Association Between Orthopaedic Outpatient Satisfaction and Non-Modifiable Patient Factors

Patient satisfaction and their determinants in outpatient department of a tertiary public hospital in Nepal: a cross-sectional study

BACKGROUND

Patient satisfaction is a vital metric for assessing healthcare quality and delivering patient-centered care. It can predict service utilization patterns by determining healthcare users' contentment with their providers. Consequently, evaluating patient satisfaction and its underlying factors is crucial to maintaining the quality of healthcare services. The present study aimed to assess patient satisfaction and its determinants in a tertiary care public hospital in Nepal. In this research, a cross-sectional design was employed to examine patient satisfaction within the Outpatient Department of Mental Hospital Lagankhel, Nepal. The study adopted a systematic random sampling approach for respondent selection, and stringent measures were implemented to uphold the validity and reliability of the collected data. To assess patient satisfaction comprehensively, the Patient Satisfaction Questionnaire-III (PSQ-III), developed by the RAND Corporation, was employed in conjunction with relevant sociodemographic variables. Utilizing mean scores and percentages, we calculated satisfaction levels across various dimensions. Additionally, a multinomial logistic regression analysis was conducted to investigate the relationships between patient satisfaction dimensions and sociodemographic characteristics.

RESULTS

This study encompassed perspective of 206 participants, with 57.3% representing patient relatives and 51% being male, median age of 32 years (standard deviation: 12.53). Notably, patients reported higher levels of satisfaction, particularly within the interpersonal relationship dimension, while the technical quality domain received comparatively lower satisfaction ratings. Multinomial logistic regression analysis underscored the significance of sociodemographic factors in shaping patient satisfaction, with age (p = 0.008), type of residence (p = 0.001), occupation (p = 0.0019), income status (p = 0.014), time to reach the healthcare facility (p = 0.013), and insurance enrollment status (p = 0.017) all demonstrating significant associations. These findings illuminate the intricate qualities of patient satisfaction within our healthcare context, offering actionable insights for enhancement and guiding the trajectory of future research endeavors.

CONCLUSIONS

Overall patient expressed satisfaction with service provided by tertiary care hospital, however continuous improvement remains essential. Conducting large-scale, nationwide studies across hospital tiers is vital. This data-driven approach empowers policymakers to allocate resources effectively, inform decision-making, and enact policies that exceed patient expectations, fostering a healthcare system of unparalleled excellence.

Patient Adherence Following Knee Surgery: Evidence-Based Practices to Equip Patients for Success

Patient adherence with postoperative wound care, activity restrictions, rehabilitation, medication, and follow-up protocols is paramount to achieving optimal outcomes following knee surgery. However, the ability to adhere to prescribed postoperative protocols is dependent on multiple factors both in and out of the patient's control. The goals of this review article are (1) to outline key factors contributing to patient nonadherence with treatment protocols following knee surgery and (2) to synthesize current management strategies and tools for optimizing patient adherence in order to facilitate efficient and effective implementation by orthopaedic health care teams. Patient adherence is commonly impacted by both modifiable and nonmodifiable factors, including health literacy, social determinants of health, patient fear/stigma associated with nonadherence, surgical indication (elective vs. traumatic), and distrust of physicians or the health care system. In addition, health care team factors, such as poor communication strategies or failure to follow internal protocols, and health system factors, such as prior authorization delays, staffing shortages, or complex record management systems, impact patient's ability to be adherent. Because the majority of factors found to impact patient adherence are nonmodifiable, it is paramount that health care teams adjust to better equip patients for success. For health care teams to successfully optimize patient adherence, focus should be paid to education strategies, individualized protocols that consider patient enablers and barriers to adherence, and consistent communication methodologies for both team and patient-facing communication.

Factors Influencing Surgical Decision Making in Trapeziometacarpal Osteoarthritis

Purpose

With trapeziometacarpal osteoarthritis (TMC OA), the relationship between disease severity and pretreatment dysfunction, patient expectations, and preferred patient treatment and management remains unclear. This study aimed to assess the association between functional status, pretreatment expectations, and demographic and clinical characteristics of TMC OA patients who decide to undergo operative management.

Methods

Patients diagnosed with TMC OA (n = 96) were administered the Thumb Arthritis Expectations Survey and the Brief Michigan Hand Questionnaire (bMHQ) during their initial office visit. Demographic data (sex, age, race, education level, marital status, comorbidities, and hand dominance) and clinical characteristics (prior injury, and therapeutic interventions including splinting, steroid injections, therapy, and anti-inflammatory medication) were collected. Multiple logistic regression was used to assess the association between surgical treatment and expectation scores.

Results

Our logistic regression model found that lower bMHQ scores, high thumb arthritis expectation survey scores, and prior treatments for TMC OA were associated significantly with the surgical treatment of TMC OA. After controlling for all possible covariates, the odds of having surgery was 3.9 times higher among patients with high expectations (above median) compared to patients with low expectations (adjusted odds ratio [AOR], 3.9; 95% confidence interval [CI], 1.3-11.2). Patients with average function, as measured by bMHQ scores, were 74.5% less likely to elect for surgery than those with the lowest bMHQ (AOR, 0.3; 95% CI, 0.1-0.9). Patients treated previously with steroids were 13 times more likely to elect for surgery than those who were never treated for TMC arthritis (AOR,13.1; 95% CI, 2.2-77.0).

Conclusions

Patients with TMC OA who elect to proceed with surgical management have lower bMHQ (greater perceived dysfunction) and higher expectations, and have had prior treatment. Age was not a significant predictor of surgical management of TMC OA.

Type of study/level of evidence

Prognostic IV.

Patient satisfaction in anesthesiology: a narrative review

PURPOSE OF REVIEW

Healthcare is increasingly expanding its view in outcome discussions to integrate patient-reported outcomes such as patient satisfaction. Involving patients in the evaluation of services and the development of quality improvement strategies is paramount, especially in the service-oriented discipline of anaesthesiology.

RECENT FINDINGS

Currently, while the development of validated patient satisfaction questionnaires is well established, the use of rigorously tested scores in research and clinical practice is not standardized. Furthermore, most questionnaires are validated for specific settings, which limits our ability to draw relevant conclusions from them, especially considering the rapidly expanding scope of anaesthesia as a discipline and the addition of same-day surgery.

SUMMARY

For this manuscript, we review recent literature regarding patient satisfaction in the inpatient and ambulatory anaesthesia setting. We discuss ongoing controversies and briefly digress to consider management and leadership science regarding 'customer satisfaction'.

Patient satisfaction with chronic disease care and its associated factors in primary health care facilities in Johannesburg, South Africa

Background

Patient satisfaction is a widely used indicator of assessing health care quality and has been used by policymakers to consider the needs of patients when developing suitable strategies for safe and high-quality care. However, in South Africa, the dual burden of HIV and NCDs has implications for the health system, whereby the factors influencing the quality of care and patient satisfaction may be unique to this context. Thus, this study examined the predictors affecting chronic disease patients' levels of satisfaction with care in Johannesburg, South Africa.

Methods

A cross-sectional study was conducted among 2,429 chronic disease patients at 80 primary healthcare facilities in Johannesburg, South Africa. A questionnaire derived from existing literature and patient satisfaction frameworks was used to measure the level of satisfaction of patients when receiving care. Patients' overall satisfaction was categorized into not satisfied and satisfied. Cronbach's alpha was used to assess scale reliability. Factor analysis was used as a data dimension reduction approach and the Kaiser-Meyer-Olkin and the Bartlett test of sphericity were used to test the sampling adequacy and to examine the inter-independence of the items. Logistic regression was used to determine factors associated with being satisfied. Significance was set at 5%.

Results

The majority of chronic disease patients 65.5% (n = 1,592) were aged 18-30 years; 63.8% (n = 1,549) were females, 55.1% (n = 1,339) were married and 2,032 (83.7%) were satisfied with care. The factor analysis results were in five sub-scales namely improving values and attitudes, cleanliness of the clinic, safe and effective care, infection control, and on the availability of medicines. In adjusted models, patients aged >51years had an increased odds of 3.18 (95% CI:1.31-7.75) of being satisfied compared to those aged 18-30 years and patients who had visited the clinic at least 6 times had 51% increased odds of being satisfied (AOR = 1.51,95% CI:1.13-2.03). The odds of being satisfied increased by 28% (AOR = 1.28,95% CI:1.07-1.53), 45% (AOR = 1.45,95% CI:1.2-1.75), 34% (AOR = 1.34,95% CI:1.13-1.59) and 4.31 (95% CI:3.55-5.23) for every score increase in the factors like improving values and attitudes, cleanliness of clinic safe and effective care and availability of medicine, respectively.

Conclusions

Key predictors of patient satisfaction were found to be sociodemographic factors including age, distance to the clinic, number of visits and waiting times as well as factors such as improving values and attitudes, cleanliness of the clinic, waiting time, safety and effective care and availability of medicines. Adjustment of existing frameworks for addressing context-specific improvement of patient experiences such as security and safety is recommended to ensure healthcare quality and service utilization for better chronic disease outcomes in South Africa.

An Analysis of Formal Patient Complaints, Risk, and Malpractice Events Involving Orthopedic Trauma Surgeons During a 10-Year Period

Formal patient complaints and malpractice events involving orthopedic trauma surgeons (OTSs) can have substantial career implications. Our purpose was to analyze formal patient complaints, risk events, and malpractice events against OTSs during a 10-year period. We reviewed all formal patient complaints within our institution's patient advocacy database involving 9 fellowship-trained OTSs throughout a decade. Complaints were categorized using the Patient Complaint Analysis System. Potential risk and malpractice events involving the OTSs were recorded. A control group of all patients seen by the surgeons during the study period was created. Demographics between patients with complaints and the control group were analyzed, as were malpractice, risk, and complaint rates between the surgeons. Of 33,770 patients, 136 filed a formal complaint (0.40%). There were 29 malpractice claims and 2 malpractice lawsuits. The care and treatment domain accounted for the highest percentage of complaints (36%), followed by the access and availability domain (26%). Results of the logistic regression analysis indicated that private insurance (odds ratio, 1.58) and operative treatment (odds ratio, 3.65) were significantly associated with complaints. Despite statistically significant differences in the rates of complaint and risk events between surgeons, malpractice events did not differ. The rate of patient complaints within a large orthopedic trauma practice during a 10-year period was 0.40%. Patients with private insurance and those treated operatively were more likely to file a complaint. Whereas complaint rates among surgeons varied, there was no significant difference in the rate of malpractice events. Understanding patient complaint rates and categorizations may allow surgeons to target areas for improvement. [Orthopedics. 2023;46(2):121-127.].

