Factors Affecting Patient Satisfaction With Their Anesthesiologist

An Analysis of 51,676 Surveys From a Large Multihospital Practice

Anastasia Pozdnyakova, BS; Avery Tung, MD, FCCM; Richard Dutton, MD, MBA; Anum Wazir, BS; David B. Glick, MD, MBA

Disclosures

Anesth Analg. 2019;129(4):951-959. 

In This Article

Abstract and Introduction

Abstract

Background: An increasing focus of health care quality is the assessment of patient-reported outcomes, including satisfaction. Because anesthesia care occurs in the context of perioperative surgical care, direct associations between anesthetic management and patient experience may be difficult to identify. We analyzed anesthesia-specific patient satisfaction survey data from a large private practice group to identify patient, procedure, and anesthetic-specific predictors of patient satisfaction with their anesthesiologist, measured via responses to a validated patient satisfaction survey instrument. We hypothesized that some factors governing satisfaction with an anesthesia provider are beyond their ability to control.

Methods: We retrospectively reviewed responses to the Anesthesia Patient Satisfaction Questionnaire (APSQ), administered online to patients cared for by US Anesthesia Partners, a multistate anesthesia group practice. The APSQ focuses on patient satisfaction with their anesthesiologist and patient-reported outcomes and is administered after discharge. Responses from May to November 2016 were aggregated, and relationships between responses and patient, procedural, and clinician-related factors were assessed using multivariable logistic regression.

Results: Out of 629,220 adult patients cared for during the study period, 51,676 responded to the survey request for a 9.3% overall response rate for patients. Nonresponders were slightly older and more likely to be male than responders. After multivariable regression, no patient or procedural factor was associated with patient rating of their anesthesiologist. However, ≥55 years of age, inpatient (versus outpatient) setting, and nighttime surgery (between 6 PM and 6 AM) were associated with lower scores on other satisfaction questions.

Conclusions: Our data suggest that some factors governing satisfaction with an anesthesia provider are beyond their ability to control. Further work is needed to identify elements of patient satisfaction with their anesthesiologist and to optimize these aspects of perioperative care.

Introduction

A growing focus in health care quality is assessment of the patient experience, and measures of such experience are now included in public reporting programs such as Physician Compare.[1] Patient experience surveys now comprise 30% of the Medicare Hospital Value-Based Purchasing Program,[2] highlighting the importance of patient satisfaction to government payers. Evaluations of the patient experience involve both surveys of patient satisfaction and assessments of specific interactions with the health care system.[3,4]

Of the survey tools for assessing the patient experience, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is the most widely used.[5] This validated, 32-question tool is required by the US Affordable Care Act of 2010, has a 27% response rate among the sample of patients surveyed, and results have been publicly reported since 2008.[5] However, the HCAHPS tool does not focus specifically on the perioperative period and provides little feedback on the role of the anesthesiologist in the patient experience.[5] The American Society of Anesthesiologists (ASA) likewise notes that no widely validated tool exists for assessing patient satisfaction with anesthesia care.[6]

Because anesthesia care occurs in the context of perioperative surgical care, associations between anesthetic management and patient satisfaction may be difficult to separate from surgical, hospital, and other factors affecting the perioperative experience. Factors associated with improved perioperative patient satisfaction have included quality of recovery, having caregivers smile, controlling postoperative pain, and informing patients about the billing process, whereas surgery late in the day has been associated with patient dissatisfaction.[7–10]

Studies of satisfaction with overall anesthesia care in non-US settings suggest inconsistent effects of patient age, sex, and ASA physical status (PS).[11–13] The effect of anesthesia type on patient satisfaction is also uncertain. While a 2017 Belgian study found that ambulatory patients who received regional anesthesia (RA) were more satisfied compared to those who received general anesthesia (GA), a 2017 multicenter Saudi Arabian study found the opposite effect.[13,14]

An important aspect of interpreting patient satisfaction surveys is clarifying the contribution of the anesthesiologist. To address this issue, we retrospectively reviewed a convenience sample of anesthesiologist-specific patient satisfaction survey data from a large multicenter private practice group. We sought to identify patient, procedure, and anesthetic-specific factors that were associated with patient satisfaction with their anesthesiologist and hypothesized that, after adjustment, some factors governing satisfaction with the anesthesia provider would be beyond their direct control.

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