Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
J Orthop Trauma. 2019 Jan;33(1):e19-e23. doi: 10.1097/BOT.0000000000001333.
What are the differences between elective and trauma patient satisfaction and do patient and diagnosis factors predict physician scores?
Prospective cohort study.
Urban Level 1 Trauma center.
PATIENTS/PARTICIPANTS: Three hundred twenty-three trauma patients and 433 elective orthopaedic patients treated at our center by the same surgeons.
Trauma patients treated surgery for one or more fractures; elective patients treated with hip, knee, or shoulder arthroplasty, or rotator cuff repair.
Telephone survey regarding patient experience and satisfaction with their care. The survey included questions from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, and responses were rated on a 1-5 point Likert scale (5 best).
Elective surgery patients had mean age of 56.4 years, and trauma patients were mean 50.3 years of age. Trauma patients rated their likelihood to make a full recovery lower than elective patients (median, interquartile range), 5.0 (1.0) versus 4.0 (2.0) (P < 0.001). After multivariate binary logistic regression, patients who rated the hospital higher (≥4 vs. ≤3) were more likely (odds ratio = 10.0, 95% confidence interval, 6.4-15.8) to score physicians better. Similarly, patients who scored their overall likelihood of recovering ≥4 compared with ≤3 were more likely (odds ratio = 3.6, 95% confidence interval, 2.9-5.6) to rate their physicians more positively.
Patient perceptions including their likelihood to make a full recovery and their overall impression of the hospital predicted higher physician scores. We conclude that these physician scores are subject to patient perception biases and are not independent of the overall care experience. We recommend HCAHPS and physician ratings' web sites include internal controls, such as the patient perception of overall likelihood to recover, to aid in interpreting survey results.
择期手术患者和创伤患者的满意度有何不同，患者和诊断因素是否能预测医生评分？
前瞻性队列研究。
城市一级创伤中心。
患者/参与者：在我们中心接受相同外科医生治疗的 323 名创伤患者和 433 名择期矫形患者。
创伤患者接受一种或多种骨折的手术治疗；择期手术患者接受髋关节、膝关节或肩关节置换术或肩袖修复术。
关于患者体验和对护理满意度的电话调查。该调查包括来自医院患者评估医疗保健提供者和系统（HCAHPS）调查的问题，回答者的回答在 1-5 分李克特量表（5 分最佳）上进行评分。
择期手术患者的平均年龄为 56.4 岁，创伤患者的平均年龄为 50.3 岁。创伤患者对完全康复的可能性评分低于择期手术患者（中位数，四分位距），分别为 5.0（1.0）与 4.0（2.0）（P<0.001）。经多变量二项逻辑回归分析，评分较高的患者（≥4 分与≤3 分）更有可能（优势比=10.0，95%置信区间，6.4-15.8）对医生评分更高。同样，与评分≤3 分相比，评分≥4 分的患者更有可能（优势比=3.6，95%置信区间，2.9-5.6）对医生的评价更为积极。
包括患者完全康复可能性和对医院整体印象在内的患者感知预测了更高的医生评分。我们的结论是，这些医生评分受到患者感知偏差的影响，并且与整体护理体验无关。我们建议 HCAHPS 和医生评分网站包括内部对照，例如患者对总体康复可能性的感知，以帮助解释调查结果。