A Physician Assistant Is Associated With Higher Patient Satisfaction With Outpatient Orthopedic Surgery

Patient satisfaction is increasingly used to assess the quality of care and determine physician reimbursement. Patient characteristics influence patient satisfaction, but the effect of physician practice parameters on satisfaction has not been studied in detail. Outpatient satisfaction scores from 11,059 patients who rated 24 orthopedic surgeons from a single institution were studied. Practice-related parameters were collected in a provider-reported survey. Univariate logistic regressions were used to test the associations between each provider characteristic and the likelihood of receiving a 5-star rating on a selection of 16 Press Ganey patient satisfaction questions. The presence of a physician assistant in the clinic positively affected the 5-star rating for all but 1 of the patient satisfaction questions examined, including overall satisfaction (odds ratio [OR], 1.38; 95% CI, 1.03-1.85; P=.031); the likelihood of being recommended to others (OR, 1.57; 95% CI, 1.16-2.14; P=.004); and friendliness/courtesy (OR, 1.58; 95% CI, 1.17-2.13; P=.003). However, having a fellow or nurse practitioner in the clinic, treating children, productivity (measured as total relative value units), taking trauma call, and provider distance from home were not associated with higher scores for any of the Press Ganey patient satisfaction questions. Having a physician assistant in the clinic is an actionable, practice-specific characteristic that positively affects patient satisfaction on many levels and may ultimately improve the perception of care. [Orthopedics. 2022;45(5):e252-e256.].

Factors associated with greater patient satisfaction in outpatient neurosurgical clinics: Recommendation for surgery, older age, cranial chief complaint, and public health insurance

OBJECTIVE

Patient satisfaction has increasingly played a role in determining care quality. Surveys are used to gauge patient experience, satisfaction of care, and likelihood to recommend providers and facilities. The aim of the study is to evaluate whether clinical and demographic data predict greater patient satisfaction with providers in the outpatient neurosurgery clinic.

METHODS

Press-Ganey (Press Ganey Associates, South Bend, IL) evaluations of 1521 patients were reviewed in an academic neurosurgical clinic from January 1, 2019 through February 1, 2021. We analyzed associations between Press-Ganey ratings and patient demographics, chief complaint, psychiatric comorbidities, number of orders placed, medication prescriptions, surgical recommendation, payor status, and referral source. We used univariate logistic regression to assess for associations between independent variables and Press-Ganey ratings. Multivariable logistic regression was used for associated factors.

RESULTS

For the Likelihood to Recommend question, older age (p = 0.003), cranial chief complaint (p = 0.046), and recommendations for surgery (p < 0.001) were significantly associated with "good" ratings. For the rating of Care Received, older age (p = 0.002), cranial chief complaint (p = 0.05), and recommendations for surgery (p = 0.002) were significantly associated with "good" ratings. For Confidence in Care Provider question, recommendations for surgery (p = <0.001) and government insurance type (p = 0.002) were significantly associated with "good" ratings.

CONCLUSIONS

Patients with older age, cranial pathologies, a recommendation for surgery, and government health insurance were significantly associated with favorable patient satisfaction with providers in the outpatient neurosurgery clinic. Prospective studies should target patient populations who are younger, have spinal complaints, have non-surgical needs, and have commercial insurance to improve satisfaction.

Recommendation of Surgery and Other Interventions Is Associated With Increased Patient Satisfaction With Orthopedic Outpatient Visits

The primary goal of our study was to determine whether satisfaction with orthopedic surgery outpatient visits is affected by a recommendation for surgery compared with a recommendation for nonoperative treatment, as measured by the Press Ganey Outpatient Medical Practice Survey (PGOMPS). Secondarily, we evaluated the effect of offering an injection, therapy, or any intervention (surgery, injection, therapy, immobilization, aspiration, or radiation therapy) on PGOMPS scores. To investigate this relationship, we reviewed new orthopedic outpatient visits at a tertiary academic center during a single year (2018). Patient satisfaction was defined as a PGOMPS score greater than the 33rd percentile. Univariate and multivariate binary logistic regression was conducted to determine the effect of a surgical recommendation and the effect of recommending an injection, therapy, or any intervention on the PGOMPS total score and provider subscore. Of the 1217 included patients, multivariate analysis showed that a surgical recommendation was significantly and independently associated with satisfaction on the PGOMPS total score and provider subscore. Multivariate analysis also showed that being offered an injection, therapy, or any intervention was significantly associated with higher PGOMPS total scores compared with not being offered those interventions. Patients who were offered surgery or other interventions were significantly more likely to be satisfied with their encounter and the surgeon. Patients who were offered surgery were significantly more likely to be satisfied with their encounter and the surgeon than those who were not offered surgery. Additionally, patients who were offered any intervention were significantly more likely to be satisfied with their encounter than those who were not offered an intervention. [Orthopedics. 2022;45(3):187-191.].

Correlation of Press Ganey Scores With Early Patient Satisfaction After Anterior Cruciate Ligament Reconstruction

Background:

Patient satisfaction metrics are commonly used to assess the quality of health care and affect reimbursement. The Press Ganey Ambulatory Surgery (PGAS) is a satisfaction survey that has emerged as a prominent quality assessment tool; however, no data exist on whether PGAS scores correlate with early postsurgical satisfaction during the PGAS survey administration period in patients who underwent anterior cruciate ligament reconstruction (ACLR).

Purpose:

To determine if PGAS scores correlate with measures of satisfaction and patient-reported outcomes (PROs) at 2 weeks postoperatively in ACLR patients.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

A retrospective review of patients who underwent ACLR at a single institution was performed. Patients who completed the PGAS survey and PROs at 2 weeks postoperatively were included in the study. Surgical satisfaction was measured with the Surgical Satisfaction Questionnaire (SSQ-8), and PROs included 6 Patient-Reported Outcomes Measurement Information System domains. Bivariate analysis between PGAS and PRO scores was conducted using the Spearman rank correlation coefficient (r_S).

Results:

Of the 716 patients who received the PGAS survey after ACLR, 81 patients completed the survey, and 39 patients also completed PROs and were included in the study. Total converted (mean scaled score) and “top box” (percentages of questions with highest rating selected) PGAS scores showed no significant correlations with the SSQ-8 (r_S =–0.24; P = .14). There were no significant correlations between SSQ-8 and PGAS domain scores except for a negative correlation with Facility domain top box scores (r_S =–0.33; P = .04), meaning that patients with higher surgical satisfaction had lower PGAS Facility scores. Total PGAS (converted and top box scores) and PGAS domain scores showed no significant correlation with any of the other PROs.

Conclusion:

PGAS scores showed no significant positive correlation with surgical satisfaction, function, pain, mental health, activity, or expectations of surgery in patients 2 weeks after ACLR. This suggests little to no relationship between PGAS score and surgical satisfaction in the early recovery period after ACLR.

Does Adjusting for Social Desirability Reduce Ceiling Effects and Increase Variation of Patient-Reported Experience Measures?

Social desirability bias (a tendency to underreport undesirable attitudes and behaviors) may account, in part, for the notable ceiling effects and limited variability of patient-reported experience measures (PREMs) such as satisfaction, communication effectiveness, and perceived empathy. Given that there is always room for improvement for both clinicians and the care environment, ceiling effects can hinder improvement efforts. This study tested whether weighting of satisfaction scales according to the extent of social desirability can create a more normal distribution of scores and less ceiling effect. In a cross-sectional study 118 English-speaking adults seeking musculoskeletal specialty care completed 2 measures of satisfaction with care (one iterative scale and one 11-point ordinal scale), a measure of social desirability, and basic demographics. Normality of satisfaction scores was assessed using Shapiro-Wilk tests. After weighting for social desirability, scores on the iterative satisfaction scale had a more normal distribution while scores on the 11-point ordinal satisfaction scale did not. The ceiling effects in satisfaction decreased from 47% (n = 56) to 2.5% (n = 3) for the iterative scale, and from 81% (n = 95) to 2.5% (n = 3) for the ordinal scale. There were no differences in mean satisfaction when the social desirability was measured prior to completion of the satisfaction surveys compared to after. The observation that adjustment for levels of social desirability bias can reduce ceiling effects suggests that accounting for personal factors could help us develop PREMs with greater variability in scores, which may prove useful for quality improvement efforts.

Patient Satisfaction in the Era of COVID-19: Virtual Visit versus In-person Visit Satisfaction

SIGNIFICANCE

Teleophthalmology became widely used during the coronavirus 2019 pandemic; however, the quality of this care remains to be understood.

PURPOSE

This study aimed to compare patient satisfaction levels from virtual and in-person visits based on post-visit surveys, as well as investigate demographic characteristics that may predict patient satisfaction with virtual visits.

METHODS

Virtual (n = 2943) and in-person (n = 56,175) visits from March 19, 2020, to July 31, 2020, were identified using the electronic health record system. For in-person visits, a random subset of 3000 visits was acquired using a random number generator. Of these, 2266 virtual and 2590 in-person visits met the inclusion criteria. Patients who completed the Telemedicine for Medical Practice Survey and Medical Practice Survey were analyzed in this report. Nonparametric Mann-Whitney test was used to compare scores between groups.

RESULTS

Two hundred eleven virtual patients (9.31%; 82 phone, 115 video, 14 hybrid) and 307 in-person patients (11.85%) completed the Telemedicine for Medical Practice Survey and Medical Practice Survey, respectively. Satisfaction scores were similar and high in both groups-virtual visit satisfaction scores averaged 4.82, whereas in-person visit satisfaction averaged 4.85 (P = .80, θ = 0.501 [0.493 to 0.509]). Only one question yielded significantly different satisfaction scores, and no demographic variables were significant predictors of satisfaction scores.

