337 - Gender and Self-reported Health Status Are Associated with Clinical En...

#337 Gender and Self-reported Health Status Are Associated with Clinical Encounter Patient Satisfaction

Value and Outcomes in Spine Surgery

Poster Presented by: K. Nicholson


K. Nicholson (1)
B. Woods (2)
G. Schroeder (2)
D.G. Anderson (2)
C. Kepler (2)
M. Kurd (2)
J. Rihn (2)
A. Vaccaro (2)
A. Hilibrand (2)
K. Radcliff (2)

(1) Rothman Institute, Philadelphia, PA, United States
(2) Rothman Institute, Thomas Jefferson University, Philadelphia, PA, United States


Introduction: Patient satisfaction is becoming increasingly important for assessing healthcare quality. It is not clear what role, if any, demographics and patient-reported functional health status has in determining patient satisfaction with their clinical encounter in a spine patient population.

Methods: Retrospective review of a consecutive series of patients who completed a satisfaction questionnaire at a large spine orthopaedics practice January 2014-January 2016. Summary scores (MCS and PCS) and individual domains of the SF-12 were collected for the same clinical encounter. Age, BMI, gender, smoking status (non, former/current), use of opioids for pain relief (yes/no) were recorded. Patient satisfaction was assessed by applying top box scoring to three questions asking patients to rate their responses on a 1-5 likert scale for service, experience, and likelihood to recommend (LTR). Demographic differences between patients who reported satisfaction with the service, experience, and LTR were determined using t-tests and chi-squared tests. Backward elimination binomial logistic regressions determined which SF-12 domains are predictors of satisfaction.

Results: 2,423 patients completed the satisfaction questionnaire; 73% completed the SF-12 (mean age 58±14 years; mean BMI 29.28±6.03). Patients were generally satisfied with service (58%) and experience (59%) and 65% were likely to recommend. Patients reported a poor PCS (mean 31.3±8.4) and average MCS (mean 48.5±11.6). One-third (35%) were former or current smokers and 47% of the patients were female. Satisfaction did not differ by age, BMI, opioid use, MCS, or PCS. Male patients reported higher satisfaction and were more likely to recommend the practice (p< 0.006). Satisfaction with service and experience was reported by 61% and 62% of males, respectively; only 55% of female patients reported “excellent” for each. Likewise, 68% of male patients indicated that they were likely to recommend the practice; 62% of female patients strongly agreed. Nonsmokers were more likely to be more satisfied than former and current smokers. There were significantly (p=0.036) more nonsmoker satisfied with experience (62%) and who were likely to recommend (68%, p=0.022) compared to smokers (56% and 62%, respectively). Smoking status did not differ by gender (p=0.1199). Despite no difference in the PCS and MCS, specific SF-12 domains were predictors of patient satisfaction. Smoking status and gender were included in the model. Patients with better overall health (question #1, OR 1.127 [95% CI 1.012-1.255]) and more limitations with moderate activities (question #2 OR 0.747 [0.626-0.890]) report higher service satisfaction (p< 0.030). Feeling “calm and peaceful” (question #6a) is associated with higher experience satisfaction (p=0.005, OR=1.118 [95% CI 1.034-1.209]) and being more likely to recommend (p=0.002, OR=1.124 [95% CI 1.044-1.210]). Male patients were also more likely to recommend (p=0.014, OR=1.407 [95% CI 1.073-1.846]). Smoking status was not a significant predictor in the regression.

Conclusion: In a spine clinic, patients who report better overall health, feel more calm, and are male report higher satisfaction. Patients who indicate more limitations with moderate activities report higher service satisfaction. Smoking status does not predict satisfaction scores independent of the SF-12 domains; the collinearity of smoking and health is well-documented. As patient satisfaction becomes more important in healthcare reimbursement models, it is important to consider patient demographics when benchmarking providers and clinics.