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Patients were assembled in two serial, prospective studies of functional outcomes in older hospitalized patients on the general medical service of University Hospitals of Cleveland, 15 between March and March The patients who completed the admission interviews and survived to discharge during these two study periods were eligible for the patient satisfaction study.

We surveyed patients at admission and at discharge. The admission interview asked patients about several measures of their health status on the day of admission including global health and independence in five activities of daily living ADLs. The five ADLs, based on the scale of Katz et al.

Patients performing each ADL without the assistance of another person were classified as independent, while patients needing assistance in one or more activities were classified as dependent. Patients were asked about their global health and independence in ADLs on the day of discharge. At discharge, patients were asked five questions about their satisfaction with the hospitalization using questions adapted from the scale of Ware and Hays.

Patients' total satisfaction scores were determined by summing the responses to the five items, and transforming the scores to a scale of 0 to The mean total satisfaction score was Analyses that considered only the response to the overall satisfaction item were similar to the presented analyses and are not reported separately. We did two sets of stratified analyses to assess the relation between the change in each health status measure from admission to discharge and patient satisfaction.

In the first set of analyses, we determined whether changes in health status were associated with patient satisfaction after controlling for admission health status. These analyses address whether patients who start their admission with similar health will differ in their satisfaction with hospitalization depending on their discharge health status.

We did analyses both for changes in global health and for changes in ADL function. For global health, we stratified patients according to whether they were in excellent or good health versus fair or poor health at admission.

Within each stratum, we compared patient satisfaction according to global health at discharge, also classified as excellent or good versus fair or poor, using Student's t tests. Within each stratum, we compared patient satisfaction scores according to ADL function at discharge classified as independent or dependent.

On average, patients who improve in health will have better discharge health and patients who decline in health will have worse discharge health than patients whose health remains stable. Therefore, it is not possible to determine from this first set of analyses whether any association between health status change and patient satisfaction reflects an association with health status change per se, or only represents a tendency of patients with better health status at discharge to report greater satisfaction at discharge.

Therefore, in the second set of analyses, we determined whether patient satisfaction was associated with changes in health status after controlling for discharge health status. This set of analyses addressed the question of whether patients with similar health status at discharge varied in patient satisfaction according to whether their discharge health status represented stable health status versus a decline or improvement in health status.

We analyzed both for changes in global health and for changes in ADL function. For global health, we stratified patients according to whether they were in excellent or good health versus fair or poor health on discharge. Within each stratum, we compared patient satisfaction according to global health at admission, also classified as excellent or good versus fair or poor.

Within each stratum, we compared patient satisfaction scores according to ADL function at admission, classified as independent or dependent. We used linear regression to determine whether there was an independent relation between change in health from admission to discharge and patient satisfaction. We again did two sets of analyses, which paralleled the bivariate analyses. In the first, we controlled for health status at admission. We developed two models, one in which change in global health entered as the unit change in global health was the independent variable of interest, the other in which change in ADL function entered as the difference in number of independent ADLs between admission and discharge was the independent variable of interest.

The second set of models was similar, except we controlled for the discharge health status measure instead of the admission health status measure. Inspection of the residual plots for the linear regression models showed that assumptions of normality were met. The mean age of the patients was At discharge, about half of the patients reported they were in fair or poor global health, and approximately one third reported they could not perform at least one of five ADLs independently.

Better health status at admission, as indicated by patients' reports of global health and ability to perform five ADLs independently, was associated with greater satisfaction at discharge Table 2 Better health status at discharge was also associated with greater satisfaction. Differences in satisfaction between patients with better and worse health status were greater at discharge than at admission. In groups of patients classified according to their health status at admission, changes in health status were associated with patient satisfaction at discharge Table 3 Among patients reporting excellent or good global health at admission, those who remained in excellent or good global health at discharge reported greater satisfaction than those whose global health worsened to fair or poor.

Among patients reporting fair or poor global health at admission, those who improved to excellent or good global health reported greater satisfaction than those whose global health remained fair or poor. Results were similar when health status was measured by the number of ADLs performed independently Table 3. Our next set of analyses stratified patients according to health status at discharge, in order to determine whether the association between health status change and patient satisfaction was explained by a direct association with health status change per se, or simply reflected a tendency of patients with better health status to report greater satisfaction.