CONCLUSIONS

Patient satisfaction is comparable between virtual and in-person visits, validating the continued usage of telemedicine for eye care visits.

Evaluating Factors That Influence Patient Satisfaction in Otolaryngology Clinics

OBJECTIVES

To identify factors that influence patient satisfaction during outpatient visits in various settings of otolaryngology clinics in an academic medical center.

STUDY DESIGN

Retrospective review.

SETTING

Academic medical center.

METHODS

We reviewed Press Ganey patient satisfaction survey responses for new, outpatient visits between January 1, 2014 and December 31, 2018. Self-reported race was identified using electronic medical records. Multivariate binary logistic regression analyses were used to identify continuous and categorical variables associated with patient satisfaction.

RESULTS

There were 3998 unique new patient visits with completed surveys. Multivariate analysis revealed that responses for patients <18 years old are less likely to be satisfied with their care compared to patients ≥18 years old (OR 0.66; P < .001). For each 10-minute increase in wait time, patients were 43.4% less likely report satisfaction (P < .001). African American patients were also less likely to report satisfaction (OR 0.22; P = .043) while Native Hawaiian and Pacific Islanders were over 3 times more likely to be satisfied (OR 3.6; P = .013). Additionally, Medicare patients and those who were seen at community satellite clinics compared to the main University Hospital had increased odds of achieving satisfactory care (OR 1.3; P = .005 and OR 1.3; P = .002, respectively).

CONCLUSIONS

Wait time, clinic location, patient race, insurance provider, and age were all shown to significantly influence patient-reported satisfaction. Understanding how these variables influence patient satisfaction will hopefully lead to processes that improve patient satisfaction.

LEVEL OF EVIDENCE

Level 3.

Preoperative Factors Associated with Press Ganey Patient Satisfaction Scores after Anterior Cruciate Ligament Reconstruction

Patient satisfaction is increasingly used as a metric to evaluate the quality of healthcare services and to determine hospital and physician compensation. The aim of this study was to identify preoperative factors associated with Press Ganey Ambulatory Surgery (PGAS) satisfaction scores, and to evaluate the effect of each PGAS domain score on the total PGAS score variability in patients undergoing anterior cruciate ligament reconstruction (ACLR). A review of a Press Ganey (PG) database at a single center was performed for patients undergoing ACLR between 2015 and 2019. Ninety-nine patients completed the PGAS survey and 54 also completed preoperative demographic and patient-reported outcome measures (PROMs) for an orthopaedic registry. PGAS scores were calculated and bivariate analysis was performed. Multivariable linear regression determined the effect of each of the six PGAS domains on the total PGAS score variability. In the total cohort of 99 patients, no factors were significantly associated with the total PGAS score or any domain scores. For the 54 patients who also participated in the orthopaedic registry, none of the preoperative PROMs were significantly correlated with total PGAS score. However, having a college degree (89 vs. 95 or 97 points; p = 0.02) and continuous femoral nerve catheter (92 vs. 100 points; p = 0.04) was associated with lower personal issue domain scores, while patients with a greater number of prior surgeries had worse registration domain scores (ρ = -0.27; p = 0.049). For the entire cohort, the registration and facility domains contributed the most variability to the total PGAS score, while the physician domain contributed the least. Few preoperative factors are associated with PGAS scores, and total PGAS scores do not significantly correlate with baseline PROMs. Surgeons may have limited ability to improve their PGAS scores given most of the variability in total scores stems from systemic aspects of the patient experience.

Patient Satisfaction in Outpatient Radiology: Effects of Modality and Patient Demographic Characteristics

Objective: To characterize predictors of patient satisfaction in outpatient radiology, we examined whether patient satisfaction differs across radiology modalities and demographic groups. Methods: A random sampling of Press-Ganey outpatient services surveys for radiology and non-radiology visits from September 2008 to September 2017 were retrospectively analyzed. Composite scores averaged across all Likert items were analyzed as both a continuous variable and a dichotomous variable of dissatisfaction (defined as ≤3 on the 5-point scale). Results: Among 9983 radiology surveys, mammography had higher composite scores than MRI, CT, radiography, US, and NM/PET (p < 0.001) and lower dissatisfaction (3.9%) than CT (6.7%), MRI (7.3%), and radiography (8.2%). Low-scoring responses were most common in the Facilities domain (7.8%) and least common in Overall Assessment (3.8%). Satisfaction metrics were lowest for ages 20-29 and highest for ages 70-79. Lower dissatisfaction rates were seen among Hispanics (3%) and whites (6%), compared to blacks (10%) and Asians (18%). Conclusion: Significant differences in patient satisfaction were found across imaging modalities and demographic variables. Further investigations to identify contributing factors may help improve patient experiences.

Press Ganey Surveys in Patients Undergoing Upper-Extremity Surgical Procedures: Response Rate and Evidence of Nonresponse Bias

BACKGROUND

Patient satisfaction surveys are important measures of the patient experience that provide data for quality improvement. The purpose of this study was to establish the response rate and the factors associated with the completion of the Press Ganey (PG) Ambulatory Surgery Survey (PGAS) in patients who underwent ambulatory upper-extremity surgical procedures.

METHODS

A prospective orthopaedic registry at a single academic ambulatory surgical center was retrospectively reviewed for patients who underwent an upper-extremity surgical procedure from 2015 to 2019. The institutional PG database was queried to determine the patients who completed the PGAS postoperatively. The response rate was calculated, and baseline characteristics and patient-reported outcome measures were compared between responders and nonresponders.

RESULTS

Of the 1,489 patients included, 201 (13.5%) were responders and 1,288 (86.5%) were nonresponders. Differences existed in baseline characteristics between groups, with responders being significantly older (p = 0.004) and having significantly higher proportions of White race (p < 0.001), college education (p = 0.011), employment (p = 0.005), marriage (p = 0.006), and higher income earners (p < 0.001). Responders had significantly better baseline Patient-Reported Outcomes Measurement Information System scores across multiple domains (p < 0.05), but these differences were not clinically meaningful.

CONCLUSIONS

PGAS response rates were low (13.5%), and differences between responders and nonresponders may be utilized by hospitals to target feedback from underrepresented patient populations. Surgeons, policymakers, and health-care administrators should use caution with the interpretation of PGAS results because responders may not be representative of all patients.

Ophthalmology Provider Ratings and Patient, Disease, and Appointment Factors

The purpose of the current study is to examine how nonmodifiable sociodemographic, disease, appointment, management, and survey factors correlate with provider rating. This was a retrospective cross-sectional study conducted on 29 857 patient Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys collected from January 2017 to January 2019 at a tertiary eye center. We included surveys of patients aged 18 years or older, who answered at least 4 of 6 subfield questions, and completed the survey within 90 days of the appointment. The main outcome was the odds of receiving top box score (TBS) of 10/10 on the survey question regarding overall provider rating. The results showed that the variables with higher odds of TBS included higher overall appointment attendance (odds ratio [OR]: 2.66 [95% CI: 1.23-5.75], P = .013); older patient age (OR 2.44 [95% CI: 2.08-2.87], P < .001]; higher percentage of survey questions completed (OR: 2.02 [95% CI: 1.79-2.27], P < .001); better best corrected visual acuity (OR: 1.85 [95% CI: 1.3-2.64], P = .001); optometry clinic visit (OR: 1.25 [95% CI: 1.15-1.36], P < .001); having procedures (OR: 1.19 [95% CI: 1.04-1.36], P = .013), surgery scheduled (OR: 1.18 [95% CI: 1.03-1.36], P = .020], or refraction done (OR: 1.16 [95% CI: 1.08-1.25], P < .001); being seen by male providers (OR: 1.11 [95% CI: 1.04-1.17], P = .001); and having additional eye testing performed (OR: 1.06 [95% CI: 1.00-1.13], P = .048). Variables associated with lower odds of TBS included longer time to complete survey (OR: 0.42 [95% CI: 0.3-0.58], P = .001); new patient encounter (OR: 0.62 [95% CI: 0.58-0.65], P < .001); and glaucoma (OR: 0.66 [95% CI: 0.59-0.75], P < .001), cornea (OR: 0.79 [95% CI: 0.71-0.87], P < .001), or comprehensive clinic visits (OR: 0.86 [95% CI: 0.79-0.94], P < .001). Thus, nonmodifiable factors may affect the provider rating, and these factors should be studied further and accounted for when interpreting the results of patient experience surveys.

An Analysis of Formal Patient Complaints and Malpractice Events Involving Hand and Upper Extremity Surgeons

INTRODUCTION

Our purpose was to define and categorize patient complaints within a hand surgery practice over a 10-year period. In addition, we aimed to define surgeon and patient factors associated with formal complaints.

METHODS

All patients who filed a complaint with our institution's patient advocacy service against six hand surgeons in an academic practice over a 10-year period were recorded and categorized using the Patient Complaint Analysis System. A control group consisting of all patients seen by the surgeons during the study period was created. Demographic differences between the complaint and control groups were analyzed, as were complaint rates between surgeons. We obtained the number of malpractice events involving each of the surgeons.

RESULTS

During the 10-year study period, 73 of 36,010 unique patients seen (0.20%) filed a complaint. Care and treatment category comprised the highest percentage of complaint designations (30%), followed by access and availability (23%). Forty-three patients (59%) who filed complaints were treated surgically. Patients with a complaint had a significantly higher percentage of mental, behavioral, or neurodevelopmental disorders compared with controls (55% versus 42%, P = 0.03). The complaint rate (total complaints/total new patients seen) ranged between 0.09% and 0.29% for the six surgeons, and these results were not statistically significant.

DISCUSSION

Within an academic hand and upper extremity surgery practice, the rate of patient complaints is 0.20% or approximately one complaint for every 500 new patients seen. Most patient complaints are categorized within the care and treatment domain. Underlying mental health conditions are associated with more frequent complaints. Communication issues appear to represent a modifiable area that hand surgeons can improve to help mitigate potential complaints. Understanding both the frequency and types of patient complaints may allow hand surgeons to recognize areas for improvement and avoid potential exposure to malpractice litigation.

