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Association Between Orthopaedic Outpatient Satisfaction and Non-Modifiable Patient Factors

Abtahi, Amir M. MD1; Presson, Angela P. PhD2; Zhang, Chong MS2; Saltzman, Charles L. MD1; Tyser, Andrew R. MD1

doi: 10.2106/JBJS.N.00950
Scientific Articles

Background: Increasingly, patient satisfaction surveys are being utilized to evaluate hospital and physician performance. Despite this, little is known about factors associated with patient satisfaction. The objective of this study was to determine whether selected non-modifiable patient characteristics are associated with outpatient satisfaction scores.

Methods: We reviewed patient satisfaction scores from 12,177 outpatient clinical encounters at an academic orthopaedic outpatient clinic between December 2010 and October 2013. Any adult patient who completed at least one patient satisfaction survey at any point during the study period was included in this study. Factors including age, sex, employment status, type of health insurance, zip code, and orthopaedic subspecialty were recorded. Patients were divided into more satisfied and less satisfied groups, and generalized estimating equation logistic regression analysis was performed to identify factors predictive of lower patient satisfaction.

Results: Age was found to be strongly associated with patient satisfaction, with younger patients reporting less satisfaction; the adjusted odds ratio for the patient age of eighteen to twenty-nine years compared with the patient age of eighty years or older was 2.78 (95% confidence interval, 1.74 to 3.82) (p < 0.001). This relationship was maintained in a predictive model across all age groups, both sexes, all travel distances, and all orthopaedic subspecialties. Travel distance was also associated with patient satisfaction, with patients who live closer reporting less satisfaction compared with patients who live farther away; the adjusted odds ratio for a distance of less than fifty miles compared with a distance of fifty miles or more was 1.18 (95% confidence interval, 1.03 to 1.33) (p = 0.016).

Conclusions: The finding that non-modifiable patient factors such as age and geographic location affect patient satisfaction challenges the utility of comparing patient satisfaction between populations that differ significantly with regard to such characteristics.

Clinical Relevance: A more complete knowledge of the factors that influence patient satisfaction may enable better insight into the interpretation of current patient satisfaction metrics and may allow physicians and hospitals to improve their delivery of care.

1Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for A.R. Tyser:

2Division of Epidemiology, Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108

Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated
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