Introduction: Patients’ satisfaction with care has emerged as a proxy for quality due to its feasibility of collection. We set out to determine whether patient satisfaction is a valid measure of quality and effectiveness of care in a prospective longitudinal spine registry.
Methods: All patients undergoing spine surgery over a 6-month period were enrolled into a prospective registry and followed for 3 months. Patient reported outcomes, patient satisfaction with outcome and with provider care, and 90-day morbidity were recorded. ROC curve analysis was used to determine if improvement in quality of life (QOL,SF-12 PCS) and disability (ODI/NDI) accurately predicted patient satisfaction [Area under the curve (AUC): <0.7: poor, 0.7-0.8: fair, >0.8: good accuracy]. Multivariate logistic regression was performed to determine if surgical morbidity (quality) or improvement in disability and QOL (effectiveness of care) were independently associated with patient satisfaction.
Results: 422 (84%) patients completed all questionnaires. Satisfaction with provider care: In ROC analyses, extent of improvement in QOL and disability predicted satisfaction with very poor accuracy, Figure 1 & 2. In regression analysis, 3-month morbidity, re-admission, improvement in QOL, or improvement in general health (HTI) were not associated with satisfaction with care, Table 1. Satisfaction with outcome: In ROC analyses, improvement in QOL and disability predicted satisfaction with fair accuracy, Figure 1 &2. In regression analysis, improvement in QOL, disability, and general health were independently associated with satisfaction with outcome, Table 2. Neither 90-day morbidity nor re-admission were associated with satisfaction with outcome.
Conclusions: Patient satisfaction with provider care is not a valid measure of quality or effectiveness of surgical spine care. Patient satisfaction with outcome may be used as a fair proxy for effectiveness but is not a valid measure of quality. Patient satisfaction metrics represent patient’s subjective contentment with healthcare experience and should not be used as a measure of quality or effectiveness.
Patient Care: Our research shows that patient satisfaction is not a valid proxy for quality and is a mere representation of patient's subjective contentment with healthcare experience.
Learning Objectives: At the end of the session, participants should be able to: 1) Discuss the feasibility of patients' satisfaction as a proxy for quality, and 2) Identify that patient satisfaction metrics represent patient’s subjective contentment with healthcare experience and should not be used as a measure of quality or effectiveness.