LEVEL OF EVIDENCE

Prognostic level III (case-control).

Predictors of two-year patient satisfaction following elective knee surgery

BACKGROUND

Patient satisfaction metrics are increasingly being utilized as tools to evaluate the quality of healthcare and affect reimbursements. The objectives of this study were to (1) identify factors associated with two-year patient satisfaction after elective knee surgery, (2) compare the Surgical Satisfaction Questionnaire-8 (SSQ-8) and a numeric satisfaction scale (NSS), and (3) determine if two-year patient satisfaction can be predicted based on preoperative factors.

METHODS

A total of 365 patients undergoing elective knee surgery at a single center were administered questionnaires to assess demographics, medical history, and various patient-reported outcomes preoperatively and at two years postoperatively. Patient satisfaction was measured at two years postoperatively with SSQ-8 and NSS. Bivariate and multivariate statistical analyses were performed to identify significant associations and independent predictors of satisfaction.

RESULTS

SSQ-8 and NSS scores were significantly correlated (r_s = 0.68, P < 0.0001). Lower SSQ-8 and NSS scores were associated with black race, higher BMI, more comorbidities, unemployment, smoking, higher ASA score, and greater Met Expectations (P < 0.05). Better scores on patient-based outcome measures and better improvement from baseline were significantly correlated with higher satisfaction on both SSQ-8 and NSS. Multivariable analysis identified greater Met Expectations and higher two-year Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference scores as independent predictors of greater SSQ-8 scores (adjusted r² = .52). Greater Met Expectations and better two-year PROMIS Social Satisfaction scores were independent predictors of NSS score (adjusted r² = .41). In contrast, when only preoperative variables were considered, the multivariable regression model accounted for only 14% of the variance in SSQ-8 and 6% of the variance in NSS.

CONCLUSION

While there are multiple preoperative factors that are associated with two-year patient satisfaction after knee surgery, those factors contribute relatively little to satisfaction. Meeting expectations and better patient-based outcomes at two years are more important.

Evaluating the impact of social deprivation on Press Ganey® Outpatient Medical Practice Survey Scores

Background

Social deprivation has been shown to affect access to health care services, and influences outcomes for a variety of physical and psychological conditions. However, the impact on patient satisfaction remains less clear. The objective of this study was to determine if social deprivation is an independent predictor of patient satisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS).

Methods

We retrospectively reviewed unique new adult patient (≥ 18 years of age) seen at a tertiary academic hospital and rural/urban outreach hospitals/clinics between January 2014 and December 2017. Satisfaction was defined a priori as achieving a score above the 33rd percentile. The 2015 Area Deprivation Index (ADI) was used to determine social deprivation (lower score signifies less social deprivation). Univariate and multivariable binary logistic regression were used to determine the impact of ADI on PGOMPS total and provider sub-scores while controlling for variables previously shown to impact scores (wait time, patient age, sex, race, specialty type, provider type, and insurance status).

Results

Univariate analysis of PGOMPS total scores revealed a 4% decrease in odds of patient satisfaction per decile increase in ADI (p < 0.001). Patients within the most deprived quartile were significantly less likely to report satisfaction compared to the least deprived quartile (OR 0.79, p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction decreased 2% for each decile increase in ADI on the Total Score (p < 0.001), independent of other variables previously shown to impact scores. For PGOMPS Provider Sub-Score, univariate analysis showed that patients in the lowest ADI quartile were significantly less likely be satisfied, as compared to the least deprived quartile (OR 0.77; 95% CI 0.70–0.86; p < 0.001). A 5% decrease in a patient being satisfied was observed for each decile increase in ADI (OR 0.95; 95% CI 0.94–0.96; p < 0.001).

Conclusions

Social deprivation was an independent predictor of outpatient visit dissatisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey. These results necessitate consideration when developing health care delivery policies that serve to minimize inequalities between patients of differing socioeconomic groups.

Factors Influencing Press Ganey Ambulatory Surgery Scores in Patients Undergoing Upper Extremity Procedures

We sought to determine whether patient and surgical factors are associated with the Press Ganey Ambulatory Surgery Survey (PGAS) satisfaction scores in patients undergoing outpatient upper extremity procedures.

How Long Will It Take to Reach Gender Parity in Orthopaedic Surgery in the United States? An Analysis of the National Provider Identifier Registry

BACKGROUND

Although previous studies have evaluated how the proportion of women in orthopaedic surgery has changed over time, these analyses have been limited by small sample sizes, have primarily used data on residents, and have not included information on growth across subspecialties and geographic regions.

QUESTION/PURPOSE

We used the National Provider Identifier registry to ask: How have the (1) overall, (2) regional, and (3) subspecialty percentages of women among all currently practicing orthopaedic providers changed over time in the United States?

METHODS

The National Provider Identifier Registry of the Centers for Medicare and Medicaid Services (CMS) was queried for all active providers with taxonomy codes pertaining to orthopaedic subspecialties as of April 2020. Women orthopaedic surgeons were identified among all physicians with subspecialty taxonomy codes. As all providers are required to provide a gender when applying for an NPI, all providers with queried taxonomy codes additionally had gender classification. Our final cohort consisted of 31,296 practicing orthopaedic surgeons, of whom 8% (2363 of 31,296) were women. A total of 11,714 (37%) surgeons possessed taxonomy codes corresponding with a specific orthopaedic subspecialty. A univariate linear regression analysis was used to analyze trends in the annual proportions of women who are active orthopaedic surgeons based on NPI enumeration dates. Specifically, annual proportions were defined using cross-sections of the NPI registry on December 31 of each year. Linear regression was similarly used to evaluate changes in the annual proportion of women orthopaedic surgeons across United States Census regions and divisions, as well as orthopaedic subspecialties. The national growth rate was then projected forward to determine the year at which the representation of women orthopaedic surgeons would achieve parity with the proportion of all women physicians (36.3% or 340,018 of 936,254, as determined by the 2019 American Medical Association Physician Masterfile) and the proportion of all women in the United States (50.8% or 166,650,550 of 328,239,523 as determined by 2019 American Community Survey from the United States Census Bureau). Gender parity projections along with corresponding 95% confidence intervals were calculated using the Holt-Winters forecasting algorithm. The proportions of women physicians and women in the United States were assumed to remain fixed at 2019 values of 36.3% and 50.8%, respectively.

RESULTS

There was a national increase in the proportion of women orthopaedic surgeons between 2010 and 2019 (r2 = 0.98; p < 0.001) at a compound annual growth rate of 2%. Specifically, the national proportion of orthopaedic surgeons who were women increased from 6% (1670 of 26,186) to 8% (2350 of 30,647). Assuming constant growth at this rate following 2019, the time to achieve gender parity with the overall medical profession (that is, to achieve 36.3% women in orthopaedic surgery) is projected to be 217 years, or by the year 2236. Likewise, the time to achieve gender parity with the overall US population (which is 50.8% women) is projected to be 326 years, or by the year 2354. During our study period, there were increases in the proportion of women orthopaedic surgeons across US Census regions. The lowest growth was in the West (17%) and the South (19%). Similar growth was demonstrated across census divisions. In each orthopaedic subspecialty, we found increases in the proportion of women surgeons throughout the study period. Adult reconstruction (0%) and spine surgery (1%) had the lowest growth.

CONCLUSION

We calculate that at the current rate of change, it will take more than 200 years for orthopaedic surgery to achieve gender parity with the overall medical profession. Although some regions and subspecialties have grown at comparably higher rates, collectively, there has been minimal growth across all domains.

CLINICAL RELEVANCE

Given this meager growth, we believe that substantive changes must be made across all levels of orthopaedic education and leadership to steepen the current curve. These include mandating that all medical school curricula include dedicated exposure to orthopaedic surgery to increase the number of women coming through the orthopaedic pipeline. Additionally, we believe the Accreditation Council for Graduate Medical Education and individual programs should require specific benchmarks for the proportion of orthopaedic faculty and fellowship program directors, as well as for the proportion of incoming trainees, who are women. Furthermore, we believe there should be a national effort led by American Academy of Orthopaedic Surgeons and orthopaedic subspecialty societies to foster the academic development of women in orthopaedic surgery while recruiting more women into leadership positions. Future analyses should evaluate the efficacy of diversity efforts among other surgical specialties that have achieved or made greater strides toward gender parity, as well as how these programs can be implemented into orthopaedic surgery.

Is There an Association Between Negative Patient-Experience Comments and Perioperative Outcomes After Primary Total Hip Arthroplasty?

BACKGROUND

Multiple stakeholders are interested in improving patient experience after primary total hip arthroplasty due to shifts toward patient-centered care. Patient free-text narratives are a potentially valuable but largely unexplored source of data.

METHODS

The records of 383 patients who underwent primary total hip arthroplasty between August 2016 and August 2019 were combined with vendor-supplied patient satisfaction data, which included patient free-text comments and the Press Ganey satisfaction survey. A total of 1295 patient comments were analyzed for sentiment, and negative comments were categorized into nine themes. Postoperative outcomes, patient-reported outcome measures, and traditional measures of satisfaction were compared between patients who provided a negative comment vs those who did not. Multivariable regression was used to determine perioperative variables associated with providing a negative comment.

RESULTS

Of the 1295 patient comments: 54% were positive, 24% were negative, 10% were mixed, and 12% were neutral. Top two themes of negative comments were room condition (25%) and inefficient communication (23%). There were no differences in studied outcomes (eg. peak pain intensity, length of stay, or improvements in hip injury and osteoarthritis outcome scores Jr. and pain visual analog scale scores at 6-week follow-up) between those who provided negative comments vs those who did not (P > .05). However, patients who made negative comments were less likely to recommend their hospital care to peers (P < .001). Finally, patients who had >2 allergies (P = .024) were more likely to provide negative comments.

CONCLUSION

The present study demonstrates that patient satisfaction appears not to be a reliable sole proxy for traditional objective outcome measures of pain relief and functional improvement.

