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Quality of Care

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Patient satisfaction with hospital care depends in part on the degree of symptom improvement during the stay

When patients are admitted to the hospital, they are typically suffering from a variety of symptoms. With today's short hospital stays, focus on laboratory data, and use of diagnostic and therapeutic interventions, the patient's symptoms often receive inadequate attention. However, patients still give high priority to their symptoms.

A decrease in symptoms by the time of hospital discharge tends to correlate with patient satisfaction with hospital care, concludes a study supported by the Agency for Healthcare Research and Quality (HS07719). Simply asking patients at the time of discharge whether they have any persistent symptoms and discussing whether further evaluation may be warranted would be a reasonable step in enhancing patient-centered care, suggest Kurt Kroenke, M.D., the study's first author, Clement J. McDonald, M.D., principal investigator, and their Indiana University colleagues.

During a 1-year period (July 1996-June 1997), they interviewed 2,126 medical patients hospitalized at one Indiana hospital within 2 hours of admission; they reinterviewed the same patients within 24 hours of discharge about symptoms, satisfaction with care, and length of hospital stay. The researchers found that symptoms were common at the time of hospital admission, particularly fatigue (80 percent of patients), dyspnea (labored breathing, 60 percent), cough (51 percent), dizziness (51 percent), headache (47 percent), chest pain (46 percent), and nausea or vomiting (43 percent).

Individual symptoms failed to resolve by hospital discharge about 25 to 50 percent of the time. Symptoms were more apt to persist if patient stays were short, patients had more severe symptoms when admitted to the hospital, and they had more total symptoms. Patients' satisfaction with care was clearly associated with total symptom severity score at discharge and the degree of symptomatic improvement that occurred during hospitalization in four areas: physical symptoms, emotional symptoms, daily functioning, and self-rated health. For example, each five-unit increase in the symptom improvement score was associated with a mean improvement in satisfaction of 0.35. Each five-unit increase in the symptom severity score was associated with a mean worsening in satisfaction of 0.5.

For more details, see "Symptoms in hospitalized patients: Outcome and satisfaction with care," by Dr. Kroenke, Timothy Stump, M.S., Daniel O. Clark, Ph.D., and others, in the November 1999 American Journal of Medicine 107, pp. 425-431.

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