Difference between patient satisfaction and intention to return to the provider in gynecology

Background: Patient evaluations of care are increasingly being seen as important outcome measures with which to examine the quality of care and to evaluate the performance of individual hospitals and health plans. Many patient satisfaction studies consider that satisfied patients are more likely to return for additional care. However, in a competitive market environment with many choices for patients it is not definite that satisfied patients return. Therefore, the primary goal of this study was to investigate the two constructs separately. We examined the evaluations of care of gynecology patients. The evaluations of such patients are of particular interest as they often differ from patients of other specialties in terms of mood and emotions; health problems are of intimate nature and may have a high emotional impact. Method: The study data were obtained from 22 hospitals in the statistical metropolitan area of Dresden, Germany. The eligible study sample included 3865 randomly selected gynecology inpatients aged 15 years and older that were discharged during January to December 2010. Study data was collected using a validated questionnaire. Additional institutional information was collected using hospital quality reports. The overall survey response rate was 25.3% (N=979). Bivariate (chi-squared test, Mann-Whitney U-test) and multivariate techniques (logistic regression) were used to reveal relations between overall satisfaction, willingness to return and assessed variables. All associations were considered to be statistically significant at p<0.05-level. Results: Study findings suggest that patients' overall satisfaction and willingness to return to the provider measure mainly the same. Differences pertained to the significance of service variables (e.g., cleanliness, quality of food) and visit-related characteristics (e.g., length of stay and occurrence of complications). The most consistent factors affecting overall satisfaction and willingness to return were found to be individualized medical care (OR: 2.65/ 2.05), treatment outcome (OR: 2.73/ 1.72), kindness of medical practitioners (OR: 1.87/ 1.65), and organization of discharge (1.59/ 1.40). Institutional characteristics such as hospital size, provider and teaching status were neither related to overall satisfaction nor willingness to return. Conclusion: Study findings suggest that overall satisfaction and willingness to return to the provider measure mainly the same. Factors being consistent for both constructs are modifiable by health care professionals. Therefore, emphasis should be put on these factors to increase the likelihood that patients will come back for additional care.