When patients were stratified according to their health status at discharge Table 3 , changes in health status were not associated with patient satisfaction. For example, among patients with excellent or good global health at discharge, satisfaction did not differ according to whether patients reached this state by improving from admission, or whether this health state was unchanged from admission. Similarly, among patients with fair or poor global health at discharge, satisfaction was similar regardless of whether this health state was similar to health at admission, or represented a decline in health from admission.

Results were similar when health status was measured by the number of ADLs performed independently. In a multivariate analysis controlling for potentially confounding factors, change in global health between admission and discharge was associated with patient satisfaction when adjusting for global health at admission Table 4 Similarly, change in the number of ADLs performed independently from admission to discharge was associated with patient satisfaction when adjusting for the number of ADLs performed independently at admission.

However, when controlling for global health at discharge, change in global health was no longer associated with patient satisfaction. Similarly, when controlling for the number of independent ADLs at discharge, change in ADL function was no longer associated with patient satisfaction. Health status changes and patient satisfaction are two different measures of hospital outcome, as well as potential measures of quality of hospital care for older patients.

First, we controlled for admission health status in both stratified and multivariate analyses. These analyses demonstrated that among patients with similar admission health status, those who improved in health status had higher satisfaction and those who declined in health status had lower satisfaction than those whose health status remained stable.

In a second set of analyses, we measured the relation between patient satisfaction and health status changes controlling for health status at discharge. These analyses demonstrated that when controlling for discharge health status, change in health status was no longer independently associated with patient satisfaction. Patients with similar discharge health status had similar satisfaction regardless of whether the discharge health status represented stable health, an improvement, or a decline in health from admission.

Taken together, these findings suggest health status changes during hospitalization are associated with patient satisfaction only to the extent they affect discharge health status. Health status at the time one is asked about patient satisfaction is associated with patient satisfaction responses.

However, change in health status during hospitalization is not an independent determinant of patient satisfaction after controlling for discharge health status. Although patients who improve in health during hospitalization are more satisfied with their care, this relation is explained by the tendency of healthier patients to report greater satisfaction with health care, rather than an effect of the change in health status per se. Although hospitals that improve the health of their patients will on average have more satisfied patients than hospitals that make their patients' health worse because health changes during hospitalization are a component of discharge health , hospitals could also achieve higher satisfaction ratings by admitting healthier patients.

For example, our data suggest that a hospital that admits patients in excellent health and discharges patients in average health will have satisfaction ratings similar to those of a hospital that admits patients in poor health and discharges patients in average health.

Our results extend previous work demonstrating a positive association between health status and patient satisfaction at the time patient satisfaction is measured, 10 — 14 and they suggest that this association is not explained by patients being more satisfied with care that results in improved outcomes. Rather, health status seems to be a patient characteristic that influences reports of satisfaction. Previous research has demonstrated a cross-sectional relation between patient satisfaction and health status; however, few investigations have assessed the relation between changes in health during hospitalization and patient satisfaction.

A few studies have shown that patients reporting their health as improved during their hospitalization are more satisfied than patients who report their health as unchanged or worse. As far as we are aware, this is the first study to assess whether changes in health measured both at admission and at discharge are associated with patient satisfaction. Our findings suggest that changes in health status during hospitalization and patient satisfaction are measuring different domains of hospital quality.

Most likely, the processes affecting health status changes and patient satisfaction differ. For example, others have shown that factors such as the quality of doctor-patient communication, interpersonal interactions between patient and hospital staff, and waiting times are associated with patient satisfaction. However, all of these factors are important to delivering care that is responsive to the needs of the individual patient.

Their importance does not depend on whether or not they improve short-term health outcomes. Some methodologic issues should be considered in interpreting our findings. First, it is possible that different associations between satisfaction and health status changes would have been observed if we had used different instruments to measure patient satisfaction or health status.

Also, our patient satisfaction measure has not been extensively validated in inpatients, though our findings were similar using a global measure of patient satisfaction. Finally, this study was limited to older general medical patients in a single center. In conclusion, in this group of older hospitalized patients, there was no association between patient satisfaction at discharge and health status changes between admission and discharge, after accounting for the cross-sectional relation between patient satisfaction and health status at discharge.

This suggests that health status changes and patient satisfaction measure different domains of hospital quality. Comprehensive efforts to fully measure the quality and outcomes of hospital care should consider both patient satisfaction and health status changes. Hartford Foundation G. Landefeld is a Senior Research Associate and Dr.

J Gen Intern Med. Author information Copyright and License information Disclaimer. Adress correspondence and reprint requests to Dr. Copyright by the Society of General Internal Medicine.

