Associations between patient experiences and clinical outcomes: a cross-sectional data linkage study of the Australian private healthcare sector

There is a growing demand internationally to evaluate patient experiences of healthcare services and to publicly report this information to drive quality improvement activities and promote patient choice.1 2 Increasingly, results of patient experience surveys are being linked to hospital funding—for example, through pay-for-performance programme.3 4 However, it is unclear whether patient experience is an accurate surrogate marker of good clinical outcomes. As the use of patient experience measures grows, it is important for patients, providers and funders to understand whether good patient experience correlates with improved outcomes. The research literature is inconsistent in showing an association between patient experiences and clinical outcomes. Some studies demonstrate better patient experiences associated with lower rates of hospital readmissions,5–7 complications8–10 and mortality7; others report no such association.11–14 Some of this variation may be attributed to the types of patient experience domains examined (eg, overall hospital rating, provider communication or hospital environment). Some, patient experience domains — such as communication with nurses and doctors – have been found to be more strongly associated with clinical outcomes than others.5 6 9 To better understand this relationship and to assess whether patient experience is a useful surrogate marker for clinical outcomes, we examined associations between patient experience domains and clinical outcomes among private inpatients of Australian hospitals. A positive association would suggest that these measures improve in tandem with each other. A negative association would caution against improving one measure at the expense of another. No association would suggest that they are independent measures of quality of care, each warranting individual attention. Secondary analysis was undertaken of a cross-sectional, de-identified Australian private health insurer’s patient perspectives of care survey (the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) …