Rabah Nicholas M, Khan Hammad A, Levin Jay M, Winkelman Robert D, Mroz Thomas E, Steinmetz Michael P
1Center for Spine Health, Cleveland Clinic.
2Case Western Reserve University School of Medicine, Cleveland.
J Neurosurg Spine. 2020 Dec 18;34(3):449-455. doi: 10.3171/2020.7.SPINE20478. Print 2021 Mar 1.
The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey was developed by the Centers for Medicare and Medicaid Services as a result of their value-based purchasing initiative. It allows patients to rate their experience with their provider in the outpatient setting. This presents a unique situation in healthcare in which the patient experience drives the marketplace, and since its creation, providers have sought to improve patient satisfaction. Within the spine surgery setting, however, the question remains whether improved patient satisfaction correlates with improved outcomes.
All patients who had undergone lumbar spine surgery between 2009 and 2017 and who completed a CG-CAHPS survey after their procedure were studied. Demographic and surgical characteristics were then obtained. The primary outcomes of this study include patient-reported health outcomes measures such as the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) surveys for both mental health (PROMIS-GH-MH) and physical health (PROMIS-GH-PH), and the visual analog scale for back pain (VAS-BP). A multivariable linear regression analysis was used to assess whether patient satisfaction with their provider was associated with changes in each health status measure after adjusting for potential confounders.
The study population included 647 patients who had undergone lumbar spine surgery. Of these, 564 (87%) indicated that they were satisfied with the care they received. Demographic and surgical characteristics were largely similar between the two groups. Multivariable linear regression demonstrated that patient satisfaction with their provider was not a significant predictor of change in two of the three patient-reported outcomes (PROMIS-GH-MH and PROMIS-GH-PH) assessed at 1 year. However, top-box patient satisfaction with their provider was a significant predictor of improvement in VAS-BP scores at 1 year.
The authors found that after adjusting for patient-level covariates such as age, diagnosis of disc displacement, self-reported mental health, self-reported overall health, and preoperative patient-reported outcome measure status, a significant association was observed between top-box overall provider rating and 1-year improvement in VAS-BP, but no such association was observed for PROMIS-GH-PH and PROMIS-GH-MH. This suggests that pain-related outcome measures may serve as better predictors of patients' satisfaction with their spine surgeons. Furthermore, this suggests that the current method by which patient satisfaction is being assessed and publicly reported may not necessarily correlate with validated measures that are used within the spine surgery setting to assess surgical efficacy.
医疗服务提供者和系统的临床医生及群体消费者评估（CG-CAHPS）调查由医疗保险和医疗补助服务中心发起，是其基于价值的采购计划的成果。该调查允许患者对其在门诊环境中与医疗服务提供者的就医体验进行评分。这在医疗保健领域呈现出一种独特的情况，即患者体验驱动市场，自该调查创建以来，医疗服务提供者一直致力于提高患者满意度。然而，在脊柱外科手术领域，患者满意度的提高是否与更好的治疗结果相关这一问题仍然存在。
对2009年至2017年间接受过腰椎手术且术后完成CG-CAHPS调查的所有患者进行研究。随后获取了人口统计学和手术特征信息。本研究的主要结果包括患者报告的健康结果指标，如用于心理健康（PROMIS-GH-MH）和身体健康（PROMIS-GH-PH）的患者报告结果测量信息系统全球健康（PROMIS-GH）调查，以及背痛视觉模拟量表（VAS-BP）。采用多变量线性回归分析来评估在调整潜在混杂因素后，患者对医疗服务提供者的满意度是否与每种健康状况指标的变化相关。
研究人群包括647例接受过腰椎手术的患者。其中，564例（87%）表示对所接受的治疗感到满意。两组的人口统计学和手术特征在很大程度上相似。多变量线性回归表明，患者对医疗服务提供者的满意度并非1年后评估的三项患者报告结果中的两项（PROMIS-GH-MH和PROMIS-GH-PH）变化的显著预测因素。然而，患者对医疗服务提供者的最高等级满意度是1年后VAS-BP评分改善的显著预测因素。
作者发现，在调整患者层面的协变量，如年龄、椎间盘移位诊断、自我报告的心理健康状况、自我报告的总体健康状况以及术前患者报告结果测量指标状态后，观察到医疗服务提供者总体最高等级评分与VAS-BP 1年改善之间存在显著关联，但在PROMIS-GH-PH和PROMIS-GH-MH方面未观察到此类关联。这表明与疼痛相关的结果指标可能是患者对脊柱外科医生满意度的更好预测因素。此外，这表明当前评估和公开报告患者满意度的方法不一定与脊柱手术环境中用于评估手术疗效的经过验证的指标相关。