Analysis of Online Reviews of Orthopaedic Surgeons and Orthopaedic Practices Using Natural Language Processing

BACKGROUND

There is growing interest in measuring and improving patient experience. Machine learning-based natural language processing techniques may help identify instructive themes in online comments written by patients about their healthcare provider. Separating individual surgeon and orthopaedic office reviews, we analyzed themes that are discussed based on the rating category, the association with review length, the number of people posting more than one review for a surgeon or office, the mean number of reviews per rating category, and the difference in review tones.

METHODS

On Yelp.com, we collected 11,614 free-text reviews-together with a one- to five-star rating-of orthopaedic surgeons. Using natural language processing, we identified the most frequently occurring word combinations among rating categories. Themes were derived by categorizing word combinations. Dominant tones (emotional and language styles) were assessed by the IBM Watson Tone Analyzer. We calculated chi-square tests for linear trend and Spearman's rank correlation coefficients to assess differences among rating category.

RESULTS

For individual surgeons and orthopaedic offices, themes such as logistics, care and compassion, trust, recommendation, and customer service varied among rating categories. More positive reviews are shorter for individual surgeons and orthopaedic offices, while rating category was comparable among people posting more than one review for both groups. Tones of joy and confidence were associated with higher ratings. Sadness and tentative tones were associated with lower ratings.

DISCUSSION

For individual orthopaedic surgeons and orthopaedic offices, patient experience may be influenced mostly by the patient-clinician relationship. Training in more effective communication strategies may help improve self-reported patient experience.

Validation of a Patient Questionnaire Assessing Patient Satisfaction With Orthopedic Outpatient Clinic Consultation

Previous qualitative research has identified a number of factors which influence patient satisfaction with orthopedic outpatient clinic visits. To further evaluate these factors, the authors initially generated a number of items or statements representing these factors. This cohort of items was then subjected to analysis by an expert group to assess which 3 items best represented each factor. These items formed the basis of a draft survey which was then administered to 323 orthopedic outpatients to assess these factors as characteristics of patient satisfaction. Items and factors were also assessed against 2 global measures of patient satisfaction. One hundred and one survey responses were returned and subjected to factorial analysis. Results indicated that factors of trust, empathy, and relatedness were not distinguishable and subsequently combined to represent a single factor, the therapeutic relationship. A final 5-factor model is proposed incorporating 3 interpersonal factors (communication, expectation, therapeutic relationship) and 2 environmental factors (clinic wait time, clinical contact time). The factors identified by this study should be considered in surveys evaluating patient satisfaction with orthopedic outpatient services.

Factors that influence inpatient satisfaction after shoulder arthroplasty

BACKGROUND

It is important to distinguish satisfaction regarding the outcome of care and satisfaction with the delivery of care. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are modern assessments of hospitals and providers of delivery of care. The purpose of this study was to report inpatient satisfaction according to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) scores after shoulder arthroplasty and to determine factors that influence them, as well as their correlation with surgical expectations, pain perception, quality of life, surgical setting, and functional outcomes.

METHODS

All patients scheduled for a shoulder arthroplasty were prospectively asked to complete a demographic and initial shoulder assessment form, a shoulder surgery expectations survey, a pain catastrophizing scale, the SF-12 (12-item Short Form) survey, and a resiliency form (Resilience Scale 11). Patient satisfaction was measured with the CG-CAHPS and HCAHPS surveys. Legacy forms, patient-specific factors, type of surgery performed, location of surgery, length of hospital stay, and discharge disposition were evaluated on their ability to predict these survey scores. Linear regression was used to calculate correlations and predictions of continuous variables, and logistic regression was used to compared the satisfied vs. unsatisfied cohorts.

RESULTS

The average HCAHPS and CG-CAHPS satisfaction scores for the population were 74.7 ± 20.7 and 82.1 ± 19.4, respectively. Nonsmokers had a mean HCAHPS score of 77.7 ± 22.0, whereas current smokers reported a mean of 59.6 ± 5.2 (P = .03). Patients who were discharged home had a mean HCAHPS score of 77.3 ± 21.9, whereas those discharged to a skilled nursing facility reported a mean of 59.3 ± 6.6 (P = .05). These same groups also had significantly higher odds of being satisfied with the hospital. No significant differences or higher odds were seen for comparisons between overall CG-CAHPS satisfaction and any of the patient-specific factors tested. There was no significant correlation between age, length of stay, pain (pain catastrophizing scale), resiliency (Resilience Scale 11), expectations (shoulder surgery expectations survey), or function (SF-12) and both the HCAHPS and CG-CAHPS satisfaction scores.

CONCLUSION

Overall, 37 patients (74%) had CG-CAHPS scores that indicated satisfaction and 34 patients (68%) had HCAHPS scores that indicated satisfaction. Nonsmokers and patients discharged home after surgery report higher levels of inpatient hospital (HCAHPS) satisfaction after shoulder arthroplasty. Patients with high preoperative surgical expectations, pain perception, and resiliency are not generally more satisfied with the hospital or clinician. Preoperative diagnosis, location of surgery, and length of stay do not reliably impact satisfaction with the hospital or clinician. Inpatient HCAHPS and CG-CAHPS satisfaction does not correlate with legacy functional outcome measures and, therefore, may not be predictive of long-term functional outcomes.

Inter-specialty variation of the Press Ganey Outpatient Medical Practice Survey

ABSTRACT

Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties.New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score.Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties.Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement.

Natural Language Processing of Patient-Experience Comments After Primary Total Knee Arthroplasty

BACKGROUND

There is interest in improving patient experience after total knee arthroplasty (TKA) due to recent shifts toward value-based medicine. Patient narratives are a valuable but unexplored source of information.

METHODS

Records of 319 patients who had undergone primary TKA between August 2016 and August 2019 were linked with vendor-supplied patient satisfaction data, which included patient comments and the Press Ganey satisfaction survey. Using machine-learning-based natural language processing, 1048 patient comments were analyzed for sentiment and classified into themes. Postoperative outcomes, patient-reported outcome measures, and traditional measures of satisfaction were compared between patients who provided a negative comment vs those who did not (positive, neutral, mixed grouped together). Multivariable regression was used to determine perioperative variables associated with providing a negative comment.

RESULTS

Of the 1048 patient comments, 25% were negative, 58% were positive, 8% were mixed, and 9% were neutral. Top 2 themes of negative comments were room condition (25%) and inefficient communication (23%). There were no differences in most of the studied outcomes (eg, peak pain intensity, length of stay, or Knee Injury and Osteoarthritis Outcome Score Junior and pain scores at 6-week follow-up) between the 2 cohorts (P > .05). However, patients who made negative comments were less likely to highly recommend their hospital care to peers (P < .001). Finally, patients who had higher American Society of Anesthesiologists Score and those who received a scopolamine patch were more likely to provide negative comments (P < .05).

CONCLUSION

Although the current study showed that patient satisfaction might not be a proxy for traditional objective perioperative outcomes, efforts to improve the nontechnical aspects of medicine are still crucial in providing patient-centered care.

The Impact of Social Deprivation on Orthopaedic Outpatient Satisfaction Using the Press Ganey Outpatient Medical Practice Survey

INTRODUCTION

In orthopaedics, multiple factors (patient age, wait time, and depression) have been associated with lower Press Ganey Outpatient Medical Practice Survey (PGOMPS) patient satisfaction scores. We hypothesized that increased social deprivation is an independent predictor of lower patient satisfaction, as measured by the PGOMPS.

METHODS

We retrospectively reviewed unique new outpatient orthopaedic surgery visits between January 1, 2014, and December 31, 2016, at a single tertiary academic institution. Given the high ceiling effects, satisfaction was defined a priori as achieving a score above the 33rd percentile. Social deprivation was determined using the 2015 Area Deprivation Index (ADI). Univariate and multivariable binary logistic regressions were used to detect factors associated with patient satisfaction for both the PGOMPS Total Score and Provider Sub-Score.

RESULTS

Of the 4,881 included patients, the mean age was 53.3 ± 15.9 years, 59.3% were women, and mean ADI was 30.1 ± 19.2. Univariate analysis revealed a significantly decreased odds of achieving satisfaction on the Total Score for each decile increase in ADI (odds ratio [OR] 0.94; P < 0.001). Compared with the least deprived quartile, patients of the most deprived quartile were significantly less likely to report satisfaction for both the Total Score (OR 0.56; P = 0.001) and Provider Sub-Score (OR 0.63; P = 0.011). Multivariable analysis revealed that the odds of achieving satisfaction for each decile increase in ADI were 0.96 for the Total Score (P = 0.014) and 0.95 for the Provider Sub-Score (P = 0.004), independent of age, wait time, race, subspecialty, provider type, and the clinic setting.

CONCLUSIONS

Increased social deprivation was an independent predictor of orthopaedic outpatient dissatisfaction on the PGOMPS. These findings should be considered when interpreting patient satisfaction scores and lend further support in an effort to improve healthcare inequalities.

LEVEL OF EVIDENCE

Level III.

The Effect of Length of Hospital Stay and Patient Factors on Patient Satisfaction in an Academic Hospital

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a metric for patient satisfaction consisting of 19 questions divided into 10 domains. Scores affect hospital reimbursements and accreditation and may play a role in patient outcomes. It is unclear how length of stay and other factors affect each of the 10 domains. This retrospective review gathered data of 600 patients between December 2008 and January 2017 who completed the HCAHPS survey. The odds of complete satisfaction in each of the 10 domains was evaluated. The results suggest increased length of stay is associated with lower odds of patient satisfaction and decreased likelihood of recommending the hospital. The odds of being completely satisfied regarding communication with physicians, discharge information, and responsiveness of the hospital staff, as well as the odds of recommending the hospital to others, were lower if the care provider was younger than the patient. Obese patients were also more likely to be satisfied with responsiveness and care transition. Male patients were more satisfied with communication about medications (odds ratio [OR], 1.694), care transition (OR, 1.489), and cleanliness (OR, 2.120). Medicare and fewer consults were related to increased odds of patient satisfaction with care transition (OR, 1.748 and 0.573, respectively). Males, older patients, and White patients were more likely to recommend the hospital (OR, 1.476, 1.025, and 1.690, respectively). Length of stay affects patient satisfaction and likelihood of recommending the hospital to others. Other factors such as a younger provider age than the patient, lower body mass index, female sex, non-Medicare insurance, and higher number of consults are also associated with lower satisfaction in various domains. Hospital systems can bolster patient satisfaction by strategizing day-of-surgery and weekend staffing to reduce length of stay. [Orthopedics. 2020;43(6):373-379.].