Abstract OBJECTIVE To examine the relation between two patient outcome measures that can be used to assess the quality of hospital care: changes in health status between admission and discharge, and patient satisfaction.

Keywords: quality of healthcare, patient satisfaction, health status, outcome assessment, hospitals. Open in a separate window. Figure 1. Providers can review these reports to check the status of their submission.

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Electrical infrastructure damage resulted in the largest power outage ever in the United State s. Many locations on the island went without power for 11 months. Before the storm, the island did not have enough generators. After the storm, shipping disruptions caused delays in providing portable generators. Compounding effects of a power outage, such as life support and electronic health record access, were slow, if even available. Illness and disease were likely without proper food storage and preparation or water sanitization.

Thomas Wildfire. However, although the area experienced a power outage, communication issues were not deficiencies. A strength of that response was the ability of separate agencies to share information in the joint information center. The rapid information exchange resulted in timely public health warnings, including air quality measurements, hazardous materials identification, animal safety messages, and evacuation notices.

The county established a call center early on that was highly effective at distributing and receiving information. This communication technology worked well and was cited in the after-action report as a success. It seems apparent that communication issues and information-sharing have continued to be problems during disaster response for most incidents. Communication and information-sharing were cited issues during Hurricane Katrina and still proved difficult years later.

In , during Katrina, cell phones were not as widespread as they are now. Most emergency communication occurred through radios and landline systems. Communication technology improved rapidly afterward. However, communication difficulties remained present even with increased cell phone capabilities and availability during Hurricanes Sandy and Maria.

The cell phone infrastructure, such as cell towers, added another layer of vulnerability without adequate protection. On the other hand, California appears to have addressed communications during disaster scenarios well.

While electronic health records were rare in during Katrina, they were more common in when Sandy hit. Then, in , they became mandatory for all healthcare organizations in the United States. Even so, there were still difficulties ensuring proper patient transport and care for evacuated individuals. Power outages impeded the ability to access electronic records during Sandy and Maria.

When medical providers could access them, there were, at times, compatibility errors between systems. Supply chain issues were present in all disaster responses.

After Katrina, supply issues were blamed on the unprecedented scale of the damage, resulting in too few supplies being pre-staged for use. For Sandy, transportation difficulties led to the shortage. Like Katrina, supply shortages during Hurricane Maria were blamed on the many disasters that occurred previously in the year. There was a failure to stock enough supplies for worst-case scenarios. Instead, jurisdictions were only prepared for a minimal response effort assuming the other entity would cover any gaps.

Disaster planning since continues to vary among communities. Emergency preparedness professionals learn from past experiences and continue improving response efforts. Unfortunately, many of the same problems continue to plague response efforts in The primary recommendation to prevent technological issues is to study the past. New technologies must be built with the intent of disaster planning, preparedness, resilience, mitigation, and prevention. The infrastructure and supporting elements must be hardened and prepared to withstand all types of disasters, especially with heavy reliance on advanced technologies, where system failures have widespread, devastating consequences.

As part of preparedness planning, it is a best practice for facilities of all types to have access to a generator or other form of emergency power supply. States could ensure the implementation of these mandates through public health inspections like those done with elevators. Hurricane Irene, which came ashore the year before Sandy, gave the region a false sense of security.

Many health facilities and other organizations felt prepared since they fared well during Irene. As a result, they did little to increase their preparedness, and many failed to take the threat of Sandy seriously.

In contrast, the utility companies in Connecticut were unprepared for Irene and spent the next year conducting mitigation activities. As a result, power loss was significantly reduced in the state when Sandy hit in Even though there were fewer power outages, healthcare facilities still experienced difficulties with communications, patient tracking, and maintaining standards of care due to staff shortages. This examination shows that complacency can be fatal and that continual upgrades are vital.

It is critical to study and learn from history. Every disaster offers an opportunity to learn from what went well and what did not. These lessons provide the information needed to enhance the preparedness level of facilities, organizations, and communities and then put into action by updating plans, policies, and exercises.

Further, individuals and organizations of all sizes must accept responsibility for their resilience by preparing for the unexpected. Although the federal government provides resources, it must not be the only source. The federal government provides immediate resources and support, state governments manage disaster recovery, and local governments implement those recoveries.

Self-reliance increases survival. Technology continues to evolve but will not always result in enhanced safety or security. Everyone must prepare their homes and families to survive a disaster and practice vigorous preparedness, mitigation, and response activities.

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