Article

OBJECTIVE: To examine how patient satisfaction with care coordination and quality
and access to medical care influence functional improvement or deterioration
(activity limitation stage transitions), institutionalization, or death among
older adults. DESIGN: National representative sample with 2-year follow-up.
SETTING: Medicare Current Beneficiary Survey from calendar years 2001 to 2008.
PARTICIPANTS: Community-dwelling adults (N=23,470) aged >/=65 years followed for
2 years. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A multinomial
logistic regression model taking into account the complex survey design was used
to examine the association between patient satisfaction with care coordination
and quality and patient satisfaction with access to medical care and activities
of daily living (ADL) stage transitions, institutionalization, or death after 2
years, adjusting for baseline socioeconomics and health-related characteristics.
RESULTS: Out of 23,470 Medicare beneficiaries, 14,979 (63.8% weighted) remained
stable in ADL stage, 2508 (10.7% weighted) improved, 3210 (13.3% weighted)
deteriorated, 582 (2.5% weighted) were institutionalized, and 2281 (9.7%
weighted) died. Beneficiaries who were in the top quartile of satisfaction with
care coordination and quality were less likely to be institutionalized (adjusted
relative risk ratio [RRR], .68; 95% confidence interval [CI], .54-.86).
Beneficiaries who were in the top quartile of satisfaction with access to medical
care were less likely to functionally deteriorate (adjusted RRR, .87; 95% CI,
.79-.97), be institutionalized (adjusted RRR, .72; 95% CI, .56-.92), or die
(adjusted RRR, .86; 95% CI, .75-.98). CONCLUSIONS: Knowledge of patient
satisfaction with medical care and risk of functional deterioration may be
helpful for monitoring and addressing disability-related health care disparities
and the effect of ongoing policy changes among Medicare beneficiaries.
CI - Copyright (c) 2016 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS