Mazur Marcus D, McEvoy Sara, Schmidt Meic H, Bisson Erica F
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
J Neurosurg Spine. 2015 Jun;22(6):666-71. doi: 10.3171/2014.10.SPINE14264. Epub 2015 Mar 20.
OBJECT Patient satisfaction scores have become a common metric for health care quality. Because satisfaction scores are right-skewed, even small differences in mean scores can have a large impact. Little information, however, is available on the specific factors that play a role in satisfaction in patients with spinal disorders. The authors investigated whether disability severity and the surgeon's recommendation for or against surgical intervention were associated with patient satisfaction scores. METHODS The authors conducted a retrospective cohort study involving adult patients who were referred to a spine surgeon for an outpatient evaluation of back pain. Patients completed the Oswestry Disability Index (ODI) before their clinic appointment and a Press Ganey patient satisfaction survey after their visit. Patients were grouped by self-assessed disability severity: mild to moderate (ODI < 40%) and severe (≥ 40%). Satisfaction scores were graded from 0 (very poor) to 100 (very good). Nonparametric tests were used to evaluate the association between patient satisfaction and current disability self-assessment. The authors also investigated whether the surgeon's recommendation against surgery negatively affected patient satisfaction. RESULTS One hundred thirty patients completed the ODI questionnaire before and satisfaction surveys after seeing a spine surgeon for a new outpatient back pain consultation. Of these, 68 patients had severe disability, 62 had mild to moderate disability, 67 received a recommendation for surgery, and 63 received a recommendation against surgery. Composite satisfaction scores were lower among patients who had severe disability than among those with mild to moderate disability (median [interquartile range]: 91.7 [83.7-96.4] vs 95.8 [91.0-99.3], respectively; p = 0.0040). Patients who received a recommendation against surgery reported lower satisfaction scores than those who received a recommendation for surgery (91.7 [83.5-95.8] vs 95.8 [88.5-99.8]; p = 0.0059). CONCLUSIONS High self-assessment of disability and a surgeon's recommendation against surgical intervention are associated with lower satisfaction scores in patients with spinal disorders.
目的 患者满意度评分已成为医疗质量的常用指标。由于满意度评分呈右偏态分布，即使平均评分的微小差异也可能产生较大影响。然而，关于脊柱疾病患者满意度的具体影响因素，目前可用信息较少。作者调查了残疾严重程度以及外科医生对手术干预的推荐与否是否与患者满意度评分相关。
方法 作者进行了一项回顾性队列研究，纳入因门诊评估背痛而被转诊至脊柱外科医生处的成年患者。患者在门诊预约前完成奥斯威斯利残疾指数（ODI），就诊后完成Press Ganey患者满意度调查。患者根据自我评估的残疾严重程度分组：轻度至中度（ODI < 40%）和重度（≥ 40%）。满意度评分从0（非常差）到100（非常好）进行分级。采用非参数检验评估患者满意度与当前残疾自我评估之间的关联。作者还调查了外科医生不建议手术是否会对患者满意度产生负面影响。
结果 130例患者在因新的门诊背痛咨询就诊脊柱外科医生之前完成了ODI问卷，就诊后完成了满意度调查。其中，68例患者有严重残疾，62例有轻度至中度残疾，67例被推荐手术，63例被推荐不进行手术。严重残疾患者的综合满意度评分低于轻度至中度残疾患者（中位数[四分位间距]：分别为91.7 [83.7 - 96.4]和95.8 [91.0 - 99.3]；p = 0.0040）。被推荐不进行手术的患者报告的满意度评分低于被推荐手术的患者（91.7 [83.5 - 95.8] vs 95.8 [88.5 - 99.8]；p = 0.0059）。
结论 残疾自我评估高以及外科医生不建议手术与脊柱疾病患者较低的满意度评分相关。
