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Patient satisfaction after fracture fixation not driven by injury severity, function
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SAN ANTONIO — Injury severity and postoperative function do not impact patient satisfaction after fracture fixation, according to researchers from Baltimore.
“In contrast to our hypothesis, our data indicate that patient satisfaction measures a distinct aspect of care that does not appear to be substantially driven by either injury severity or functional outcome,” Eric J. Belin, MD, said during his presentation at the 2011 Annual Meeting of the Orthopaedic Trauma Association. “These data demonstrate the importance of obtaining independent satisfaction data and highlight potential areas for improvement in care.”
He noted that many consumer groups use patient satisfaction as an indication of health care quality.
“Due to increased pressure, various health care professions have shown or are beginning to apply incentives to produce higher levels of patient satisfaction,” Belin said. “However, the actual meaning of patient satisfaction is still controversial and almost nothing is known about patient satisfaction in the orthopedic trauma setting.”
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Belin and colleagues studied 104 patients between the ages of 17 years and 80 years who were treated for at least one fracture requiring fixation of the upper and/or lower extremity. The researchers excluded patients who were unable to complete their questionnaire and those with compound injuries such as burns, spinal cord injuries or amputations.
They assessed functional status using the Short Musculoskeletal Function Assessment (SFMA) and used the Patient Satisfaction Questionnaire (PSQ) to evaluate various aspects of satisfaction. The researchers calculated differences in patient and injury characteristics using an analysis of variance. They quantified correlations between PSQ and SFMA scores using Pearson correlation co-efficients with 95% confidence intervals.
The investigators found that patient satisfaction was high in the domains of communication, manner, technical quality and general satisfaction. Patients gave lower scores for time spent with their physicians, accessibility and convenience, and orthopedic recovery. They gave the lowest satisfaction scores for financial aspects of care.
The correlations between PSQ domains and SMFA scores were not statistically significant, Belin said. Patient satisfaction did not correlate with injury severity since no statistically significant relationships existed between any domain of satisfaction and Injury Severity Score, Abbreviated Injury Scale score or injury type, according to Belin. – by Renee Blisard
Reference:
- Belin EJ, Paryavi E, Castillo RC, O’Toole RV. Is patient satisfaction after fracture predicted by functional outcome or injury severity? Paper #29. Presented at the 2011 Annual Meeting of the Orthopaedic Trauma Association. Oct. 12-15. San Antonio.
- Eric J. Belin, MD, can be reached at Shriners Hospitals for Children; 3551 N. Broad St., Philadelphia, PA 19140; 215-430-4026; email: ebelin@shrinenet.org.
- Disclosure: Belin has no relevant financial disclosures.
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This study evaluated patient satisfaction (PS) after trauma. The author’s hypothesis that PS was driven by functional outcome and injury severity was disproven. Functional outcome did not predict PS. Since functional outcome as measured by SMFA did not predict PS, it was not surprising that injury severity did not predict PS.
Overall, the PS was high. Specific areas that scored lower included time spent with physician. This emphasizes how important it is we, as physicians, spend quality time in the office visit with the patient, taking time to answer their questions and guide their recovery. Lower scores were also found in accessibility and convenience. Perhaps this is reflective of the urban location of most level 1 academic trauma centers. A possible consideration might be comparison with a private or community level 1 trauma center.
The lowest PS was with the financial aspects of their care. This is not surprising considering there may be far reaching implications of the patient’s trauma. It would have been interesting to add a screening question for post-traumatic stress disorder, and see if that affected patient satisfaction.
In conclusion, the research was interesting and left open more considerations and questions on improving PS.
— Lisa K. Cannada, MD
Orthopedics
Today Editorial Board member
Associate Professor of Orthopaedic
Traumatology
St. Louis University School of Medicine
St. Louis, Mo.
Disclosures: Cannada is on the board of directors for the
Orthopaedic Trauma Association and Ruth Jackson Orthopaedic Society, is on the
Editorial Board for the Journal of Orthopaedic Trauma and receives
research grants from the Department of Defense, Southeast Fracture Consortium,
Arthrex and Synthes USA.