Early patient satisfaction following orthopaedic surgery

BACKGROUND

The healthcare industry is shifting its focus from traditional clinical outcome measures to patient satisfaction metrics. This change has caused orthopaedic surgeons to become increasingly interested in factors influencing patient satisfaction, which would allow them to potentially modify these factors in an effort to increase postoperative satisfaction. The objective of this study was to identify factors associated with patient satisfaction two weeks following extremity orthopaedic surgery.

METHODS

Patients completed questionnaires preoperatively to assess demographics, activity, pain, expectations, and Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing for Physical Function, Pain Interference, Social Satisfaction, Depression, Anxiety, and Fatigue. Two weeks after their operation, patients completed the same questionnaires in addition to an Improvement Survey and Met Expectations. Satisfaction was assessed with the Surgical Satisfaction Questionnaire.

RESULTS

Greater surgical satisfaction two weeks following orthopaedic surgery was associated with higher education, alcohol use, better scores on all PROMIS domains at baseline and two weeks, greater activity levels at baseline and two weeks, less bodily pain at baseline and two weeks, less pain in the surgical site at two weeks, greater met expectations, and greater improvement (p < 0.05).

CONCLUSION

This study provides important information about patient satisfaction two weeks after orthopaedic surgery.

Patient Satisfaction Is Improved With Exposure to Trauma Recovery Services

INTRODUCTION

The purpose of this study is to assess the impact of Trauma Recovery Services (TRS), a program facilitating engagement and recovery on satisfaction after orthopaedic trauma.

METHODS

Two hundred ninety-four patients with surgically managed extremity fractures were prospectively surveyed. Satisfaction was assessed after 12 months using a 13-question telephone survey, rated on a Likert scale from 1 to 5 (with five being excellent). TRS resource utilization during and after hospitalization was recorded. Eighty-eight patients (30%) used TRS.

RESULTS

Overall satisfaction was high with a mean score of 4.32. Although no differences were observed between the control group and patients with TRS utilization in age, sex, race, insurance, smoking history, or employment status, TRS patients sustained more high-energy mechanisms (81% versus 56%) and had more associated psychiatric illness (33% versus 17%), both P < 0.01. Multivariable regression indicated general exposure to TRS to be an independent predictor of higher overall care ratings (B = 1.31; P = 0.03).

DISCUSSION

Utilization of TRS was the greatest predictor of better overall care ratings. This study builds on existing evidence demonstrating the positive impact of Trauma Survivor Network programming. We conclude that a hospital-wide program supporting patient education and engagement can effectively increase patient satisfaction after traumatic injury.

LEVEL OF EVIDENCE

Prognostic Level II.

Effect of Patient Body Mass Index, Recommendation for Weight Modification, and Nonmodifiable Factors on Patient Satisfaction

INTRODUCTION

Patient satisfaction serves an increasingly important role in health care. Multiple nonmodifiable patient factors have been found to influence patient satisfaction. To the best of our knowledge, however, no study has investigated the influence of body mass index (BMI) on satisfaction scores. The objective of this study was to evaluate whether BMI and provider recommendation for patient weight modification were associated with patient satisfaction.

METHODS

We reviewed Press Ganey patient satisfaction survey scores from 3,044 clinical encounters in an academic orthopaedic center between November 2010 and May 2017. Multiple patient factors, BMI, and recommendation for weight loss, or requirement of weight loss, before surgery were recorded. Patient satisfaction was operationalized as a binary outcome of completely satisfied or not completely satisfied, and multiple logistic regression was used to estimate the odds of being completely satisfied from the subset of potential predictors.

RESULTS

White patients (odds ratio [OR] = 1.340, 95% confidence interval [CI]: 1.113 to 1.584, P = 0.0007) and Medicare-insured patients (OR = 1.260, 95% CI: 1.044 to 1.521, P = 0.0164) were more likely to be completely satisfied, whereas patients being seen by a provider for the first time were less likely to be completely satisfied (OR = 0.728, 95% CI: 0.626 to 0.847, P < 0.0001). BMI, recommendation for weight loss, and requirement of weight modification before surgery were not found to be associated with patient satisfaction.

DISCUSSION

Neither patient BMI nor provider recommendation for weight loss, or as a requirement for surgery, was associated with patient satisfaction. Race, insurance status, and previous visits with the care provider were identified as nonmodifiable patient factors that influence patient satisfaction.

LEVEL OF EVIDENCE

Level III.

Defining Meaningful Functional Improvement on the Visual Analog Scale for Satisfaction at 2 Years After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

PURPOSE

To (1) define Substantial Clinical Benefit (SCB), Patient Acceptable Symptomatic State (PASS), and Minimal Clinically Important Difference (MCID) for the visual analog scale (VAS) Satisfaction in patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS), and (2) identify preoperative predictors of achieving each outcome end-point.

METHODS

Data from consecutive patients who underwent primary hip arthroscopy between November 2014 and January 2017 were prospectively collected and retrospectively analyzed. Inclusion criteria consisted of patients with clinical and radiographic diagnosis of FAIS, who failed nonoperative treatment, underwent primary hip arthroscopy to address the FAIS, and had at minimum 2-year follow-up. Baseline data and postoperative patient-reported outcome scores were recorded at 2 years postoperatively. To quantify clinical significance of outcome achievement on the VAS)Satisfaction, we calculated MCID, PASS, and SCB for this outcome measure. A multivariate logistic regression analysis was used to identify preoperative predictors of achieving SCB, PASS, and MCID satisfaction.

RESULTS

A total of 335 patients were included in the final analysis, with an average age and body mass index (BMI) of 32.8 (standard deviation ± 12.4) years and 25.2 (standard deviation ± 5.3), respectively, and the majority being female (69.3%). The values on the VAS satisfaction were identified to represent MCID, PASS, and SCB, respectively: 52.8, 80.9, and 89.7. The rates of achieving clinically significant improvement on the VAS Satisfaction was 85.6%, 68.1%, and 56.9% for MCID, PASS, and SCB, respectively. A larger preoperative alpha angle was predictive for achieving SCB (odds ratio [OR], 1.076; P = .046), whereas lower BMI (OR, 0.955; P = .047) and larger preoperative alpha angle (OR, 1.12; P = .025) were predictors for achieving PASS.

CONCLUSIONS

This study identified threshold VAS satisfaction scores of 52.8, 80.9, and 89.7 for achieving MCID, SCB, and PASS, respectively, at 2-year follow-up following hip arthroscopy for FAIS. Furthermore, preoperative variables including larger preoperative alpha angles and lower BMI are predictors of achieving superior clinical satisfaction.

LEVEL OF EVIDENCE

Level IV, Case Series.

Early Postoperative Radiographs Have No Effect on Orthopaedic Trauma Patient's Satisfaction With Their Clinic Visit

BACKGROUND

Patient satisfaction plays a prominent role in modern orthopaedic care, reimbursement, and quality assessment, even if it runs contrary to the "standard of care." The literature shows that routine early radiographs after acute fracture care have no impact on clinical decision-making or patient outcomes, but little is known about their effect on patient satisfaction and understanding of their injuries. We hypothesized that eliminating these radiographs would negatively influence patient satisfaction scores with their clinic visit.

METHODS

One hundred patients were prospectively enrolled after acute fracture fixation. Half the patients obtained radiographs at the 2-week follow-up visit, whereas the other half did not. All patients completed a satisfaction survey about their clinic visit.

RESULTS

No difference was observed between the groups in overall satisfaction with the clinic visit (P = 0.62) or complications. However, patients with radiographs were more satisfied with the surgeon's explanations of their injury and progression (P = 0.03).

CONCLUSION

Eliminating routine early postoperative radiographs had no effect on overall patient satisfaction with the clinic visit, but it did affect satisfaction with the surgeon's explanation of their injury. This could save time, money, and radiation exposure without adversely affecting patient outcome or satisfaction, but an equivalent educational tool should be identified for clinic visits.

Examining the relationship between epidural steroid injections and patient satisfaction

BACKGROUND CONTEXT

Hospitals and policy makers have placed increasing importance on patient satisfaction with medical care. Minimal research exists on patient satisfaction in the context of epidural steroid injections (ESIs) for radicular pain.

PURPOSE

Describe patient satisfaction with ESIs for the treatment of radicular pain and identify patient demographic and clinical characteristics associated with patient satisfaction.

STUDY DESIGN/SETTING

This was a retrospective study conducted at a large, academic medical center.

METHODS

This was a single-center retrospective study of prospectively collected registry data including patients treated with ESIs from August 2006 to May 2018. The primary outcomes were: overall Press Ganey (PG) score, patient satisfaction with the physician, and likelihood to recommend both the physician and the practice. Age, body mass index, Charlson Comorbidity Index, immediate change in pain, sex, spinal segmental level of injection, prior opioid use, insurance status, and ethnicity were compared with the four PG measures of satisfaction using both univariable and multivariable regression analysis. No sources of funding were used for this project. The authors report no conflict of interest in relation to this manuscript.

RESULTS

Two-hundred ninety patients underwent 377 injections. Overall, patients were highly satisfied; 86% recommend their physician and 85% recommend the practice, each with the highest possible PG score. The median overall PG score was 97.2 (interquartile range [IQR]: 89.3, 100), and the median physician satisfaction score was 100 (IQR: 95, 100). The median immediate reduction in pain was 3 points (IQR: -5,-2) on the numerical rating scale scale postinjection. Increased age was associated with increased satisfaction with the physician (reported rate ratios [Relative Risk (RR)] for dissatisfaction: 0.73, 95% confidence interval [CI]: 0.58, 0.93, p=.011) and increased likelihood to recommend the physician (odds ratio: 1.46, 95% CI: 1.06, 2.01, p=.022) in multivariable analysis. Medicare as opposed to private insurance was associated with higher dissatisfaction with the physician (RR: 2.04, 95% CI: 1.15, 3.61, p=.014) and decreased likelihood to recommend the practice (RR: 0.38, 95% CI: 0.15, 0.94, p=.037).

