Satisfaction is not a guarantee of quality

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According to a new study, patient satisfaction is not a valid measure for assessing overall quality and effectiveness of spinal surgery procedures as it probably represents the patient’s satisfaction with their healthcare service rather than the actual procedure.

Scott Parker (Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, USA) told delegates at ISASS13 (International Society for the Advancement of Spine Surgery; 3–5 April, Vancouver, Canada) that the standard measures of measuring quality and effectiveness, such as surgical morbidity and validated questionnaires of effectiveness, can be “burdensome and costly to collect”. Therefore, he said, patient satisfaction with treatment was being “used as a proxy for quality and effectiveness due to its feasibility of collection”. However, Parker added that patient satisfaction had not been validated as a measure of overall quality and that, in their prospective longitudinal study, he and his colleagues aimed to determine if it was a valid measure.


Parker et al, over a course six months, prospectively followed all patients undergoing elective spinal surgery for degenerative conditions at a single institution. The outcomes were pain, disability, quality of life, depression/anxiety, and patient satisfaction (both with outcome and with provider care). Using receiver operator characteristic (ROC) analyses, the investigators sought to determine if extent of improvement in quality of life and disability could accurately predict patient satisfaction vs. dissatisfaction. Parker reported that they also used multivariate logistic regression analysis “to determine if surgical morbidity (quality) or improvement in disability and quality of life (effectiveness of care) were independently associated with patient satisfaction.”


Of 500 patients contacted, 422 (84%) completed all study questionnaires three months after surgery. Parker noted that patients reported a high level of satisfaction (84.8%) with provider care and with outcome (68.2%). However, in the ROC analyses, extent of improvement and disability differentiated between satisfaction with provider care and dissatisfaction with provider care with “very poor accuracy”. Additionally, regression analysis found that three-month morbidity, re-admission, improvement in quality of life, and improvement in general health were not associated with satisfaction of care. Regarding patient satisfaction with outcome, Parker said: “In ROC analyses, improvement in quality of life and disability failed to differentiate satisfaction with good accuracy. Neither 90-day morbidity nor 90-day re-admission was associated with satisfaction outcome in regression analysis.”


Summarising his presentation, Parker said that patient satisfaction was not a valid measure of overall quality or effectiveness of surgical spine care and commented that it, instead, “likely represents a patient’s subjective contentment with healthcare service, a distinct aspect of care”. He added: “Satisfaction metrics are important patient-centred measures of a healthcare service, but should not be used a proxy for overall quality, safety, or effectiveness of surgical spinal care.”


Parker told Spinal News International: “Our results suggest that patient satisfaction metrics should not be expanded in their use to represent anything more than what they measure: the patient’s contentment with their healthcare service. There is no doubt that the use of patient satisfaction metrics represents an important movement towards patient-centred care and can help drive demand for a specific healthcare entity in a consumer driven market. However, patient satisfaction scores alone should not be used to represent the overall quality of spinal care, as they have now been shown to have no direct relation to the safety or effectiveness of healthcare delivery.”

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