Key drivers of patient satisfaction with spine surgeons in the outpatient setting

2021 ◽  
pp. 1-8
Author(s):  
Nicholas M. Rabah ◽  
Hammad A. Khan ◽  
Robert D. Winkelman ◽  
Jay M. Levin ◽  
Thomas E. Mroz ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Outpatient Setting ◽  
Categorical Variables ◽  
Lumbar Spine Surgery ◽  
Continuous Variables ◽  
Multivariable Logistic Regression Model ◽  
Patient Reported ◽  
Key Drivers

OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.

scholarly journals Long-term impact of obesity on patient-reported outcomes and patient satisfaction after lumbar spine surgery: an observational study

2021 ◽  
Vol 34 (1) ◽  
pp. 73-82 ◽  
Author(s):  
Christine Park ◽  
Alessandra N. Garcia ◽  
Chad Cook ◽  
Christopher I. Shaffrey ◽  
Oren N. Gottfried
Keyword(s):  
Patient Satisfaction ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Normal Weight ◽  
Lumbar Spine Surgery ◽  
Morbidly Obese ◽  
Lumbar Surgery ◽  
Patient Reported

OBJECTIVEObese body habitus is a challenging issue to address in lumbar spine surgery. There is a lack of consensus on the long-term influence of BMI on patient-reported outcomes and satisfaction. This study aimed to examine the differences in patient-reported outcomes over the course of 12 and 24 months among BMI classifications of patients who underwent lumbar surgery.METHODSA search was performed using the Quality Outcomes Database (QOD) Spine Registry from 2012 to 2018 to identify patients who underwent lumbar surgery and had either a 12- or 24-month follow-up. Patients were categorized based on their BMI as normal weight (≤ 25 kg/m2), overweight (25–30 kg/m2), obese (30–40 kg/m2), and morbidly obese (> 40 kg/m2). Outcomes included the Oswestry Disability Index (ODI) and the visual analog scale (VAS) for back pain (BP) and leg pain (LP), and patient satisfaction was measured at 12 and 24 months postoperatively.RESULTSA total of 31,765 patients were included. At both the 12- and 24-month follow-ups, those who were obese and morbidly obese had worse ODI, VAS-BP, and VAS-LP scores (all p < 0.01) and more frequently rated their satisfaction as “I am the same or worse than before treatment” (all p < 0.01) compared with those who were normal weight. Receiver operating characteristic curve analysis revealed that the BMI cutoffs for predicting worsening disability and surgery dissatisfaction were 30.1 kg/m2 and 29.9 kg/m2 for the 12- and 24-month follow-ups, respectively.CONCLUSIONSHigher BMI was associated with poorer patient-reported outcomes and satisfaction at both the 12- and 24-month follow-ups. BMI of 30 kg/m2 is the cutoff for predicting worse patient outcomes after lumbar surgery.

scholarly journals Influence of racial disparities on patient-reported satisfaction and short- and long-term perception of health status after elective lumbar spine surgery

2018 ◽  
Vol 29 (1) ◽  
pp. 40-45 ◽  
Author(s):  
Aladine A. Elsamadicy ◽  
Hanna Kemeny ◽  
Owoicho Adogwa ◽  
Eric W. Sankey ◽  
C. Rory Goodwin ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Lumbar Spine ◽  
Racial Disparities ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Readmission Rates ◽  
Patient Reported ◽  
Short And Long Term ◽  
Satisfaction Measures

OBJECTIVEIn spine surgery, racial disparities have been shown to impact various aspects of surgical care. Previous studies have associated racial disparities with inferior surgical outcomes, including increased complication and 30-day readmission rates after spine surgery. Recently, patient-reported outcomes (PROs) and satisfaction measures have been proxies for overall quality of care and hospital reimbursements. However, the influence that racial disparities have on short- and long-term PROs and patient satisfaction after spine surgery is relatively unknown. The aim of this study was to investigate the impact of racial disparities on 3- and 12-month PROs and patient satisfaction after elective lumbar spine surgery.METHODSThis study was designed as a retrospective analysis of a prospectively maintained database. The medical records of adult (age ≥ 18 years) patients who had undergone elective lumbar spine surgery for spondylolisthesis (grade 1), disc herniation, or stenosis at a major academic institution were included in this study. Patient demographics, comorbidities, postoperative complications, and 30-day readmission rates were collected. Patients had prospectively collected outcome and satisfaction measures. Patient-reported outcome instruments—Oswestry Disability Index (ODI), visual analog scale for back pain (VAS-BP), and VAS for leg pain (VAS-LP)—were completed before surgery and at 3 and 12 months after surgery, as were patient satisfaction measures.RESULTSThe authors identified 345 medical records for 53 (15.4%) African American (AA) patients and 292 (84.6%) white patients. Baseline patient demographics and comorbidities were similar between the two cohorts, with AA patients having a greater body mass index (33.1 ± 6.6 vs 30.2 ± 6.4 kg/m2, p = 0.005) and a higher prevalence of diabetes (35.9% vs 16.1%, p = 0.0008). Surgical indications, operative variables, and postoperative variables were similar between the cohorts. Baseline and follow-up PRO measures were worse in the AA cohort, with patients having a greater baseline ODI (p < 0.0001), VAS-BP score (p = 0.0002), and VAS-LP score (p = 0.0007). However, mean changes from baseline to 3- and 12-month PROs were similar between the cohorts for all measures except the 3-month VAS-BP score (p = 0.046). Patient-reported satisfaction measures at 3 and 12 months demonstrated a significantly lower proportion of AA patients stating that surgery met their expectations (3 months: 47.2% vs 65.5%, p = 0.01; 12 months: 35.7% vs 62.7%, p = 0.007).CONCLUSIONSThe study data suggest that there is a significant difference in the perception of health, pain, and disability between AA and white patients at baseline and short- and long-term follow-ups, which may influence overall patient satisfaction. Further research is necessary to identify patient-specific factors associated with racial disparities that may be influencing outcomes to adequately measure and assess overall PROs and satisfaction after elective lumbar spine surgery.

