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Publication Briefs

Study Identifies which VA Mental Health Program Characteristics are Associated with Patient Satisfaction

Satisfaction with care is an important, patient-centered measure of health system performance because it can identify gaps in quality potentially missed by other measures, help detect cross-population disparities, and serve as a catalyst for quality improvement. Yet the relationship between patient satisfaction and quality of care, though generally positively correlated, is not fully understood. Therefore, this study examined the relationships between a set of patient satisfaction measures and a large collection of mental health program characteristics for Veterans with a recent mental health encounter in the VA healthcare system – the largest provider of mental healthcare in the United States. Using data from the Survey of Healthcare Experiences of Patients (SHEP), investigators identified 6,990 Veterans who received VA mental healthcare in 2013. Each month, the SHEP surveys about 30,000 ambulatory care patients who visit VA healthcare and who have not been surveyed in the prior year. The SHEP was the source of satisfaction measures for this study. Mental health program characteristics, including access, continuity of care, patient safety, and quality of care at the facility level, were assessed using VA administrative data-based performance measures.


  • Broad measures of mental healthcare program reach (i.e., proportion of patients served) and intensity (i.e., number of visits) – and nearly all measures of treatment continuity were consistently and positively associated with patient satisfaction. More narrow performance measures – those that focus on specific diagnostic populations (e.g., those with PTSD and serious mental illness) – were less likely to be positively associated with satisfaction.
  • Satisfaction with access to VA healthcare among Veterans with mental health conditions was higher than satisfaction with care encounters.
  • Of all the categories of program characteristics, those pertaining to psychosocial service access were least associated with satisfaction measures.
  • Of the study cohort, 48% of Veterans had a depression diagnosis, 37% had psychosis, 17% had an alcohol use disorder, and 9% had a drug use disorder.


  • Because psychosocial services are clinically valuable, policymakers and managers should not interpret a lack of association with satisfaction to justify reducing their availability.
  • Policymakers and managers should be aware that satisfaction with care, as currently measured, may not rise as more patients initiate treatment, unless continuity of care is maintained or enhanced.

This study was partly funded by HSR&D (CRE 12-023) and QUERI (Quality Enhancement Research Initiative). Drs. Frakt and Pizer are part of HSR&D/QUERI's Partnered Evidence-Based Policy Resource Center (PEPReC), Boston, MA. Dr. Trafton is with HSR&D's Center for Innovation to Implementation (Ci2i), Palo Alto, CA.

Frakt A, Trafton J, and Pizer S. The Association of Mental Health Program Characteristics and Patient Satisfaction. The American Journal of Managed Care. May 19, 2017; Epub ahead of print.

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