ORIGINAL ARTICLE

Evaluation of Patient Satisfaction Surveys in Pediatric Orthopaedics Lee S. Segal, MD, Carla Plantikow, MSc, Randon Hall, MBA, MD, Kristina Wilson, MD, MPH, and M. Wade Shrader, MD

Background: Patient satisfaction survey scores are increasingly being tied to incentive compensation, impact how we practice medicine, influence decisions on where patients seek care, and in the future may be required for accreditation. The goal of this study is to compare the results of an internal distribution of patient satisfaction surveys at the point of care to responses received by mail in a hospital-based, high-volume pediatric orthopaedic practice. Methods: A pediatric outpatient survey is used at our institution to evaluate patient satisfaction. Surveys are randomly mailed out to families seen in our clinic by the survey vendor, and the results are determined on a quarterly basis. We distributed the same survey in a similar manner in our clinic. The results of the surveys, external/mailed (EXM) versus internal/point of care (INP) over the same 3-month time period (second quarter 2013) were compared. The survey questions are dichotomized from an ordinal scale into either excellent (9 to 10) or not excellent (0 to 8) commonly used in patient satisfaction methodology. We evaluated the raw data from the INP surveys for the question on provider rating by evaluating the mean score, the standard excellent response (9 to 10), and an expanded excellent response (8 to 10). Results: Response rate was 72/469 (15.4%) for EXM, and 231/ 333 (69.4%) for INP. An excellent response for the “rating your provider” question was 72.2% (EXM) versus 84.8% (INP) (P = 0.015). Our analysis of the raw data (INP) has a mean rating of 9.42. The expanded scale (8 to 10) for an excellent response increased the provider rating to 94.4% (P = 0.001). Waiting time response within 15 minutes was the only item that correlated with rating of provider (P = 0.02). For the majority of the items, the INP responses were consistently higher than the EXM responses, including 6/7 responses that were statistically significant (P < 0.05). Conclusions: As mandated by the Centers for Medicare and Medicaid Services, patient satisfaction surveys will be important in determining health care outcomes. Properly designed and administered surveys provide robust measures of quality. Our study reinforces methodological concerns about patient satFrom the Center for Pediatric Orthopaedics, Phoenix Children’s Hospital, Phoenix, AZ. The authors declare no conflicts of interest. Reprints: Lee S. Segal, MD, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Avenue, Madison, WI 53705-2281. E-mail: [email protected]. Copyright r 2014 Wolters Kluwer Health, Inc. All rights reserved.

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isfaction surveys distributed in a high-volume pediatric subspecialty practice. Further research is needed to evaluate the patients’ health care experience and true quality of care in pediatric subspecialty ambulatory settings. Key Words: patient satisfaction surveys, health care outcomes, pediatric orthopaedics (J Pediatr Orthop 2015;35:774–778)

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he patient care experience or patient satisfaction has become an increasingly important measure of health care quality. In 2001, the Institute of Medicine defined patient-centered care as one of the specific goals for improvement needed for health care to bridge the quality chasm existing in the present health care environment.1 The Centers for Medicare and Medicaid Services (CMS) included patient satisfaction as a quality mandate in 2008.2 Patient satisfaction is thought by several authors to be a complex concept, often dependent on specific patient characteristics and expectations.3–5 Another important aspect of patient satisfaction is the perception of the care actually received. These include the technical quality of care, the interpersonal skills of the physician, and accessibility/availability.3,5 Measurement of patient satisfaction by patient survey scores are increasingly being tied to incentive compensation, and used for benchmarking of both physicians and hospitals by specialties and geographic areas. Medicare reimbursements to health care facilities could decrease by as much as 2% if hospitals do not meet benchmark patient satisfaction goals determined by the CMS. These surveys may also impact how we practice medicine, influence decisions on where patients seek care, and in the future may be required for accreditation.2,6–9 An entirely new industry centered on health care–related patient satisfaction surveys has evolved with the mandates from the CMS to measure patient satisfaction. The literature is replete with concerns regarding patient satisfaction questionnaires. These include the types of surveys used, how surveys are constructed, how the surveys are distributed,6,10–13 timing of survey distribution,7,14,15 response rates and nonresponse bias,12,16–20 costs associated with survey administration and distribution,6,7 the impact on physician productivity,21 and the impact on resident training.22

J Pediatr Orthop



Volume 35, Number 7, October/November 2015

Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.

J Pediatr Orthop



Volume 35, Number 7, October/November 2015

A limited number of studies have addressed patient satisfaction surveys specific to orthopaedics.9,23–25 The goal of this study is to compare the results of an internal distribution of patient satisfaction surveys at the point of care to responses received by mail in a hospital-based, high-volume pediatric orthopaedic practice. It was our hypothesis that onsite patient satisfaction surveys would yield a higher response rate and different scores than surveys mailed out by an external health care patient satisfaction survey vendor.

METHODS Study Design and Setting This was a prospective study spanning a 3-month timeframe from April 2013 to June 2013. The study was conducted in a high-volume pediatric orthopaedic surgery practice involving 5 pediatric orthopaedic surgeons and 1 primary care sports medicine specialist, in a large southwest metropolitan Children’s Hospital. The practice sees over 20,000 patient visits per year.

Selection of Participants A pediatric outpatient survey is used at our institution to evaluate patient satisfaction. These surveys are randomly mailed to families on a quarterly basis. During this same 3-month period of the study, the same survey instrument external/mailed (EXM) out by the survey vendor was distributed to the parents of our patients in our clinic. The point of care surveys were given out by our front desk staff, and the families were instructed to complete the survey before leaving the clinic setting. Families were asked to return the survey by placing it in a secure collection box located near the exit to the clinic. For the purpose of anonymity and confidentiality, the collection box was placed out of sight from the front entrance to the clinic and from the view of the front desk staff. The internal/point of care (INP) distributed survey asked some demographic data questions that were added to those on the EXM survey. This study was reviewed and determined to be a quality improvement project by our Institutional Review Board.

Data Collection and Analysis The data collected from the internally distributed survey (INP) was compared to the data obtained from the quarterly data provided from the mailed surveys returned to the external vendor (EXM). w2 test was used for each of the responses. P values of

Evaluation of Patient Satisfaction Surveys in Pediatric Orthopaedics.

Patient satisfaction survey scores are increasingly being tied to incentive compensation, impact how we practice medicine, influence decisions on wher...
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