Evaluation of Patient Satisfaction Surveys in Pediatric Orthopaedics.

BACKGROUND: Patient satisfaction survey scores are increasingly being tied to incentive compensation, impact how we practice medicine, influence decisions on where patients seek care, and in the future may be required for accreditation. The goal of this study is to compare the results of an internal distribution of patient satisfaction surveys at the point of care to responses received by mail in a hospital-based, high-volume pediatric orthopaedic practice. METHODS: A pediatric outpatient survey is used at our institution to evaluate patient satisfaction. Surveys are randomly mailed out to families seen in our clinic by the survey vendor, and the results are determined on a quarterly basis. We distributed the same survey in a similar manner in our clinic. The results of the surveys, external/mailed (EXM) versus internal/point of care (INP) over the same 3-month time period (second quarter 2013) were compared. The survey questions are dichotomized from an ordinal scale into either excellent (9 to 10) or not excellent (0 to 8) commonly used in patient satisfaction methodology. We evaluated the raw data from the INP surveys for the question on provider rating by evaluating the mean score, the standard excellent response (9 to 10), and an expanded excellent response (8 to 10). RESULTS: Response rate was 72/469 (15.4%) for EXM, and 231/333 (69.4%) for INP. An excellent response for the "rating your provider" question was 72.2% (EXM) versus 84.8% (INP) (P=0.015). Our analysis of the raw data (INP) has a mean rating of 9.42. The expanded scale (8 to 10) for an excellent response increased the provider rating to 94.4% (P=0.001). Waiting time response within 15 minutes was the only item that correlated with rating of provider (P=0.02). For the majority of the items, the INP responses were consistently higher than the EXM responses, including 6/7 responses that were statistically significant (P<0.05). CONCLUSIONS: As mandated by the Centers for Medicare and Medicaid Services, patient satisfaction surveys will be important in determining health care outcomes. Properly designed and administered surveys provide robust measures of quality. Our study reinforces methodological concerns about patient satisfaction surveys distributed in a high-volume pediatric subspecialty practice. Further research is needed to evaluate the patients' health care experience and true quality of care in pediatric subspecialty ambulatory settings.

Range of motion and patient satisfaction with traditional and high-flexion rotating-platform knees.

Although a high degree of flexion is necessary for some activities of daily living, most total knee arthroplasty implants are designed to provide only up to 120° of flexion. Some new designs claim to provide greater flexion. In this retrospective study, we evaluated the Sigma rotating-platform high-flex knee against the traditional Sigma rotating-platform knee (DePuy, Warsaw, IN). There were 153 knees evaluated. We matched the subjects primarily on preoperative flexion and had 64 matched pairs. We also evaluated the knees based on their preoperative flexion, either <120° or ≥120°. In comparing the two implants, there were no significant differences in the patients' overall satisfaction, flexion gained or lost, or the need for further surgery. This study was approved by an institutional review board.

Efficacy and cost-effectiveness of a blood salvage system in primary total knee arthroplasty--a retrospective match-controlled chart review.

We retrospectively reviewed the clinical and cost effectiveness of the OrthoPAT blood salvage system (Haemonetics Corp., Braintree, MA) following total knee arthroplasty (TKA). Two-hundred-and-two patients who received the OrthoPAT system were matched to 202 controls. A second match was performed for subjects weighing <75 kg. For all matched subjects, no significant difference in allogeneic blood transfusion (ABT) rate was found between the control and study groups (p=0.55). In the subjects <75 kg, use of the OrthoPAT system almost halved the incidence of ABT; however, in this small population the result was not statistically significant (p=0.10). Blood management costs for study patients were significantly higher than those of the control group in both the total matched pairs and those <75 kg (p< 0.0001 and p= 0.05, respectively).