Rabah Nicholas M, Khan Hammad A, Winkelman Robert D, Levin Jay M, Mroz Thomas E, Steinmetz Michael P
1Center for Spine Health, Cleveland Clinic.
2Case Western Reserve University School of Medicine.
J Neurosurg Spine. 2021 Mar 19;34(6):871-878. doi: 10.3171/2020.9.SPINE201292. Print 2021 Jun 1.
The Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS) was developed as a result of the value-based purchasing initiative by the Center for Medicare & Medicaid Services. It allows patients to rate their experience with their provider in the outpatient setting. These ratings are then reported in aggregate and made publicly available, allowing patients to make informed choices during physician selection. In this study, the authors sought to elucidate the primary drivers of patient satisfaction in the office-based spine surgery setting as represented by the CG-CAHPS.
All patients who underwent lumbar spine surgery between 2009 and 2017 and completed a patient experience survey were studied. The satisfied group comprised patients who selected a top-box score (9 or 10) for overall provider rating (OPR) on the CG-CAHPS, while the unsatisfied group comprised the remaining patients. Demographic and surgical characteristics were compared using the chi-square test for categorical variables and the Student t-test for continuous variables. A multivariable logistic regression model was developed to analyze the association of patient and surgeon characteristics with OPR. Survey items were then added to the baseline model individually, adjusting for covariates.
The study population included 647 patients who had undergone lumbar spine surgery. Of these patients, 564 (87%) selected an OPR of 9 or 10 on the CG-CAHPS and were included in the satisfied group. Patient characteristics were similar between the two groups. The two groups did not differ significantly regarding patient-reported health status measures. After adjusting for potential confounders, the following survey items were associated with the greatest odds of selecting a top-box OPR: did this provider show respect for what you had to say? (OR 21.26, 95% CI 9.98-48.10); and did this provider seem to know the important information about your medical history? (OR 20.93, 95% CI 11.96-45.50).
The present study sought to identify the key drivers of patient satisfaction in the postoperative office-based spine surgery setting and found several important associations. After adjusting for potential confounders, several items relating to physician communication were found to be the strongest predictors of patient satisfaction. This highlights the importance of effective communication in the patient-provider interaction and elucidates avenues for quality improvement efforts in the spine care setting.
医疗服务提供者与系统消费者评估临床医生及团体调查（CG-CAHPS）是医疗保险和医疗补助服务中心基于价值的采购倡议的成果。它允许患者对其在门诊环境中与医疗服务提供者的体验进行评分。然后，这些评分会进行汇总并公开，以便患者在选择医生时做出明智的选择。在本研究中，作者试图阐明以CG-CAHPS为代表的门诊脊柱手术环境中患者满意度的主要驱动因素。
对2009年至2017年间接受腰椎手术并完成患者体验调查的所有患者进行研究。满意组包括在CG-CAHPS上对总体医疗服务提供者评分（OPR）选择最高评分（9或10）的患者，而不满意组包括其余患者。使用卡方检验对分类变量和学生t检验对连续变量进行人口统计学和手术特征比较。建立多变量逻辑回归模型以分析患者和外科医生特征与OPR的关联。然后将调查项目逐个添加到基线模型中，并对协变量进行调整。
研究人群包括647例接受腰椎手术的患者。在这些患者中，564例（87%）在CG-CAHPS上选择了9或10的OPR，并被纳入满意组。两组患者的特征相似。两组在患者报告的健康状况指标方面没有显著差异。在调整潜在混杂因素后，以下调查项目与选择最高评分OPR的最大几率相关：这位医疗服务提供者是否尊重你所说的话？（比值比21.26，95%置信区间9.98 - 48.10）；以及这位医疗服务提供者似乎是否了解你的重要病史信息？（比值比20.93，95%置信区间11.96 - 45.50）。
本研究旨在确定门诊脊柱手术后患者满意度的关键驱动因素，并发现了几个重要关联。在调整潜在混杂因素后，发现几个与医生沟通相关的项目是患者满意度的最强预测因素。这突出了有效沟通在医患互动中的重要性，并阐明了脊柱护理环境中质量改进努力的途径。