CONCLUSIONS

The present data, based on PG scores, demonstrated that ESIs are associated with greater patient satisfaction with increasing age, but lower satisfaction in patients with Medicare compared with private insurance when controlling for other demographic factors. Satisfaction was not associated with the degree of pain relief.

Evaluating opportunities for improved orthopedics outpatient satisfaction: an analysis of Press Ganey® Outpatient Medical Practice Survey responses

INTRODUCTION

The Press Ganey® Outpatient Medical Practice Survey (PGOMPS) is composed of 10 provider-specific and 15 non-provider-specific questions. Some healthcare systems link PGOMS overall scores to physician reimbursements. The aim of this study was to determine the frequency of patient satisfaction across individual PGOMPS question, the null hypothesis being that there was no variability between the frequency of satisfaction and similar questions.

METHODS

We reviewed all new patient orthopedic PGOMPS scores between January 2014 and December 2017. Due to the large ceiling effect, satisfaction was defined as a perfect total score. The frequency of perfect scores for each question was calculated.

RESULTS

Five thousand one hundred sixty-three patients met the inclusion criteria. Two thousand two hundred sixty-six (43.89%) provider-specific questions received perfect satisfaction versus 986 (19.10%) with perfect satisfaction for non-provider-specific questions (p <  0.001). The five questions most likely to receive perfect satisfaction were MD friendliness/courtesy (80.36), MD spoke using clear language (80.35%), likelihood to recommend practice (79.11%), likelihood to recommend MD (78.8%), and MD confidence (78.74%). The five least likely were convenience of office hours (60.44%), ease of getting on phone (59.72%), ability to get desired appointment (59.50%), wait time (54.63%), and information about delays (53.80%).

CONCLUSIONS

Our results suggest that the majority of orthopedic patients are satisfied with their provider, demonstrating that room for improvement is limited with provider-specific areas. Leaders of health care teams should consider these results when seeking to improve patient satisfaction scores and determining how and if scores should be linked to reimbursements.

Depression and Non-modifiable Patient Factors Associated with Patient Satisfaction in an Academic Orthopaedic Outpatient Clinic: Is it More Than a Provider Issue?

BACKGROUND

Patient satisfaction surveys play an increasingly important role in United States healthcare policy and serve as a marker of provided physician services. In attempts to improve the patient's clinical experience, focus is often placed on components of the healthcare system such as provider interaction and other experiential factors. Patient factors are often written off as "non-modifiable"; however, by identifying and understanding these risk factors for dissatisfaction, another area for improvement and intervention becomes available.

QUESTIONS/PURPOSES

(1) Do patients in the orthopaedic clinic with a preexisting diagnosis of depression report lower satisfaction scores than those without a preexisting diagnosis of depression? (2) What other non-modifiable patient factors influence patient-reported satisfaction?

METHODS

We reviewed Press Ganey Survey scores, which assess patient experiential satisfaction with a single clinical encounter, from 3044 clinic visits (2527 patients) in adult reconstructive, sports, and general orthopaedic clinics at a single academic medical center between November 2010 and May 2017, during which time approximately 19,000 encounters occurred. Multiple patient factors including patient age, gender, race, health insurance status, number of previous clinic visits with their physician, BMI, and a diagnosis of depression were recorded. Patient satisfaction was operationalized as a binary outcome as satisfied or less satisfied, and a multiple logistic regression analysis was used to estimate the odds of being satisfied.

RESULTS

After adjusting for all other covariates in the model, we found that patients with a diagnosis of depression were less likely to be satisfied than patients without this diagnosis (odds ratio 0.749 [95% confidence interval, 0.600-0.940]; p = 0.01). Medicare-insured patients were more likely to be satisfied than non-Medicare patients (OR 1.257 [95% CI, 1.020-1.549]; p = 0.03), patients in the sports medicine clinic were more likely to be satisfied than those seen in the general orthopaedic clinic (OR 1.397 [95% CI, 1.096-1.775]; p = 0.007), and established patients were more likely to be satisfied than new patients (OR 0.763 [95% CI, 0.646-0.902]; p = 0.002).

CONCLUSIONS

Given the association of depression with lower satisfaction with a single visit at the orthopaedic clinic, providers should screen for depression and address the issue during the outpatient encounter. The impact of such comprehensive care or subsequent treatment of depression on improving patient-reported satisfaction offers areas of future study.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Predictors of Patient Satisfaction in Hand and Upper Extremity Clinics

Introduction  Patient satisfaction is an important clinical marker for hand/upper extremity patients. Few studies have investigated the predictors of patient satisfaction in the clinic setting. Our objective was to analyze patient satisfaction surveys to explore factors that influence patient satisfaction. Materials and Methods  We conducted a retrospective analysis assessing patient satisfaction in the hand/upper extremity clinics at our university medical center between 2012 and 2018. Patient satisfaction was assessed via Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems surveys. Patient demographics, satisfaction scores, and clinic experience questionnaire responses were evaluated. Statistical analysis was conducted to identify significant trends. Results  Between 2012 and 2018, 102 surveys were completed. Scores ranged from 5 to 10 with an average provider rating of 9.56. We found six factors significantly influenced patient satisfaction: adequate time was spent with the provider, provider showed respect, patient was seen by provider within 15 minutes of appointment time, provider listened sufficiently, patient received understandable medical instructions, and understandable medical explanations ( p < 0.05). Conclusion  Achieving patient satisfaction is an important clinical marker in hand/upper extremity clinics. Patient satisfaction has defined predictors wherein various clinical factors can influence patient satisfaction and willingness to refer their provider to other patients.

Evaluating the Impact of Wait Time on Orthopaedic Outpatient Satisfaction Using the Press Ganey Survey

The Press Ganey Outpatient Medical Practice Survey is a commonly utilized questionnaire that attempts to measure satisfaction with outpatient health care. A wide variety of factors have been associated with lower satisfaction scores among orthopaedic patients, including age, sex, presence of psychological disorders, and driving distance to the point of care. The impact of clinic workflows is less clear. In this study, we hypothesized that an increased clinic wait time was an independent predictor of lower patient satisfaction as measured by the Press Ganey survey.

Predictors of patient satisfaction and survey participation after spine surgery: a retrospective review of 17,853 consecutive spinal patients from a single academic institution. Part 1: Press Ganey

OBJECTIVEPress Ganey surveys are common modalities used to assess patient satisfaction scores in an outpatient setting. Despite the existence of data, neurosurgical and orthopedic literature on patient satisfaction following spinal surgery is scarce.METHODSA total of 17,853 patients who underwent spinal procedures at the authors' institution were analyzed retrospectively for Press Ganey survey participation. Appropriate demographic, surgical, comorbidity, and complication data were collected; 1936 patients had patient satisfaction survey data, and further survey metrics were collected for this subset of patients.RESULTSMale patients, patients with urgent/emergency procedures, and patients with longer length of stay (LOS) were less likely to fill out Press Ganey surveys (OR 0.822, p < 0.001; OR 0.781, p = 0.010; and OR 0.983, p < 0.001, respectively). Posterior approach was negatively associated with Press Ganey participation (OR 0.907, p = 0.055). Patients undergoing fusion procedures were more likely to participate in Press Ganey surveys (OR 1.419, p < 0.001). Of the patients who filled out surveys, there were no positive predictors associated with receiving perfect scores on Press Ganey surveys. High Charlson Comorbidity Index (OR 0.959, p = 0.02), increasing elapsed time since surgery or discharge (OR 0.996, p = 0.03), and increasing LOS (OR 0.965, p = 0.009) were all negatively associated with receiving a perfect score. Patients who underwent a posterior-approach procedure compared with other approaches were less likely to report a low Press Ganey score (OR 0.297, p = 0.046). Patient sex and race did not influence the likelihood of receiving perfect or low Press Ganey scores. Finally, the perceived skill of the surgeon was not a significant predictor for perfect (p > 0.99) or low (p = 0.828) Press Ganey scores.CONCLUSIONSPatient participation in Press Ganey surveys strongly correlated with preoperative factors such as procedure approach and type, as well as postoperative factors such as LOS and complications. No factors were associated with an increased likelihood of receiving a perfect Press Ganey score. Similarly, LOS and time elapsed since surgery to survey completion were significant negative predictors of perfect Press Ganey scores. Skill of surgeon, sex, and race did not correlate with a predictive value for Press Ganey outcomes. In addition, overall comorbid disease burden was found to be a significant negative predictor for high patient satisfaction scores. Further study on predictors of patient satisfaction within spine surgery is needed to better assist physicians in improving the surgical experience for patients.

Predictors of patient satisfaction and survey participation after spine surgery: a retrospective review of 17,853 consecutive spinal patients from a single academic institution. Part 2: HCAHPS

OBJECTIVEPatient satisfaction is a new and important metric in the American healthcare system. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a common modality used to assess patient satisfaction in inpatient settings. Despite the existence of data, neurosurgical literature on patient satisfaction following spinal surgery is scarce.METHODSA total of 17,853 patients who underwent spinal procedures at the authors' institution were analyzed retrospectively for HCAHPS survey participation. Appropriate demographic, surgical, comorbidity, and complication data were collected; 1118 patients had patient satisfaction survey data, and further survey metrics were collected for this subset of patients.RESULTSMale patients, patients with urgent/emergency procedures, and patients with a longer length of stay were less likely to complete an HCAHPS survey (OR 0.820, p < 0.001; OR 0.818, p = 0.042; and OR 0.983, p < 0.001, respectively). Posterior approach was negatively associated with HCAHPS survey participation (OR 0.868, p = 0.007). Patients undergoing fusion procedures were more likely to participate in HCAHPS surveys (OR 1.440, p < 0.001). Of the completed HCAHPS surveys, there were no positive predictors associated with perfect scores. High Charlson Comorbidity Index (OR 0.931, p = 0.007), increasing elapsed time since surgery or discharge (OR 0.992, p = 0.004), and increasing length of stay (OR 0.928, p < 0.001) were all negatively associated with a perfect score. Finally, patient sex and race did not influence the likelihood of a perfect or low survey score.CONCLUSIONSParticipation in HCAHPS surveys was correlated with preoperative and postoperative factors. Among these, procedure approach and type, length of stay, and complications seemed to influence participation the most. No factors were associated with an increased likelihood of receiving a perfect score. Similarly, length of stay and time elapsed since surgery to survey completion were significant negative predictors of receiving perfect HCAHPS survey scores. Increasing comorbid burden was also found to be a negative predictor for high scores. Further study on predictors of inpatient satisfaction within spine surgery is needed.

