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

View More View Less
  • 1 Center for Spine Health, Cleveland Clinic;
  • 2 Case Western Reserve University School of Medicine, Cleveland;
  • 3 Department of Neurosurgery, Cleveland Clinic; and
  • 4 Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
Restricted access

Purchase Now

USD  $45.00

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

OBJECTIVE

The 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.

METHODS

All 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.

RESULTS

The 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.

CONCLUSIONS

The 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.

ABBREVIATIONS CG-CAHPS = Clinician and Group Consumer Assessment of Healthcare Providers and Systems; OPR = overall provider rating; PROM = patient-reported outcome measure; PROMIS-GH = Patient-Reported Outcomes Measurement Information System Global Health; PROMIS-GH-MH = PROMIS-GH Mental Health subscore; PROMIS-GH-PH = PROMIS-GH Physical Health subscore; VAS-BP = visual analog scale for back pain.

Spine - 1 year subscription bundle (Individuals Only)

USD  $369.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Correspondence Nicholas M. Rabah: The Cleveland Clinic, Cleveland, OH. nmr68@case.edu.

INCLUDE WHEN CITING Published online December 18, 2020; DOI: 10.3171/2020.7.SPINE20478.

Disclosures Dr. Mroz receives royalties from Stryker ($1,150,000). Dr. Steinmetz receives royalties from Zimmer/Biomet ($9000/year) and Elsevier ($3000/year); is a consultant for Globus ($5000/year); and receives honoraria from Globus ($9000) and Stryker ($7500).

  • 1

    Development of the CAHPS Clinician and Group Survey. Agency for Healthcare Research and Quality. February 2018. Accessed January 30, 2020. https://www.ahrq.gov/cahps/surveys-guidance/cg/about/Develop-CG-Surveys.html

    • Search Google Scholar
    • Export Citation
  • 2

    Physician Compare datasets. Data.Medicare.gov. Accessed August 25, 2020. https://data.medicare.gov/data/physician-compare

  • 3

    Elliott MN, Cohea CW, Lehrman WG, Accelerating improvement and narrowing gaps: trends in patients’ experiences with hospital care reflected in HCAHPS public reporting. Health Serv Res. 2015;50(6):18501867.

    • Search Google Scholar
    • Export Citation
  • 4

    Elliot MN, Lehrman WG, Goldstein EH, Hospital survey shows improvements in patient experience. Health Aff (Millwood). 2010;29(11):20612067.

    • Search Google Scholar
    • Export Citation
  • 5

    Pascoe GC. Patient satisfaction in primary health care: a literature review and analysis. Eval Program Plann. 1983;6(3-4):185210.

  • 6

    Salisbury C, Wallace M, Montgomery AA. Patients’ experience and satisfaction in primary care: secondary analysis using multilevel modelling. BMJ. 2010;341:c5004.

    • Search Google Scholar
    • Export Citation
  • 7

    Glickman SW, Boulding W, Manary M, Patient satisfaction and its relationship with clinical quality and inpatient mortality in acute myocardial infarction. Circ Cardiovasc Qual Outcomes. 2010;3(2):188195.

    • Search Google Scholar
    • Export Citation
  • 8

    Kane RL, Maciejewski M, Finch M. The relationship of patient satisfaction with care and clinical outcomes. Med Care. 1997;35(7):714730.

    • Search Google Scholar
    • Export Citation
  • 9

    Tevis SE, Kennedy GD, Kent KC. Is there a relationship between patient satisfaction and favorable surgical outcomes? Adv Surg. 2015;49(1):221233.

    • Search Google Scholar
    • Export Citation
  • 10

    Lyu H, Wick EC, Housman M, Patient satisfaction as a possible indicator of quality surgical care. JAMA Surg. 2013;148(4):362367.

  • 11

    Kennedy GD, Tevis SE, Kent KC. Is there a relationship between patient satisfaction and favorable outcomes? Ann Surg. 2014;260(4):592600.

    • Search Google Scholar
    • Export Citation
  • 12

    Sharma M, Ugiliweneza B, Beswick J, Boakye M. Concurrent validity and comparative responsiveness of PROMIS-SF versus legacy measures in the cervical and lumbar spine population: longitudinal analysis from baseline to postsurgery. World Neurosurg. 2018;115:e664e675.

