• A model of the relationships between health status and satisfaction with care delivery outcomes and health care need and use

      Parker, Ruth Rominger; Waltz, Carolyn Feher; Johantgen, Mary E. (2000)
      Guided by the Behavioral Model of Health Services Use (Andersen and Davidson, 1996), this existing data study tested the influence of population characteristics (predisposing, enabling, and need) and health care use on the outcomes of satisfaction with care delivery and health status after hospital discharge. A descriptive, cross-sectional design was employed to examine outcomes at two to four weeks after discharge from a single academic medical center. Study methodology involved a secondary analysis of survey (satisfaction and health status) and administrative data for a sample of 804 adult, medical-surgical patients discharged home after their acute care stay. The analytic approach was structural equation modeling using Amos. The hypothesized model had an adequate fit with the data; however, it provided minimal explanation of the relationships of health care need and use and predisposing/enabling factors with the outcomes of satisfaction or health status. Of the health care need variables, only transfer status had a significant influence on one of the outcome variables--physical health. Current health care use was found to have no significant relationships with either health status or satisfaction. However, 'past' health care use (defined as the number of hospitalizations the year prior to the current hospital stay) did have a significant influence on both satisfaction and physical health. Of the predisposing characteristics only marital status significantly predicted satisfaction with care delivery. Significant relationships were found between age and mental health and employment with both physical and mental health. Examination of relationships among the outcome variables revealed that satisfaction with care delivery was more strongly associated with physical than mental health in this population. The largest effects with both physical and mental health were seen with nursing care and overall satisfaction. Study limitations which may have contributed to the lack of significant relationships included the absence of baseline health assessment and truncated administrative data, the last of which may have hampered the assessment of both comorbidities and complications. Implications for clinical practice, theory development and future research are proposed.