Something is Missing

Lisa Charbonneau, DO, MSMedical Director, New England Rehabilitation Hospital of PortlandNovember 2014

Something is Missing

In this session, we will explore current state of knowledge on patient preferences and views on low back pain.

Patient Satisfaction – WHY DO WE CARE?

The utility of patient satisfaction questionnaires – WHY?▪ Identify ways to improve your practice▪ Improve care delivery▪ Results in more satisfied, happier patients▪ Show staff that you are interested in quality▪ Marketplace now demands data on patient

satisfaction▪ Provides quality data▪ Enables practice comparisons standardized

assessments on a broad scale

Patient Satisfaction

We have entered the era of pay for performance measures

Patient satisfaction scores will figure into the equation for reimbursement for hospitals and physicians

Setting the stage for realistic outcomes

▪ What do patients want?▪ Clear diagnosis▪ Information and instructions▪ Pain relief▪ A physical exam (touch the patient!)

What do patients want?

▪ More diagnostic tests▪ Other therapeutic modalities▪ Referral to specialists▪ Certification of disability ▪ Expert confirmation that “their pain is real”

What kind of relationship do patients want with their doctor?

▪ Understanding▪ Listening▪ Respect▪ Inclusion in decision making

Patient expectations

Reviewing the spectrum of potential outcomes from increased function, elimination of pain to treatment of chronic low back pain▪ Patient expectations are more influenced by

family, friends and prior experiences▪ Most patients with LBP expect an X-ray to

identify “the cause of pain.”▪ Prior relationship with their physician

correlates to the degree of patient satisfaction

Patient expectations

Opioids +/- Cognitive Behavioral Therapy (CBT) had no effect on improving perceptions of pain, fatigue, level of distress in patients with chronic LBP (J. of Pain Research Jan 2012)

Examining patient satisfaction

Younger patients have higher expectations before surgery with regard to symptom relief, mobility and reducing the impact the condition has on current and future life.

Patients with more significant disability have higher expectations prior to (cervical) spine surgery.

Do we ask the right questions?

Patient Satisfaction -

Do we understand the scores? Who is completing the

questionnaire? Are happy patients more or less

likely to complete the questionnaire? Should we “teach for the test?” Do we spend enough time listening

to our patients?

Is Patient Satisfaction a valid measure of overall quality of care?

One large center study of 422 patients found that extent of improvement in quality of life and disability did not correlate with patient satisfaction scores.

Study concluded that patient satisfaction is NOT a valid measure of overall quality or effectiveness of surgical spine care and should not be used as a proxy for overall quality, safety, or effectiveness of care. (Spine J, 2013 Sep;13(9):1006-12)

Including patient opinions when creating CPGs

How do we involve the public in the creation of CPG’s?▪ Spine (2004) “Practice guidelines should pay

more attention to the best way of discussing causes and diagnosis with patients and should involve them in decision making.”

 Have we included patients in the creations of CPGs in the last decade?

Are patients included in the process of creating CPGs?

▪ CPGs reviewed by AAPMR CPG committee in the area of back pain and Agree II score:▪ NASS (Spinal Stenosis) 1▪ NASS (Spondylolisthesis) 1▪ AAOS (Sympt CF) 3▪ APTA (CPG linked to ICF) 1

The answer is NO!!!

Summary

We know what patients want. We have an idea of patient

expectations. Patient satisfaction scores do not

correlate with quality of care. We have not done a good job of

including patients (lay public) in the creation of CPGs.

We are not “satisfying” patients because we are not creating realistic expectations and are not asking the right questions.

Something is missing

References

Hoffman et al. Patients expectations of acute low back pain management. J Fam Prac 2013;14(7).

Sanderson, Kristen, et al. Investigating patient expectations and treatment outcome in a chronic low back pain population.J of Pain Research Jan 2012

Verbeck J, et al. Patient expectations of treatment for back pain; a systematic review of qualitative and quantitative studeis. Spine 2004 Oct 15;29(20)2309-18

AAPMR website CPGs endorsed by the Academy

References

Godil SS et al, Determining the quality and effectiveness of surgical spine care:patient satisfaction is not a valid proxy.Spine J, 2013 Sep; 13(9):1006-12

Mancuso, CA et al, Patients’ expectations of cervical spine surgery, Spine. 2014;39(14):1157-1162

Bowling A, et al, The measurement of patients’ expectations for health care: a review and psychometric testing of a measure of patients’ expectations. Health Technol Assess, 2012 Jul:16(30):i-xii

Maine – the way life should be…