Women's satisfaction with their on-going primary health care services: a consideration of visit-specific and period assessments

OBJECTIVE: To compare and contrast patient ratings of satisfaction with primary care on the day of visit versus over the last 12 months. Data SOURCES/STUDY SETTING: Survey data were collected from female participants at primary care centers affiliated with the University of Michigan, University of Pittsburgh, and Wake Forest University. STUDY DESIGN: One thousand and twenty-one patients attending a primary care visit with at least one prior visit to the study site were consented on site, enrolled in the study, and surveyed at two time points: pre- and immediately postvisit. DATA COLLECTION: The previsit survey included demographics, self-rated health, visit history (site continuity), and expectations for health care; the postvisit survey focused on patient experiences during the visit, assessment of health care quality using the Primary Care Satisfaction Survey for Women instrument, and global satisfaction with visit and health care over the past 12 months. Expectation discrepancy scores were constructed from the linked expectation-experience ratings. Path analysis and indices of model fit were used to investigate the strength of theoretical links among the variables in an analytic model considering both day-of-visit and past-year ratings with global measures of patient satisfaction as the dependent variables. PRINCIPAL FINDINGS: General health, site continuity and fulfillment of patient expectations for care were linked to global ratings of satisfaction through effects on communication, care coordination, and office staff and administration. Importantly, past-year ratings were mediated largely by care coordination and continuity; day-of-visit ratings were mediated by communication. CONCLUSION: Ratings of health care quality for a specific visit appear to be conceptually distinct from ratings of care over the past 12 months, and thus are not interchangeable.