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2013년 10월 15일 화요일

Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy

Brief review


이 논문은 환자 만족도의 질과 유효성을 평가하는 내용 입니다.
10가지 항목으로 평가하였고, 환자의 만족도는 척추 수술의 질과 유효성을 결정하기에는 충분치 않다는 결론 입니다. 
이와 관련하여 The Spine Journal에 환자만족도가 합리적인 측정결과인지에 대한 Commentary도 출판되어 있으니 참고하시기 바랍니다.
(http://www.thespinejournalonline.com/article/S1529-9430(12)00996-5/abstract

*Title: Determining the quality and effectiveness of surgical spine care: patient satisfaction is not a valid proxy.
수술적 척추 치료의 질과 유효성의 결정: 환자의 만족도는 유효한 대용물이 아니다.

*Author: Saniya S. Godil, Scott L. Parker, Scott L. Zuckerman, Stephen K. Mendenhall, Clinton J. Devin, Anthony L. Asher, Matthew J. McGirt




BACKGROUND CONTEXT: .
Patients' satisfaction has commonly used metric as a proxy. But It has yet to be validated as a measure of overall quality of surgical spine care.


PURPOSE:
To determine whether patient satisfaction is a valid measure of safety and effectiveness of care in a prospective longitudinal spine registry.


STUDY DESIGN: Prospective longitudinal cohort study.


PATIENT POPULATION:
All patients undergoing elective spine surgery for degenerative conditions over a 6-month period at a single medical center.


OUTCOME MEASURES:
Patient-reported outcome instruments as follow.
1. numeric rating scale [NRS]
2. Oswestry disability index [ODI]
3. neck disability index [NDI]
4. short-form 12-item survey [SF-12]
5. Euro-Qol-5D [EQ-5D]
6. Zung depression scale
7. Modified Somatic Perception Questionnaire[MSPQ] (anxiety scale)
8. return to work
9. patient satisfaction with outcome
10. patient satisfaction with provider care.


METHODS:
Subject: undergoing elective spine surgery for degenerative conditions (over a 6-month period)
Measurement: NRS, ODI, NDI, SF-12, EQ-5D, Zung depression scale, and MSPQ anxiety scale, return to work, patient satisfaction with outcome, and patient satisfaction (3 months after treatment)


RESULTS:
422 patients (84%) completed all questionnaires 3 months after surgery during the reviewed time period (mean age 55±14 years).
(Lumbar surgery was performed in 287 (68%) and Cervical surgery in 135 (32%) patients)

-complications: 51 patients (12.1%) (90-day)
-readmissions: 21 (5.0%)
-return to operating room: 12 (2.8%)
-patients satisfied with provider care: 358 (84.8%)
-patients satisfied with outcome: 288 (68.2%)
-In ROC analyses, improvement in quality of life(SF-12), disability(ODI/NDI) differentiated satisfaction VS dissatisfaction with care with very poor accuracy (AUC 0.49-0.69).




CONCLUSIONS:
-Patient satisfaction is not a valid measure of overall quality or effectiveness of surgical spine care.

-Patient satisfaction metrics likely represent the patient's subjective contentment with health-care service, a distinct aspect of care.

-Satisfaction metrics are important patient-centered measures of health-care service but should not be used as a proxy for overall quality, safety, or effectiveness of surgical spine care.