Meta-analysis: complex relationships between patient satisfaction, age and item-level response rate

Abstract

Causality of the relationship between the objective quality outcomes of care and patient satisfaction has been questioned in many studies. Consequently, it is highly important to study potential confounders in order to improve reliability and validity of patient satisfaction surveys and enable comparisons between objective and subjective outcomes. This study aimed to test the effect of item-level response rate on the results of patient satisfaction surveys and its interaction with another potential confounding factor, patient age. The data included 39 surveys with balanced Likert-scale items. The surveys were systematically gathered from PubMed and had been published 2005–2014. The relationship between the item-level patient satisfaction and item-level response rate was almost without exception positive when the overall patient satisfaction was >4.2 on a traditional 1–5 scale and patients were middle-aged or older. The meta-analysis demonstrated that the relationship between item-level patient satisfaction and item-level response rate is situational, and generalisations regarding the size of the correlation should be made with caution. Controlling for item-level response rate and patient age, simultaneously, is necessary to improve validity of patient satisfaction surveys. The present study calls for novel age-specific approaches to deal with missing data.