Editor's Correspondence
July 23, 2012

Satisfied to Death: A Spurious Result?—Reply

Author Affiliations

Author Affiliations: Department of Family and Community Medicine, Center for Health Services Research in Primary Care, University of California, Davis, Sacramento.

Arch Intern Med. 2012;172(14):1110-1114. doi:10.1001/archinternmed.2012.2562

In reply

Friedberg et al write that a “large,” methodologically strong literature demonstrates a clear link between satisfaction, or higher Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience ratings, and better outcomes. In our view, they exaggerate both the breadth and the strength of the CAHPS literature.

In the study by Sequist et al,1 for example, Friedberg et al emphasize a few positive correlations between patient experience measures (aggregated at the physician and practice level) and Health Plan Employer Data and Information Set (HEDIS) quality metrics. But most correlations in this study, particularly those related to physician care, were weak and nonsignificant. The study also lacked adjustment, which makes their criticism of our adjusted findings ironic. Indeed, our study adjusted not only for self-reported health but also for chronic conditions, prior expenditures, prescriptions, hospital, and office use. Far from underadjusted, our results may be overadjusted and therefore conservative.

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