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Do patients' reports of their health care experiences reflect the quality of care? Despite the increasing role of such measures in research and policy, there's no consensus regarding their legitimacy in quality assessment. Indeed, as physician and hospital compensation becomes increasingly tied to patient feedback, health care providers and academics are raising strong objections to the use of patient-experience surveys. These views are fueled by studies indicating that patient-experience measures at best have no relation to the quality of delivered care and at worst are associated with poorer patient outcomes. Conversely, other studies have found that better patient experiences -- even more than adherence to clinical guidelines -- are associated with better outcomes. Which conclusion is correct? We believe that when designed and administered appropriately, patient-experience surveys provide robust measures of quality, and our efforts to assess patient experiences should be redoubled.
Critics express three major concerns about patient-reported measures, particularly those assessing "patient satisfaction." First, they argue that patient feedback is not credible because patients lack formal medical training. They believe that patient-satisfaction measures actually capture some aspect of "happiness," which is easily influenced by factors unrelated to care. Articles in the popular press have even suggested that employing singing, costumed greeters would raise patient-experience scores. However, Jha and colleagues found that overall satisfaction with care is positively correlated with clinical adherence to treatment guidelines.1 One explanation for this correlation is that patients base their satisfaction rating on an accurate "sense" of the quality of technical care. That would make patient-experience measures and clinical adherence measures redundant, which might imply that patient feedback has no additional value -- but then the concern about credence would be meritless.
Another explanation is that the measures used to capture patient satisfaction reflect interpersonal care experiences, such as patient-provider communication, which correlate with technical care but represent a unique dimension of quality. Health care is, after all, a service, so measures of its quality should include assessment of the extent to which the patient and service provider reach a common understanding of the patient's situation.2 For example, a language barrier between patient and physician may affect the course -- and therefore quality -- of treatment. We have found that patient-reported measures not only are strongly correlated with better...