The association between patient rating of their spine surgeon and quality of postoperative outcome

2020 ◽  
pp. 1-7
Author(s):  
Nicholas M. Rabah ◽  
Hammad A. Khan ◽  
Jay M. Levin ◽  
Robert D. Winkelman ◽  
Thomas E. Mroz ◽  
...  
Keyword(s):  
Mental Health ◽  
Patient Satisfaction ◽  
Lumbar Spine ◽  
Linear Regression ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Linear Regression Analysis ◽  
Lumbar Spine Surgery ◽  
Patient Rating ◽  
Patient Reported

OBJECTIVEThe 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.METHODSAll 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.RESULTSThe 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.CONCLUSIONSThe 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.

scholarly journals ISSLS prize in clinical science 2020: the reliability and interpretability of score change in lumbar spine research

2019 ◽  
Vol 29 (4) ◽  
pp. 663-669 ◽  
Author(s):  
C. Parai ◽  
O. Hägg ◽  
B. Lind ◽  
H. Brisby
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Rating Scale ◽  
Categorical Variables ◽  
Lumbar Spine Surgery ◽  
Minimal Important Change ◽  
Score Change ◽  
Degenerative Lumbar Spine ◽  
Patient Reported ◽  
Smallest Detectable Change

Abstract Purpose A statistically significant score change of a PROM (Patient-Reported Outcome Measure) can be questioned if it does not exceed the clinically Minimal Important Change (MIC) or the SDC (Smallest Detectable Change) of the particular measure. The aim of the study was to define the SDC of three common PROMs in degenerative lumbar spine surgery: Numeric Rating Scale (NRSBACK/LEG), Oswestry Disability Index (ODI) and Euroqol-5-Dimensions (EQ-5DINDEX) and to compare them to their MICs. The transition questions Global Assessment (GABACK/LEG) were also explored. Methods Reliability analyses were performed on a test–retest population of 182 symptomatically stable patients, with similar characteristics as the Swespine registry population, who underwent surgery for degenerative lumbar spine conditions 2017–2018. The MIC values were based on the entire registry (n = 98,732) using the ROC curve method. The ICC for absolute agreement was calculated in a two-way random-effects single measures model. For categorical variables, weighted kappa and exact agreement were computed. Results For the NRS, the SDC exceeded the MIC (NRSBACK:3.6 and 2.7; NRSLEG: 3.7 and 3.2, respectively), while they were of an equal size of 18 for the ODI. The gap between the two estimates was remarkable in the EQ-5DINDEX, where SDC was 0.49 and MIC was 0.10. The GABACK/LEG showed an excellent agreement between the test and the retest occasion. Conclusion For the tested PROM scores, the changes must be considerable in order to distinguish a true change from random error in degenerative lumbar spine surgery research. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

Key Drivers of Patient Satisfaction in Lumbar Spine Surgery Setting

2017 ◽  
Vol 17 (10) ◽  
pp. S114-S115
Author(s):  
Jay M. Levin ◽  
Robert Winkelman ◽  
Joseph E. Tanenbaum ◽  
Gabriel A. Smith ◽  
Thomas E. Mroz ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Lumbar Spine Surgery ◽  
Key Drivers

scholarly journals P.219 The effect of peri-operative adverse events on long-term patient reported outcomes after lumbar spine surgery

2021 ◽  
Vol 48 (s3) ◽  
pp. S83-S83
Author(s):  
O Ayling ◽  
C FIsher
Keyword(s):  
Lumbar Spine ◽  
Adverse Events ◽  
Spine Surgery ◽  
Physical Disability ◽  
Research Network ◽  
Lumbar Spine Surgery ◽  
Degenerative Disorders ◽  
Patient Reported ◽  
Euroqol 5D