Primer on adult patient satisfaction in perioperative settings

The topic of patient satisfaction has gained increasing importance over the past decade. Due to the impact of patient satisfaction on health care quality, understanding factors that predict satisfaction is vital. The purpose of this review is to examine the literature and identify factors related to patient perioperative satisfaction as well as predictive variables that, if modified, can enhance satisfaction scores of patients undergoing surgery. Our review reports that patient satisfaction scores are affected by modifiable factors such as clinician-patient communication, information provision to patients, and operational function of a hospital. Non-modifiable factors affecting patient satisfaction scores include patient demographics such as gender, age, and education. In order to enhance patient perioperative satisfaction, we suggest that anesthesiologists and surgeons focus their efforts on enhancing their communication skills and providing information that is appropriately tailored to the understanding of their patients.

Patient Satisfaction in the Preoperative Period: Preparing for Hand Surgery

Background: The potential impact of the number and type of preoperative encounters on satisfaction rates prior to elective surgical procedures is unclear, specifically scheduling and medical clearance encounters. Methods: Questionnaires investigating satisfaction with the preoperative process were collected for 200 patients presenting for elective hand surgery. The number of telephone, surgeon, and medical clearance encounters were recorded, and satisfaction was determined for each type based on a 4-category Likert scale. All patients 18 years or older were included, while only patients providing incomplete questionnaires were excluded. Outcome data were assessed for associations between different encounter totals or types and satisfaction rates. Results: Among 200 patients, 197 completed the questionnaire and were included. Overall satisfaction with the preoperative process was 92.9%, with only 3% of patients dissatisfied. There was a significant association between satisfaction and the number of telephone and total encounters. Satisfaction fell below 90% after 4 or more telephone calls (66.6%, P = 0.005) and 5 or more total encounters (80%, P = 0.008). When considered individually, there was no significant association between satisfaction and the number of surgeon (P = 0.267) or medical office encounters (P = 0.087), or a patient's perceived health status (P = 0.14). Conclusions: Greater than 3 telephone or 4 total encounters significantly decreases patient satisfaction, while surgeon and medical office visits are not associated with satisfaction rates when considered individually. This suggests the number, not the type, of preoperative encounters impact satisfaction and highlight the importance of efficient communication between patients and providers.

Patient Satisfaction in the Hand Surgery Clinic: An Analysis of Factors That Impact the Press Ganey Survey

PURPOSE

Our purpose was to test the null hypothesis that no patient or clinic visit characteristics affect satisfaction of hand surgery outpatients, as measured by the Press Ganey Outpatient Medical Practice Survey (PGOMPS).

METHODS

Adult patients (≥ 18 years) evaluated by 5 fellowship-trained hand surgeons between January 2014 and December 2016 for a new patient clinic visit at a single tertiary academic medical center, were included. Prospectively collected PGOMPS data were reviewed retrospectively for each visit. Chart review was performed to collect demographic and visit characteristics data. Satisfaction was defined a priori as achieving a PGOMPS score above the 33rd percentile. Both the PGOMPS Total Score (primary outcome) and Provider Subscore (secondary outcome) were analyzed using univariate and multivariable logistic regression.

RESULTS

Of 748 included patients, the mean age was 51.7 ± 15.5 years, and 64% were women. Leading diagnoses included tendinitis (19%), neuropathy (19%), arthritis (16%), and fracture-dislocation (13%). Multivariable modelling of the PGOMPS Total Score revealed that older age, shorter wait times, and scheduling surgery were significantly associated with greater satisfaction. The PGOMPS Provider Sub-Score multivariable modelling revealed that older age, shorter wait times, scheduling surgery, and administering injections were significantly associated with greater satisfaction. Diagnostic category and insurance status did not affect satisfaction.

CONCLUSIONS

Increasing patient age, decreased wait time, and receiving an intervention (scheduling of surgery or receiving an injection) are associated with increased satisfaction among newly presenting hand surgery clinic patients as measured by the Press Ganey Outpatient Medical Practice Survey. Diagnosis and access to health care (insurance status and distance to clinic) did not influence patient satisfaction.

TYPE OF STUDY/LEVEL OF EVIDENCE

Diagnostic III.

The Effect of Workers' Compensation Status on the Patient Experience

Background:

Rating the patient experience is an increasingly important component of value-based health care. Generation of lower ratings on validated functional assessments by patients with Workers’ Compensation is well known; however, the relationship between Workers’ Compensation status and patient satisfaction is poorly described in orthopaedic patient populations.

Methods:

All orthopaedic outpatient patient satisfaction surveys (Press Ganey) generated over an 18-month period at a U.S. academic tertiary care center were included in this study. Data with regard to the primary payer, demographic characteristics, orthopaedic subspecialty, and planned surgical interventions with the provider for whom the survey was completed were analyzed in conjunction with patient satisfaction data.

Results:

During the study period, 3,720 consecutive patient satisfaction surveys were generated, and 244 surveys were generated by 215 patients with Workers’ Compensation. Satisfied patients with Workers’ Compensation were more likely to be male (p = 0.0007), to have higher mental health self-assessments (p = 0.004), and to be scheduled for surgical intervention (p = 0.03). Scheduling a surgical procedure was independently associated with improved patient satisfaction, whereas Workers’ Compensation status was independently associated with dissatisfaction when adjusting for sex, language, race, and marital status. Across all patient satisfaction domains, patients with Workers’ Compensation gave significantly lower scores (p < 0.05) compared with all other patients. Patients with Workers’ Compensation were more likely to rate their overall health as lower compared with other patients (p < 0.0001). Patients with Workers’ Compensation were more likely to give lower ratings to providers on a 1-to-10 scale (p < 0.0001) and were less likely to recommend the practice to others (p < 0.0001).

Conclusions:

Workers’ Compensation status is a non-modifiable independent predictor of dissatisfaction with health care compared with other primary payer groups. Further research is warranted to understand the factors influencing patient satisfaction ratings.

Patient Satisfaction and Press Ganey Scores for Spine Versus Nonspine Neurosurgery Clinics

STUDY DESIGN

Retrospective survey review.

OBJECTIVE

We seek to evaluate satisfaction scores in patients seen in neurosurgical spine versus neurosurgical nonspine clinics.

SUMMARY OF BACKGROUND DATA

The Press Ganey survey is a well-established metric for measuring hospital performance and patient satisfaction. These measures have important implications in setting hospital policy and guiding interventions to improve patient perceptions of care.

METHODS

Retrospective Press Ganey survey review was performed to identify patient demographics and patient visit characteristics from January 1st, 2012 to October 10th, 2017 at Stanford Medical Center. A total of 40 questions from the Press Ganey survey were investigated and grouped in categories addressing physician and nursing care, personal concerns, admission, room, meal, operating room, treatment and discharge conditions, visitor accommodations and overall clinic assessment. Raw ordinal scores were converted to continuous scores of 100 for unpaired student t test analysis. We identified 578 neurosurgical spine clinic patients and 1048 neurosurgical nonspine clinic patients.

RESULTS

Spine clinic patients reported lower satisfaction scores in aggregate (88.2 vs. 90.1; P=0.0014), physician (89.5 vs. 92.6; P=0.0002) and nurse care (91.3 vs. 93.4; P=0.0038), personal concerns (88.2 vs. 90.9; P=0.0009), room (81.0 vs. 83.1; P=0.0164), admission (90.8 vs. 92.6; P=0.0154) and visitor conditions (87.0 vs. 89.2; P=0.0148), and overall clinic assessment (92.9 vs. 95.5; P=0.005).

CONCLUSIONS

This study is the first to evaluate the relationship between neurosurgical spine versus nonspine clinic with regards to patient satisfaction. The spine clinic cohort reported less satisfaction than the nonspine cohort in all significant questions on the Press Ganey survey. Our findings suggest that efforts should be made to further study and improve patient satisfaction in spine clinics.

LEVEL OF EVIDENCE

Level III.

Association Between Nonmodifiable Demographic Factors and Patient Satisfaction Scores in Spine Surgery Clinics

The Press Ganey survey is the most widely used instrument for measuring patient satisfaction. Understanding the factors that influence these surveys may permit better use of survey results and may direct interventions to increase patient satisfaction. Press Ganey Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys administered to ambulatory spine surgery clinic patients within a large tertiary care network from May 2016 to September 2017 were retrospectively reviewed. Mean comparison testing was performed to measure associations between patient demographics and responses to "overall provider rating" and "recommend this provider's office" survey questions. Mean difference to achieve significance was set at α<0.05. A multivariate analysis was performed to determine independent factors. A total of 1400 survey responses from the offices of 11 orthopedic spine surgeons were included. Patients 18 to 34 years old had significantly lower responses to the overall provider rating question than older patients (P<.001), and increasing patient age was correlated with improved ratings. Highest education level was inversely correlated with satisfaction scores, with patients who had attained graduate level education having the lowest satisfaction scores (P=.001). Those with commercial insurance had significantly lower ratings for recommend this provider's office (P=.042) and overall provider rating (P=.022) questions than those with other insurance types. Patients administered the survey on paper had significantly lower ratings than those administered the survey online (P=.006). Provider ratings were significantly higher when the sex and ethnicity of the patient were concordant with the provider (P=.021). This study showed that independent, nonmodifiable factors such as age, education level, and survey mode were significantly associated with the satisfaction of ambulatory spine surgery clinic patients. [Orthopedics. 2019; 42(3):143-148.].