Methodological Considerations When Studying the Association between Patient-Reported Care Experiences and Mortality

Objective To illustrate methodological considerations when assessing the relationship between patient care experiences and mortality. Data Source Medical Expenditure Panel Survey data (2000–2005) linked to National Health Interview Survey and National Death Index mortality data through December 31, 2006. Study Design We estimated Cox proportional hazards models with mortality as the dependent variable and patient experience measures as independent variables and assessed consistency of experiences over time. Data Extraction Methods We used data from respondents age 18 or older with at least one doctor's office or clinic visit during the year prior to the round 2 interview. We excluded subjects who died in the baseline year. Principal Findings The association between overall care experiences and mortality was significant for deaths not amenable to medical care and all‐cause mortality, but not for amenable deaths. More than half of respondents were in a different care experience quartile over a 1‐year period. In the five individual experience questions we analyzed, only time spent with the patient was significantly associated with mortality. Conclusions Deaths not amenable to medical care and the time‐varying and multifaceted nature of patient care experience are important issues to consider when assessing the relationship between care experience and mortality.