A Missed Opportunity to Improve Patient Satisfaction? Patient Perceptions of Inpatient Communication with Their Primary Care Physician

Background:

Improving patient satisfaction is a major focus of hospitals and is a widely reported, public hospital quality measure. Satisfaction could be driven by many factors, including patient perceptions of communication and continuity of care with their primary care physician (PCP). Hospitalists play a key role in this communication. This study aims to characterize patient perceptions of hospital team‐PCP communication and their relationship to overall patient satisfaction with their hospital care.

Methods:

From 2003‐2013 we surveyed eligible hospitalized patients and their PCPs at an academic medical center, oversampling frail elders as defined by the Vulnerable Elders Survey (VES‐13). Telephone interviews of discharged patients were conducted 4 weeks after discharge to elicit overall patient satisfaction and perceptions of communication between the hospital team and PCP. Satisfaction was defined as Excellent or Very Good on a scale that included Good, Fair or Poor. Each patient’s PCP was faxed a survey two weeks after discharge to assess communication with the hospital team. Descriptive statistics were used to summarize satisfaction and communication outcomes. To test the association between patient satisfaction and perceptions of inpatient‐PCP communication, we used the non‐parametric Kruskal‐Wallis Test.

Results:

804/1058 patients were included in our sample (mean age 72 ± 16 years). 62.3% of patients were satisfied with their hospital care and 50.0% were satisfied with the coordination and teamwork between their hospital team and PCP. More PCPs reported communicating with the hospital team than patients perceived, with 80.7% of PCPs reporting communication compared with 64.8% of patients (p<0.001). Among patients whose PCP did not report communication, 51.6% believed that communication had occurred. Patient perceptions of hospital team‐PCP communication were positively correlated with overall patient satisfaction, while PCP reports of communication were not. Patients who perceived communication were more satisfied than those who did not (69.0% vs. 50.0%, p<0.001); there was no difference between patients whose PCPs did or did not report communication (63.1% vs. 59.4%, p=0.676). Neither patient perceptions of communication nor PCP reports of communication were correlated with acute care events within 30 days after discharge, including readmissions or Emergency Department visits (p=0.627).

Conclusions:

Patients over‐estimated hospital team‐PCP communication when it did not occur, implying a lack of patient awareness that discontinuity of care had occurred. This lack of patient awareness could impede patient safety. Further, patient perception of hospital team‐PCP communication is positively correlated with satisfaction. Therefore, it is possible that hospitals could improve both patient safety and overall satisfaction by seizing a missed opportunity to improve patient awareness of hospital team‐PCP communication. Hospitalists play a key role in this communication and should be aware of the need to communicate with the PCP and to relay the results of that communication to the patient as a way to boost satisfaction.