The effects of integrated inpatient health care on patient satisfaction and health-related quality of life: Results of a survey among heart disease patients in Germany

Objectives: Since 2004 a large German health insurance company (Techniker Krankenkasse) has provided integrated inpatient health care (INC) contracts to its members. The aim of the study was to evaluate the effects of this programme on patient satisfaction and health-related quality of life among heart disease patients. Methods: A case-control study was conducted with patients in cardiologic and cardiosurgical units who were discharged in 2006. The cases included approximately 750 IHC patients from eight hospitals, whereas the controls were chosen both from the same and other hospitals. Data consisted of interviews in written form (overall response rate: 70.7%), and routine data of health insurances. Main assessment criteria were patient satisfaction with care measured by a modified standardised questionnaire (FK-P), and the SF-12 instrument for measuring health-related quality of life. Results: In many respects, patient satisfaction with care was the highest among the IHC patients, followed by controls from the same hospitals, and by those from other hospitals. The process indicator of the lowest satisfaction across all three groups was the provision of competencies to deal with problems at home after discharge ("patient education"). Further benefits of IHC are the reduction of both the average length of hospital stay and the waiting time of patients for rehabilitation. By contrast, no statistically significant differences were found with regard to patient-reported health improvement and health-related quality of life. Conclusions: Although the IHC programme did not seem to improve the patients' health-related quality of life and health status, positive effects on patient satisfaction and the efficiency of hospital care could be detected. For future research one ought to check the advantages and/or disadvantages of IHC for other disease groups, and should, if possible, use a prospective study design as well as integrate clinical parameters. (C) 2010 Elsevier Ireland Ltd. All rights reserved.