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Self-Reported Recovery Likelihood Predicts Higher Physician Ratings

A Survey of Patients After Orthopaedic Surgery

Rascoe, Alexander S., MD, MBA; Treiman, Scott, BS; Gunasekar, Ashwath, MD; Vallier, Heather A., MD

doi: 10.1097/BOT.0000000000001333
Current Opinions and Surveys

Objectives: What are the differences between elective and trauma patient satisfaction and do patient and diagnosis factors predict physician scores?

Design: Prospective cohort study.

Setting: Urban Level 1 Trauma center.

Patients/Participants: Three hundred twenty-three trauma patients and 433 elective orthopaedic patients treated at our center by the same surgeons.

Intervention: Trauma patients treated surgery for one or more fractures; elective patients treated with hip, knee, or shoulder arthroplasty, or rotator cuff repair.

Main Outcome Measurements: Telephone survey regarding patient experience and satisfaction with their care. The survey included questions from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, and responses were rated on a 1–5 point Likert scale (5 best).

Results: Elective surgery patients had mean age of 56.4 years, and trauma patients were mean 50.3 years of age. Trauma patients rated their likelihood to make a full recovery lower than elective patients (median, interquartile range), 5.0 (1.0) versus 4.0 (2.0) (P < 0.001). After multivariate binary logistic regression, patients who rated the hospital higher (≥4 vs. ≤3) were more likely (odds ratio = 10.0, 95% confidence interval, 6.4–15.8) to score physicians better. Similarly, patients who scored their overall likelihood of recovering ≥4 compared with ≤3 were more likely (odds ratio = 3.6, 95% confidence interval, 2.9–5.6) to rate their physicians more positively.

Conclusions: Patient perceptions including their likelihood to make a full recovery and their overall impression of the hospital predicted higher physician scores. We conclude that these physician scores are subject to patient perception biases and are not independent of the overall care experience. We recommend HCAHPS and physician ratings' web sites include internal controls, such as the patient perception of overall likelihood to recover, to aid in interpreting survey results.

Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.

Reprints: Heather A. Vallier, MD, Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109 (e-mail:

The authors report no conflict of interest.

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Accepted August 28, 2018

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