Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT, USA.
Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, UT, USA.
Foot Ankle Int. 2020 Oct;41(10):1206-1211. doi: 10.1177/1071100720937013. Epub 2020 Jul 14.
Patient satisfaction has garnered interest as a tool to measure health care quality. However, orthopedic studies in total joint arthroplasty, spine, and hand patients have offered conflicting relationships between Press Ganey (PG) satisfaction metrics and patient-reported outcome (PRO) measures. No prior study has assessed the relationship between PG and PROs in foot and ankle patients. Whether satisfaction and outcomes instruments, though, measure similar or differing aspects of the patient experience is unclear. Here, we tested if there was an association between Patient-Reported Outcomes Measurement Information System (PROMIS) outcomes and PG satisfaction scores.
PG and PROMIS outcomes data for new patient visits to an orthopedic foot and ankle clinic between 2015 and 2017 were retrospectively analyzed. Patients that completed PG satisfaction surveys were included for study. All patients who completed PG surveys and completed one or both PROMIS physical function (PF) or pain interference (PI) metrics administered by computerized adaptive testing were included. Negative binomial regressions were used to compare PRO scores to PG overall satisfaction and PG satisfaction with care provider, adjusting for patient characteristics. Results were reported as dissatisfaction score ratios, which represented the amount of PG dissatisfaction associated with a 10-point increase in PROMIS PF or PI. Of the 3984 new patient visits, only 441 completed the PG survey (11.3% response rate).
Ceiling effects were seen with PG data: 64% of patients reported perfect satisfaction with care provider and 27% had perfect overall satisfaction. Higher function on the PROMIS PF was weakly associated with increased overall satisfaction (ratio = 0.82, 95% CI: 0.68-0.99, = .039) and increased satisfaction with care provider (ratio = 0.60, 95% CI: 0.40-0.92, = .019). However, pain (PROMIS PI) was not associated with overall satisfaction or with satisfaction with care provider.
Based on our data here, patient satisfaction was weakly related to patient-reported function but not pain interference among this subset of new patients presenting to a foot and ankle clinic. Given our essentially negative findings, further study is needed to determine which aspects of the PG satisfaction and PROMIS scores track similarly. Further, our findings add to the growing literature showcasing limitations of the PG tool, including low response rates and notable ceiling effects. If satisfaction metrics and patient-reported outcomes capture differing aspects of the patient experience, we need to better understand how that influences the measurement of health care quality and value.
Level III, comparative study.
患者满意度作为衡量医疗质量的工具已受到关注。然而，在全关节置换、脊柱和手部患者的骨科研究中，盖恩斯民意调查（PG）满意度指标与患者报告的结果（PRO）测量结果之间存在相互矛盾的关系。之前没有研究评估 PG 和足部和踝关节患者的 PRO 之间的关系。然而，满意度和结果工具是否衡量患者体验的相似或不同方面尚不清楚。在这里，我们测试了患者报告的结果测量信息系统（PROMIS）结果与 PG 满意度评分之间是否存在关联。
回顾性分析了 2015 年至 2017 年间到骨科足踝诊所就诊的新患者的 PG 和 PROMIS 结果数据。纳入完成 PG 满意度调查的患者进行研究。所有完成 PG 调查并通过计算机自适应测试完成一项或两项 PROMIS 躯体功能（PF）或疼痛干扰（PI）指标的患者均被纳入研究。使用负二项回归比较 PRO 评分与 PG 总体满意度和 PG 对医疗服务提供者的满意度，同时调整患者特征。结果以不满评分比表示，这代表 PROMIS PF 或 PI 增加 10 分与 PG 不满意程度相关的程度。在 3984 名新患者就诊中，只有 441 名完成了 PG 调查（11.3%的应答率）。
PG 数据存在天花板效应：64%的患者报告对医疗服务提供者非常满意，27%的患者对总体满意度非常满意。PROMIS PF 上更高的功能与总体满意度的增加呈弱相关（比值=0.82，95%置信区间：0.68-0.99，P=.039）和对医疗服务提供者的满意度增加（比值=0.60，95%置信区间：0.40-0.92，P=.019）。然而，疼痛（PROMIS PI）与总体满意度或对医疗服务提供者的满意度无关。
根据我们在此处的数据，在向足踝诊所就诊的新患者亚组中，患者满意度与患者报告的功能呈弱相关，但与疼痛干扰无关。鉴于我们的基本否定发现，需要进一步研究以确定 PG 满意度和 PROMIS 评分的哪些方面具有相似性。此外，我们的发现增加了越来越多的关于 PG 工具局限性的文献，包括低应答率和明显的天花板效应。如果满意度指标和患者报告的结果捕获患者体验的不同方面，我们需要更好地了解这如何影响医疗保健质量和价值的衡量。
三级，比较研究。