Background: Peri-operative adverse events (AE) lead to patient disappointment and greater costs. There is a paucity of data on how AEs affect long-term outcomes. The purpose of this study is to examine peri-operative AEs and their impact on outcome after lumbar spine surgery. Methods: 3556 consecutive patients undergoing surgery for lumbar degenerative disorders enrolled in the Canadian Spine Outcomes and Research Network were analyzed. AEs were defined using the validated Spine AdVerse Events Severity system. Outcomes at 3,12, and 24 months post-operatively included the Owestry Disability Index (ODI), SF-12 Physical (PCS) and Mental (MCS) scales, visual analog scale (VAS) leg and back, Euroqol-5D (EQ5D), and satisfaction. Results: Adverse events occurred in 767 (21.6%) patients, 85 (2.4%) suffered major AEs. Patients with major AEs had worse OD (physical disability) scores and did not reach minimum clinically important differences at 2 years (no AE 25.7±19.2, major: 36.4±19.1, p<0.001). Major AEs were associated with worse ODI (physical disability) scores on multivariable linear regression (p=0.011). Conclusions: Major AEs after lumbar spine surgery lead to worse functional outcomes and lower satisfaction. This highlights the need to implement strategies aimed at reducing adverse events.

Physical Performance Tests Provide Distinct Information in Both Predicting and Assessing Patient-Reported Outcomes Following Lumbar Spine Surgery

Spine ◽  
2020 ◽  
Vol 45 (23) ◽  
pp. E1556-E1563
Author(s):  
Hiral Master ◽  
Jacquelyn S. Pennings ◽  
Rogelio A. Coronado ◽  
Abigail L. Henry ◽  
Michael T. O’Brien ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Physical Performance ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Lumbar Spine Surgery ◽  
Performance Tests ◽  
Patient Reported

Impact of Preoperative Opioid Use on Postoperative Patient-reported Outcomes in Lumbar Spine Surgery Patients

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Joseph A. Weiner ◽  
Joseph E. Snavely ◽  
Daniel J. Johnson ◽  
Wellington K. Hsu ◽  
Alpesh A. Patel
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Patient Reported Outcomes ◽  
Lumbar Spine Surgery ◽  
Opioid Use ◽  
Postoperative Patient ◽  
Patient Reported

Correlation between the Oswestry Disability Index and the 4-item short forms for physical function and pain interference from PROMIS

2019 ◽  
Vol 31 (5) ◽  
pp. 691-696 ◽  
Author(s):  
Timothy J. Yee ◽  
Brandon W. Smith ◽  
Jacob R. Joseph ◽  
Yamaan S. Saadeh ◽  
Jay K. Nathan ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Physical Function ◽  
Spine Surgery ◽  
Oswestry Disability Index ◽  
Short Form ◽  
Pearson Correlation ◽  
Pain Interference ◽  
Lumbar Spine Surgery ◽  
Time Points ◽  
Patient Reported

OBJECTIVEThe Oswestry Disability Index (ODI) is one of the most commonly used patient-reported outcome instruments, but completion of this 10-question survey can be cumbersome. Tools from the Patient-Reported Outcomes Measurement Information System (PROMIS) are an alternative, and potentially more efficient, means of assessing physical, mental, and social outcomes in spine surgery. Authors of this retrospective study assessed whether scores on the 4-item surveys of function and pain from the PROMIS initiative correlate with those on the ODI in lumbar spine surgery.METHODSPatients evaluated in the adult neurosurgery spine clinic at a single institution completed the ODI, PROMIS Short Form v2.0 Physical Function 4a (PROMIS PF), and PROMIS Short Form v1.0 Pain Interference 4a (PROMIS PI) at various time points in their care. Score data were retrospectively analyzed using linear regressions with calculation of the Pearson correlation coefficient.RESULTSThree hundred forty-three sets of surveys (ODI, PROMIS PF, and PROMIS PI) were obtained from patients across initial visits (n = 147), 3-month follow-ups (n = 107), 12-month follow-ups (n = 52), and 24-month follow-ups (n = 37). ODI scores strongly correlated with PROMIS PF t-scores at baseline (r = −0.72, p < 0.0001), 3 months (r = −0.79, p < 0.0001), 12 months (r = −0.85, p < 0.0001), and 24 months (r = −0.89, p < 0.0001). ODI scores also correlated strongly with PROMIS PI t-scores at baseline (r = 0.71, p < 0.0001), at 3 months (r = 0.82, p < 0.0001), at 12 months (r = 0.86, p < 0.0001), and at 24 months (r = 0.88, p < 0.0001). Changes in ODI scores moderately correlated with changes in PROMIS PF t-scores (r = −0.68, p = 0.0003) and changes in PROMIS PI t-scores (r = 0.57, p = 0.0047) at 3 months postoperatively.CONCLUSIONSA strong correlation was found between the ODI and the 4-item PROMIS PF/PI at isolated time points for patients undergoing lumbar spine surgery. Large cohort studies are needed to determine longitudinal accuracy and precision and to assess possible benefits of time savings and improved rates of survey completion.

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