OP0317 ASSOCIATION OF PATIENT SATISFACTION WITH HEALTHCARE UTILIZATION, COST, AND QUALITY OF LIFE IN RHEUMATOID ARTHRITIS
Authors: Nasim Khan, Fawad Aslam, Wais Afzal, Chenghui LI
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Patient satisfaction and experience with care is being used as a surrogate marker of quality and value of healthcare delivery. No study has evaluated the association of patient satisfaction with healthcare utilization and cost, and quality of life in RA patients. <h3>Objectives</h3> To examine the association of RA patient satisfaction with healthcare utilization and cost, and quality of life. <h3>Methods</h3> 2010-2015 longitudinal files from the Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the US civilian non-institutionalized population were used to identify patients with self-reported RA diagnosis. MEPS has overlapping panel design with participants interviewed up to 5 rounds over a 2- year period. In rounds 2 and 4, patient satisfaction is assessed by the four items about physician interaction – listened carefully, explained things well, showed respect, and spent enough time; and one item for overall satisfaction with quality of care received. A patient satisfaction score was constructed from standardized composite score of these items, and classified as most satisfied (patient satisfaction quartile 4) and less satisfied (patient satisfaction quartiles 1-3). The outcome measures were assessed in year 2: healthcare utilization (any emergency department visit, any inpatient stay, number of visits to office-based providers, outpatient department, and prescription drugs); total healthcare expenditures (measured in 2015 dollars), and quality of life (QoL, measure using 12-item Short Form healthy survey (SF-12)). Two statistical approaches were used: a standard logistic regression comparing most satisfied with less satisfied, and propensity score matching. Propensity scores were estimated using a logistic regression to model most satisfied quartile (vs. lower) as a function of covariates (satisfaction score in year 1 were matched 1 to 1 without replacement using a greedy matching algorithm. After matching, means of outcomes in year 2 were compared among matched pairs. Standard errors were estimated using bootstrapping method with 200 repetitions. Covariates included socio-demographic measures, health behaviors, health status (Charlson Comorbidity Index, general health, activity limitation, and pain affecting activities); RA measures (DMARDs, corticosteroids, and analgesics use); and the Year 1 outcome measures (utilization, total expenditure, QoL). <h3>Results</h3> 568 patients had a self-reported RA diagnosis. 1025 (65.4%) patients were analyzed (326 patients excluded for missing satisfaction response; 201 patients for missing information on other study variables; and 16 for not having data in all 5 rounds). The results using the propensity score matching approach are presented in the Table (202 most satisfied matched to 202 less satisfied patients). There were no differences in the healthcare utilization, cost and QoL among the two groups. Logistic regression approach yielded similar results. <h3>Conclusion</h3> Patient satisfaction score of RA patients was not associated with healthcare utilization and cost, and quality of life measures. <h3>Reference</h3> [1] Fenton JJ et al. Arch Intern Med. 2012;172(5):405-411 <h3>Disclosure of Interests</h3> None declared