    • Search Google Scholar
    • Export Citation
  • 13

    Hung M, Hon SD, Franklin JD, Psychometric properties of the PROMIS physical function item bank in patients with spinal disorders. Spine (Phila Pa 1976). 2014;39(2):158163.

    • Search Google Scholar
    • Export Citation
  • 14

    Godil SS, Parker SL, Zuckerman SL, Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy. Spine J. 2013;13(9):10061012.

    • Search Google Scholar
    • Export Citation
  • 15

    Chotai S, Sivaganesan A, Parker SL, Patient-specific factors associated with dissatisfaction after elective surgery for degenerative spine diseases. Neurosurgery. 2015;77(2):157163.

    • Search Google Scholar
    • Export Citation
  • 16

    Levin JM, Winkelman RD, Smith GA, The association between the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey and real-world clinical outcomes in lumbar spine surgery. Spine J. 2017;17(11):15861593.

    • Search Google Scholar
    • Export Citation
  • 17

    Agency for Healthcare Research and Quality. The CAHPS Clinician & Group Survey Database: How Results are Calculated. Centers for Medicare and Medicaid Services; 2017. Accessed August 26, 2020. https://cahpsdatabase.ahrq.gov/cahpsidb/Public/Files/Doc6_How_Results_are_Calculated_CG_2016.pdf

    • Search Google Scholar
    • Export Citation
  • 18

    Gershon RC, Rothrock N, Hanrahan R, The use of PROMIS and assessment center to deliver patient-reported outcome measures in clinical research. J Appl Meas. 2010;11(3):304314.

    • Search Google Scholar
    • Export Citation
  • 19

    Wewers ME, Lowe NK. A critical review of visual analogue scales in the measurement of clinical phenomena. Res Nurs Health. 1990;13(4):227236.

    • Search Google Scholar
    • Export Citation
  • 20

    Chapin L, Ward K, Ryken T. Preoperative depression, smoking, and employment status are significant factors in patient satisfaction after lumbar spine surgery. Clin Spine Surg. 2017;30(6):E725E732.

    • Search Google Scholar
    • Export Citation
  • 21

    Celestin J, Edwards RR, Jamison RN. Pretreatment psychosocial variables as predictors of outcomes following lumbar surgery and spinal cord stimulation: a systematic review and literature synthesis. Pain Med. 2009;10(4):639653.

    • Search Google Scholar
    • Export Citation
  • 22

    Maillard J, Elia N, Haller CS, Preoperative and early postoperative quality of life after major surgery—a prospective observational study. Health Qual Life Outcomes. 2015;13:12.

    • Search Google Scholar
    • Export Citation
  • 23

    Tripp DA, Abraham E, Lambert M, Biopsychosocial factors predict quality of life in thoracolumbar spine surgery. Qual Life Res. 26(11):30993110.

    • Search Google Scholar
    • Export Citation
  • 24

    Rapkin BD, Garcia I, Michael W, Distinguishing appraisal and personality influences on quality of life in chronic illness: introducing the Quality-of-Life Appraisal Profile version 2. Qual Life Res. 2017;26(10):28152829.

    • Search Google Scholar
    • Export Citation
  • 25

    Bombardier C. Outcome assessments in the evaluation of treatment of spinal disorders: summary and general recommendations. Spine (Phila Pa 1976). 2000;25(24):31003103.

    • Search Google Scholar
    • Export Citation
  • 26

    Mannion AF, Dvorak J, Müntener M, Grob D. A prospective study of the interrelationship between subjective and objective measures of disability before and 2 months after lumbar decompression surgery for disc herniation. Eur Spine J. 2005;14(5):454465.

    • Search Google Scholar
    • Export Citation
  • 27

    Panagopoulos J, Hush J, Steffens D, Hancock MJ. Do MRI findings change over a period of up to 1 year in patients with low back pain and/or sciatica?: a systematic review. Spine (Phila Pa 1976). 2017;42(7):504512.

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 160 160 31
Full Text Views 70 70 10
PDF Downloads 60 60 7
EPUB Downloads 0 0 0