Methodological Considerations When Studying the Association Between Patient-Reported Care Experiences and Mortality

OBJECTIVE: To illustrate methodological considerations when assessing the relationship between patient care experiences and mortality. DATA SOURCE: Medical Expenditure Panel Survey data (2000–2005) linked to National Health Interview Survey and National Death Index mortality data through December 31, 2006. STUDY DESIGN: We estimated Cox proportional hazards models with mortality as the dependent variable and patient experience measures as independent variables and assessed consistency of experiences over time. DATA EXTRACTION METHODS: We used data from respondents age 18 or older with at least one doctor's office or clinic visit during the year prior to the round 2 interview. We excluded subjects who died in the baseline year. PRINCIPAL FINDINGS: The association between overall care experiences and mortality was significant for deaths not amenable to medical care and all-cause mortality, but not for amenable deaths. More than half of respondents were in a different care experience quartile over a 1-year period. In the five individual experience questions we analyzed, only time spent with the patient was significantly associated with mortality. CONCLUSIONS: Deaths not amenable to medical care and the time-varying and multifaceted nature of patient care experience are important issues to consider when assessing the relationship between care experience and mortality.