Elsevier

Gynecologic Oncology

Volume 142, Issue 2, August 2016, Pages 299-303
Gynecologic Oncology

Who presents satisfied? Non-modifiable factors associated with patient satisfaction among gynecologic oncology clinic patients

https://doi.org/10.1016/j.ygyno.2016.06.009Get rights and content

Highlights

  • Domain-specific patient satisfaction scores are associated with non-modifiable demographic, financial and geographic patient factors.

  • These non-modifiable factors affect the varying domains of patient satisfaction differently.

  • Comparing hospitals to one another using summed domains of patient satisfaction scores may disproportionately penalize hospitals caring for underserved patients.

Abstract

Objective

To examine associations between non-modifiable patient factors and patient satisfaction (PS) among women presenting to a gynecologic oncology clinic.

Methods

This is a cross sectional analysis of patients presenting for surgical management by a gynecologic oncologist at a tertiary care academic medical center. The Patient Satisfaction Questionnaire (PSQ-18) that measures PS in seven domains of health care was administered. Scores were converted to “satisfied” versus “unsatisfied/equivocal”. Demographic and medical factors were obtained from the medical record. Chi-square, t-tests, and multivariable logistic regression were used.

Results

208 patients completed the baseline patient satisfaction questionnaire and the median PSQ-18 score was 70.5 (range: 42–90). Median age was 58 years (range: 22–93). Several non-modifiable factors were associated with PS. White patients had higher interpersonal PS than minorities (86% v 65%, p = 0.002). The uninsured had lower interpersonal (60% v 86%, p = 0.003) and accessibility PS (33% v 67%, p = 0.03). Increasing education and less time travelled to care were both associated with higher interpersonal (p = 0.03, p = 0.05) and accessibility PS (p = 0.01, p = 0.01). There was no association between clinical factors (BMI, comorbidities, cancer) and PS. In multivariable analysis, the strongest predictor of interpersonal PS was white race while the strongest predictors of accessibility PS were time travelled to care and insurance status.

Conclusions

Patient satisfaction scores among patients presenting to a gynecologic oncology clinic are associated with non-modifiable demographic, financial and geographic factors. Pay for performance measures that use summed patient satisfaction scores may penalize hospitals for patient-mix driven differences.

Introduction

The Affordable Care Act mandates that payments to hospitals depend on providing value-based care [1]. Two percent of total hospital Center for Medicaid and Medicare Services (CMS) reimbursements are calculated using value-based performance scores [2]. Within these value-based performance scores, a subjective measure of performance called the ‘patient experience of care domain’, is 30% of the total hospital performance score [2]. This domain is measured using a patient satisfaction questionnaire.

Given that patient satisfaction is part of how the delivery of value-based care is measured, many investigators have examined the relationship between patient satisfaction and other markers of high quality healthcare with mixed results. In some studies, higher patient satisfaction scores have been correlated with decreased hospital readmissions, decreased length of hospital stay and decreased mortality [3]. Others studies, specifically in surgery, have found no relationship between patient satisfaction and adherence to Surgical Care Improvement Program (SCIP) process measures, postoperative complications or mortality [4], [5]. Paradoxically, one study actually found an inverse relationship: patient satisfaction was associated with increased healthcare costs and increased mortality [6].

In addition to studying the relationship between patient satisfaction and other markers of high quality healthcare, investigators have also examined the association between non-modifiable patient factors and patient satisfaction. In this work, patient satisfaction scores vary with a number of non-modifiable patient and hospital system factors. At the patient level, lower satisfaction scores have been found for younger and more educated patients [7], [8]. Other studies have found lower satisfaction scores for patients who are non-English speakers [8]. At the systems level, lower patient satisfaction scores have been observed for densely populated urban areas, hospitals with more beds and those that are non-profit or academic [8], [9]. The consistent variation of patient satisfaction by non-modifiable factors suggests that patient satisfaction may be measuring factors beyond just the quality of healthcare delivered.

However, much of this literature focuses on the inpatient setting, and the association between non-modifiable factors and patient satisfaction has not been studied to date in outpatient gynecologic oncology patients. Our objective was to evaluate the association between non-modifiable patient factors and domain-specific patient satisfaction scores among women presenting to a gynecologic oncology clinic.

Section snippets

Methods

We conducted a cross sectional analysis of a larger parent prospective cohort study: The Impact of Surgical Complications on Health Related Quality of Life [10]. The recruitment of this cohort has been previously described. Briefly, patients were identified and enrolled in a hospital-based registry, the University of North Carolina at Chapel Hill (UNC) Health Registry/Cancer Survivorship Cohort (HR/CSC), as well as the parent study when presenting to the Gynecologic Oncology outpatient clinic

Results

Of the 281 women who consented for the parent study, we had patient satisfaction data for 208 (74%). Of the 73 patients without data available, 12 were ineligible due to enrollment criteria or patient withdrawal, 38 did not respond to interview requests and 23 did not have medical data abstracted as they only completed a baseline assessment.

Our 208 patients had the following demographic characteristics (Table 1). Median age was 58 years (range: 22–93) and median PSQ-18 score was 70.5 (range:

Discussion

This study agrees with previous work in other disciplines that patient satisfaction scores are affected by non-modifiable patient and system factors, such as the age of the patient or the size of the hospital [8], [9]. In a cohort of gynecologic oncology patients in an outpatient setting, we found that patient satisfaction scores are associated with non-modifiable demographic, financial and geographic factors. Additionally, these non-modifiable patient factors have varying effects on the

Conflict of interest statement

The authors declare there are no conflicts of interest.

Financial support

Dr. Barber is supported by NIH T32 HD040672-15. Dr. Doll is supported by NCI 2R25CA116339.

Acknowledgement

The authors thank the UNC Health Registry/Cancer Survivorship Cohort (HR/CSC) participants for their important contributions. The HR/CSC is funded in part by the UNC Lineberger Comprehensive Cancer Center's University Cancer Research Fund.

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Presentations: The data contained within this article was presented in abstract form at both the Annual Winter Meeting of the Society of Gynecologic Oncology February, 2016 in Squaw Valley, CA and at the Society for Gynecologic Oncology Annual Meeting March, 2016 in San Diego, CA.

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