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Yano EM, Lanto AB, Wang MM, Lee M, Rubenstein LV. Organizational determinants of outpatient satisfaction. Sepulveda, CA: Center for the Study of Healtcare Provider Behavior; 1999 Aug 1. Report No.: 99-MC811.
Purpose: Managed care organizations are concerned about patient satisfaction, but often unsure about what produces it. Organizational features of medical centers and of their primary care programs might be expected to influence patient satisfaction, and we have evaluated the links between these structural characteristics and patient satisfaction outcomes.Methods: Observational study based on (1) the 1996 VHA Survey of Delivery Models for Primary Care (DMPC), an organizational survey of ambulatory care structural features of medical centers and (2) the 1996 VHA National Ambulatory Care Survey (NACS), a national VA patient satisfaction survey. The DMPC is a previously evaluated national survey of top and middle management at each of the 160 VA medical centers that assesses overall medical center characteristics and primary care program features. The NACS is a national survey administered to 200-300 randomly selected patients per VA medical center by the VHA National Customer Feedback Center. The survey includes 7 previously validated and reliable scales. We evaluated the three scales that most closely reflect Institute of Medicine primary care goals-continuity, coordination, and timeless/access. We used ANOVA to examine the basic relationships between organizational variables and average patient satisfaction scores.Results: Satisfaction with continuity (p < .005) and coordination (p < .0001) were lower in large urban medical centers and among those delivering some care through outlying community-based clinics (p < .001). Patients were also less satisfied with continuity at academically affiliated medical centers, and at those centers that did not restrict specialist-to-specialist referrals (p < .005). Satisfaction with continuity (p < .001), coordination (p < .01), and timelines/access (p < .05) was higher when primary care physicians were expected to follow patients from their panels who were admitted to the hospital. Formal primary care notification policies for admissions to the (1) hospital, (2) nursing home and (3) access (1, 3) (p < .05).Conclusions: Higher patient satisfaction with continuity, coordination and/or access is associated with the presence of structural features of care that reflect primary care tenets, such as policies fostering follow-up of patients across settings and discouraging referral from specialist to specialist. Large, academic and geographically dispersed setting are likely to have lower satisfaction ratings in the aspects studied, and probably face special obstacles in achieving care consistent with primary care goals.