship of expectations to satisfaction.

METHODS:
As part of a larger study, patients in primary care clinic waiting areas at the Philadelphia VAMC and the University of Pennsylvania Health System were invited to participate. Participants provided sociodemographic information and were administered the REALM (a health literacy assessment), a series of 13 questions to assess expectations, and a patient satisfaction survey. Patients indicated whether it was absolutely necessary, somewhat necessary, somewhat unnecessary, or absolutely unnecessary for their primary care provider to perform certain activities during their clinic visit. The list of expectations included items about communication, procedures, and prescriptions. Chi-square analyses were used to compare expectations for race, literacy, clinic site and sex subgroups. Total numbers of expectations were correlated with satisfaction subscale scores.

FINDINGS/RESULTS:
866 patients participated. The sample was 73% African American and 27% Caucasian; 62% came from a VAMC clinic; 64% were men; and 40% had a literacy level less than or equal to 8th grade. Over 70% of the sample believed 10 of the 13 behaviors were absolutely necessary. For 10 out of 13 behaviors, expectations were higher for African Americans (Ps < .01); for 7 out of 13 behaviors, expectations were higher for those with lower literacy (Ps < .02). The average number of expectations expressed was 7.5 (SD 3.6). Gender and clinic site were not related to expectations. Total number of expectations was not related to overall satisfaction (p=.72), nor was it generally related to satisfaction subscale scores for the total group or for race and literacy based subgroups.

IMPACT:
Future assessment of patients’ expectations should recognize that there may be sociodemographic differences in expectations that are not associated with differences in measured satisfaction.

PUBLICATIONS:

Journal Articles

1. Weiner J, Aguirre A, Ravenell K, Kovath K, McDevit L, Murphy J, Asch DA, Shea JA. Designing an illustrated patient satisfaction instrument for low-literacy populations. American Journal of Managed Care. 2004; 10(11 Pt 2): 853-60.
2. Shea JA, Beers BB, McDonald VJ, Quistberg DA, Ravenell KL, Asch DA. Assessing health literacy in African American and Caucasian adults: disparities in rapid estimate of adult literacy in medicine (REALM) scores. Family Medicine. 2004; 36(8): 575-81.

DRA: Health Services and Systems, Special (Underserved, High Risk) Populations
DRE: Technology Development and Assessment, Communication and Decision Making, Quality of Care
Keywords: Ethnic/cultural, Minority, Quality assessment, Research measure, Satisfaction (patient)
MeSH Terms: Ambulatory Care, United States Department of Veterans Affairs, Educational Status