Thurs., 10/13/11 Polytrauma, Paper #29, 3:19 pm OTA-2011
Is Patient Satisfaction After Fracture Predicted by Functional Outcome or Injury Severity?
Eric J. Belin, MD1; Ebrahim Paryavi, MD1; Renan C. Castillo, PhD2; Robert V. O’Toole, MD1;
1R Adams Cowley Shock Trauma Center, Dept. of Orthopaedics, University of Maryland
Medical School, Baltimore, Maryland, USA
2Center for Injury Research & Policy, Johns Hopkins Bloomberg School of Public Health,
Baltimore, Maryland, USA
Purpose: Patient satisfaction (PS) is becoming a critical metric used by consumers, insurance providers, and healthcare decision makers. However, the actual meaning of PS is still controversial and almost nothing is known about PS in the orthopaedic trauma setting. In particular, it is unknown to what extent PS contributes additional information or is merely a proxy for either the severity of the injury or functional recovery. Our hypothesis was that PS is driven by both functional outcome and injury severity.
Methods: Our study group was 104 patients with at least 1 fracture treated at orthopaedic trauma clinics at one Level 1 trauma center who were ≥6 months from injury. Outcome measures were the Short Musculoskeletal Function Assessment (SMFA) and Patient Satisfaction Questionnaire (PSQ), which investigates multiple domains of patient satisfaction. We evaluated the relationship between domains of PS, injury severity determined by upper and lower extremity AIS (abbreviated injury scale) and ISS, and functional outcome (as measured by the SMFA) following orthopaedic injuries. Analysis of variance was used to determine differences in mean satisfaction by patient and injury characteristics. Pearson correlation coefficients with 95% confidence intervals were used to assess the correlation between PSQ domains and SMFA.
Results: PS was moderate to high in general (greater than 4.0 on a 5-item scale) (mean, 4.08; 95% confidence interval [CI] 3.97, 4.19), and in particular for the domains communication, manner, technical quality, and general satisfaction (scores range, 4.24-4.42). PS was lower for the satisfaction with time spent with physician, accessibility and convenience, and orthopaedic recovery (mean scores 3.84, 3.77, and 3.81 respectively). Patients experienced particularly low satisfaction with the financial aspects of their care (mean, 3.6; 95% CI 3.36, 3.76). The SMFA did not predict PS, as overall, observed correlations between domains of patient satisfaction and the SMFA function and bothersome indices were generally nonsignificant (95% CI includes 0) and weak (r <0.3). PS also did not correlate substantially with injury severity, as there was no statistically significant relationship between any domain of satisfaction and ISS, AIS, or injury type (P >0.3).
Conclusion: In contrast to our hypothesis, our data indicate that patient satisfaction measures a distinct aspect of care that does not appear to be substantially driven by either injury severity or functional outcome. Overall, satisfaction was high in this population; however, many experienced low satisfaction with certain satisfaction domains, particularly financial aspects of their care, and satisfaction with orthopaedic recovery. These data demonstrate the importance of obtaining independent satisfaction data and highlight potential areas for improvement in care.
Alphabetical Disclosure Listing (628K PDF)
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing. Δ OTA Grant.