Assessment of Sensory Impairment and Health Care Satisfaction Among Medicare Beneficiaries

Abstract

Importance: Satisfaction with care is associated with improved quality of care and health outcomes. Sensory impairment can be a barrier to effective communication and access to care, and this may result in reduced satisfaction with care.

Objective: This study examined the association between sensory impairment and health care satisfaction among Medicare beneficiaries.

Design, setting, and participants: This cross-sectional study used data from the 2017 Medicare Current Beneficiary Survey (MCBS), a nationally representative in-person survey of Medicare beneficiaries. Functional sensory impairment was categorized as no sensory impairment, hearing impairment, vision impairment, and dual sensory impairment. Patient dissatisfaction included responses on quality of care, ease to get to a doctor, out-of-pocket costs paid, information given, and doctors' concern with overall health rather than an isolated symptom or disease.

Exposures: Self-reported functional sensory impairment.

Main outcomes and measures: Multivariable-adjusted odds ratios (ORs) of the association between dissatisfaction with care and sensory impairment.

Results: A total of 10 783 respondents representing 44 736 889 Medicare beneficiaries (8944 [85.3%] aged ≥65 years, 5733 [52.9%] women, and 8195 [75.5%] non-Hispanic White) were included. Dual sensory impairment compared with no sensory impairment was associated with the highest odds of dissatisfaction across outcomes, including quality of care (OR, 1.52; 95% CI, 1.12-2.08). Compared with no sensory impairment, having dual sensory impairment (OR, 1.82; 95% CI, 1.40-2.37), hearing impairment (OR, 1.67; 95% CI, 1.29-2.17), or vision impairment (OR, 1.56; 95% CI, 1.18-2.08) were associated with dissatisfaction with the information provided about what was wrong. Those with hearing impairment (OR, 1.38; 95% CI, 1.03-1.86) or dual sensory impairment (OR, 2.03; 95% CI, 1.55-2.66) were more likely to be dissatisfied with doctors' concern with overall health compared with those with no sensory impairment. Having dual sensory impairment or vision impairment only was associated with greater odds of dissatisfaction with ease to get to a doctor (dual sensory: OR, 1.69; 95% CI, 1.24-2.30; vision: OR, 1.63; 95% CI, 1.14-2.31) and out-of-pocket costs paid (dual sensory: OR, 1.27; 95% CI, 1.04-1.54; vision: OR, 1.31; 95% CI, 1.07-1.61).

Conclusions and relevance: These findings contribute to the growing body of literature on sensory impairment and patient satisfaction and have implications for health care system planning and spending to provide patient-centered care for older adults.

Figure.. Satisfaction With Overall Quality and Different Aspects of Care by Sensory Impairment Status in the 2017 Medicare Current Beneficiary Survey

Responses totaled 10 783, representing 44 736 889 Medicare beneficiaries. Participants were asked about their satisfaction with the overall quality of the health care received in the past year (quality), the ease and convenience of getting to a doctor or other health professional from where they live (ease), the out-of-pocket costs they paid for health care (cost), the information they were given about what was wrong with them (information), and the concern of doctors or other health professionals for their overall health rather than just for an isolated symptom or disease (concern). DSI indicates dual sensory impairment; HI, hearing impairment; and VI, vision impairment.