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Patient Preferences in Office-Based Orthopedic Care: A Prospective Evaluation

October 11, 2018 | Surgery
Eric J. Cotter, MD ; Charles P. Hannon, MD ; Tori A. Edmiston, MD ; Sean Kearns, BS ; Kyle Petersen, MD ; Brett R. Levine, MD, MS
Author and Disclosure Information

Authors’ Disclosure Statement: The authors report no actual or potential conflict of interest in relation to this article.

Dr. Cotter is an Orthopaedic Resident, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin. Dr. Hannon is an Orthopaedic Resident, Rush Medical Center, Chicago, Illinois. Dr. Edmiston is a Family Medicine Resident, Genesys Regional Medical Center, Grand Blanc, Michigan. Mr. Kearns is a Medical Student, Tulane University, New Orleans, Louisiana. Dr. Petersen is an Orthopedic Resident, Summa Health, Arkon, Ohio. Dr. Levine is an Associate Professor and Attending Orthopaedic Physician, Rush Medical Center, Chicago, Illinois.

Address correspondence to: Brett R. Levine, MD, Midwest Orthopaedics at Rush, 1611 W. Harrison Street, Suite 300, Chicago, IL 60612 (tel, 708-236-2664; email, Levine.research@rushortho.com).

Eric J. Cotter, MD Charles P. Hannon, MD Tori A. Edmiston, MD Sean Kearns, BS Kyle Petersen, MD Brett R. Levine, MD, MS . Patient Preferences in Office-Based Orthopedic Care: A Prospective Evaluation. Am J Orthop.

October 11, 2018

TAKE-HOME POINTS

  • The vast majority of patients desire only 10 to 20 minutes with their doctor and are highly satisfied with the amount of time their surgeon spends with them.
  • Patients reported no significant gender- or ethnicity-based preferences for their doctor.
  • The majority of patients believe that a wait time exceeding 30 minutes is too long.
  • Nearly 42% of respondents felt they would be receiving below average medical care if seen only by a nurse practitioner or physician’s assistant at a postoperative appointment.
  • Recommendations from friends is the most common way patients find their physicians.

Patient satisfaction has become an important focus in the rapidly changing healthcare environment due to the significant impact it has on healthcare delivery, healthcare economics, assessment of the quality of care, development of patient-care models, and quality improvement initiatives.1-4 Historically, the quality of care was measured by objective metrics such as complication rates, range-of-motion, and the provider’s expert opinion on the outcome. While those metrics are still impactful variables when defining a successful outcome, the medical community is now increasingly recognizing the importance of patients’ perspectives when defining successful treatments. Patient satisfaction is now highly regarded by clinicians and the government when considering outcomes and is even being incorporated into determining the value of care. Under the Affordable Care Act, patients assumed a more active role in clinical decision-making as well as in creating quality and efficiency initiatives.5,6 By 2017, 2% of the United States government’s Medicare payments will be redistributed among hospitals and physicians based on their quality and efficiency metrics, which are largely determined by patients’ evaluations of care.7 As a result, there has been significant interest in identifying variables influencing patient satisfaction and subjective outcomes.8,9

Patient satisfaction is related to both the outcomes of care and the process of care. As first described by Donabedian,10patients may be satisfied with the successful outcome of their care, but dissatisfied with how they received their care. The process of care is complex and considers many aspects of healthcare delivery, including time, cost, healthcare provider interactions, and burdens faced. While patient satisfaction with outcomes and process of care are heavily related, they should be regarded separately. It is essential that providers understand what variables are important to patients with regards to how they experience healthcare and choose their provider, especially surrounding elective procedures such as hip and knee arthroplasty.11,12

Within orthopedic surgery, patient satisfaction scores are beginning to be incorporated as part of the standard-of-care quality metrics obtained along with patient-reported outcome measures (PROMs) at defined time points postoperatively. Furthermore, PROMs and patient satisfaction data are becoming an increasingly important component of medical decision-making.13-16 Several authors have reported that increased patient satisfaction is correlated with increased compliance, improved treatment outcomes across numerous medical settings, including orthopedics, decreased risk of litigation, and higher patient ratings of the quality of care.17,18 Various factors, including meeting of expectations, staff politeness, the communication skills of the surgeon, and waiting times, have been suggested to influence eventual patient satisfaction within the surgical literature.19-21 However, within orthopedic surgery there is a paucity of investigations evaluating how patients determine preferences and satisfaction with the process of care.

The purpose of this study is to determine what preferences, if any, patients have when selecting their physician and how they experience care in an outpatient orthopedic setting. The authors hypothesize that the majority of patients find their physicians through online rating sites or recommendations from family and friends. The authors believe that patients expect to be seen in <30 minutes and will be unsatisfied overall with the amount of time that they spend with their physician.

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