Is Patient Satisfaction the Same Immediately After the First Visit Compared to Two Weeks Later?
Methods
Study Design
After Institutional Review Board approval of this prospective, longitudinal, observational cohort study, we prospectively enrolled 150 adult patients between November 29, 2017 and January 10, 2018. Patients were seen at 5 orthopaedic clinics in a large urban area. We included all new English-speaking patients aged 18 to 89 years who were visiting 1 of 6 participating orthopaedic surgeons for any upper extremity problem and who were able to provide informed consent. We excluded follow-up visits and patients who were unable to speak and understand English. Four research assistants who were not involved with patient treatment described the study to patients before or after the visit with the surgeon. We were granted a waiver of written informed consent; patients indicated their consent by completing the surveys.
Patients could choose either phone or email as their preferred mode of contact for follow-up in this study. For patients who selected email as the preferred mode of contact, the follow-up survey was sent automatically 2 weeks after completion date, and a maximum of 3 reminder emails with 2-day time intervals between them were sent to those who did not respond to the initial invitation. For patients who selected phone as the preferred mode of contact, the follow-up survey was done by an English-speaking research assistant who was not involved with patient treatment. When a response was not obtained on the initial phone call, 3 additional phone calls were made (1 later that same day and 2 the next day). One patient declined participation because he was not interested in the study and had no time after his visit.
Measurements
Patients were asked to complete a set of questionnaires at the end of their visit:
1. A demographic questionnaire consisting of preferred mode of contact for follow-up (phone or email), age, sex, race/ethnicity, marital status, education status, work status, insurance status, and type of visit (first visit or second opinion);
2. An 11-point ordinal measure of satisfaction with the surgeon, with scores ranging from 0 (Worst Surgeon Possible) to 10 (Best Surgeon Possible);
3. The patient’s rating of the surgeon’s empathy, measured by the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE).13 The JSPPPE is a 5-item questionnaire, measured on a 7-point Likert scale, with scores ranging from 1 (Strongly Disagree) to 7 (Strongly Agree), that assesses agreement with statements about the physician. The total score is the sum of all item scores (5-35), with higher scores representing a higher degree of perceived physician empathy.
4. Upper extremity disability, measured by the Patient-Reported Outcomes Measurement Information System Physical Function-Upper Extremity (PROMIS PF-UE) Computer Adaptive Test (CAT).14-16 This is a measure of physical limitations in the upper extremity. It can be completed with as few as 4 questions while still achieving high precision in scoring and thereby decreasing survey burden. PROMIS presents a continuous T-score with a mean of 50 and standard deviation (SD) of 10, with higher scores reflecting better physical function compared to the average of the US general population.15
After completing the initial questionnaire, the research assistant filled out the office and surgeon name and asked the surgeon to complete the diagnosis. All questionnaires were administered on an encrypted tablet via the secure, HIPAA-compliant electronic platform REDCap (Research Electronic Data Capture), a web-based application for building and managing online surveys and databases.17 The follow-up survey was sent automatically or was done by phone call as previously described. The follow-up survey consisted of (1) the 11-point ordinal measure of satisfaction with the surgeon, (2) the JSPPPE for perceived empathy, and (3) the PROMIS PF-UE for physical limitations in the upper extremity.
