Self-Reported Recovery Likelihood Predicts Higher Physician Ratings following Orthopaedic Surgery.

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:: 323 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 surveys (HCAHPS), 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) vs. 4.0(2.0) (p<0.001). Following multivariate binary logistic regression, patients who rated the hospital higher (≥4 versus ≤3), were more likely OR=10.0, 95% CI [6.4, 15.8] to score physicians better. Similarly, patients who scored their overall likelihood of recovering ≥4 compared to ≤3, were more likely OR=3.6, 95% CI [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 websites include internal controls, such as the patient perception of overall likelihood to recover, to aide in interpreting survey results.

LEVEL OF EVIDENCE: Level 2: Prospective comparative study.