Determinants of Patient Satisfaction in an Academic Rheumatology Practice Jennifer H. Ku, MPH,* Abhijeet Danve, MD,* Helena Pang, BS,* Dongseok Choi, PhD,† and James T. Rosenbaum, MD*‡ Background: Although patient satisfaction is used as a measure of physician performance and is an essential component of chronic disease management, there is limited understanding about factors affecting satis- faction in rheumatologic settings. Objective: Our study aimed to identify factors affecting satisfaction in outpatients with rheumatic diseases by correlating satisfaction with various factors. Methods: We conducted a cross-sectional cohort study of rheumatology patients at Oregon Health & Science University in 2013. Patient satisfac- tion ratings were obtained, and data were collected from medical records. Descriptive and quantile regression analyses were performed to describe the population and to model predictors of satisfaction. Results: We obtained data from 573 patients, 76% were females, 92% were non-Hispanic white, with a mean age of 50 (SD, 15)years. Female gender (β = 7.51; 95% confidence interval [CI], 6.16–8.86), older age (β = 0.10; 95% CI, 0.01–0.20), and follow-up visit (β = 4.04; 95% CI, 0.14–7.93) had a positive impact on satisfaction, whereas polymyalgia rheumatica (β = -9.25; 95% CI, -15.25 to -3.25), arthralgia (β = -8.67; 95% CI, -16.60 to -0.74), myalgia (β = -8.67; 95% CI, -16.60 to -0.74), gout (β = -7.5; 95% CI, -14.13 to -0.89), ankylosing spondy- litis (β = -5.20; 95% CI, -9.65 to -0.75), pain (β = -4.62; 95% CI, -8.43 to -0.81), fibromyalgia (β = -4.62; 95% CI, -7.80 to -1.44), longer visit duration (β = -0.08; 95% CI, -0.13 to -0.03), and afternoon appointments (β = -4.62; 95% CI, -7.04 to -2.20) had an inverse effect. Conclusions: Factors contributing to satisfaction scores differed for median satisfaction level and lower satisfaction level. Most of the factors identified as influencing patient satisfaction were unrelated to the physician or the skills of that physician. Key Words: patient satisfaction, rheumatic diagnosis, rheumatology (J Clin Rheumatol 2015;21: 256–262) P atient satisfaction is widely used as a measure of physician per- formance. Physician and hospital compensation are becoming increasingly tied to patient satisfaction as health plans use patient satisfaction scores to determine hospital reimbursement. Under the Patient Protection and Affordable Care Act, the 2010 national health care reform legislation, patient satisfaction scores have had a direct impact for hospital reimbursements. 1 The Centers for Medicare & Medicaid Services distributes payments to hospitals based on their performance on several quality measures, in part determined by patient satisfaction surveys. 1–3 There are also sev- eral patient satisfaction surveys commercially available, such as Press Ganey Surveys (Press Ganey Associate, Inc, South Bend, IN), Hospital Consumer Assessment of Healthcare Providers and Systems, and Medical Group Management Associate surveys, which evaluate satisfaction on factors such as courtesy of staff in the wait area, wait time in clinic, friendliness of providers, and personal issues. Despite the increasing role of patient satisfaction measures in health care and policy making, there is no consensus regarding the validity of these measures in assessing quality of care. Further- more, although results of patient satisfaction scores influence hos- pital reputation and profits, patient satisfaction is complex and is not solely determined by quality of care. Critics voice concerns about the use of patient satisfaction surveys as a measure of qual- ity of care and as a tool to help make administrative or medical decisions, backed up by recent studies suggesting that patient- reported measures have no relation to the quality of care and at worst are linked to poorer patient outcomes. 4 Wood et al 5 showed that physician productivity had a relatively small influence on patient satisfaction because patient satisfaction is influenced by many other nonclinical factors. In a study by Kendrick and col- leagues, 6 among 4432 patients with low-back pain, 199 patients who were randomly selected to receive x-rays were more satisfied but experienced more pain and disability and had more visits to a physician. Moreover, Fenton et al 7 evaluated data from Medical Expenditure Panel Surveys about patient-reported health status and experiences with health care on a satisfaction rating scale of 0 to 10. This study suggested that more satisfied patients had greater chances of being admitted to the hospital, higher total health care costs, higher prescription drug expenditures, and, most strikingly, higher mortality. One explanation may be that patients who receive more discretionary services are more likely to be sat- isfied regardless of medical benefits, and their physicians are more likely to provide such services to increase satisfaction rat- ings. 7,8 In addition, some assert that physicians whose incentives are more closely linked to patient satisfaction ratings are more likely to approve requests for discretionary services such as rapid and advanced imaging. 9 While the validity of patient satisfaction rating as a measure of quality of care has been questioned, some studies have found higher satisfaction correlated with better patient outcomes. Data from Hospital Consumer Assessment of Healthcare Providers and Systems surveys showed that hospitals with higher patient sat- isfaction tend to provide care somewhat higher in quality and that overall satisfaction with care is positively linked to clinical adher- ence to treatment guidelines. 10 Other studies have also reported that patient-reported measures not only are associated with better outcomes but also adequately capture patient evaluation of com- munications with care providers rather than other aspects of patient experience unrelated to quality of care. For example, Boulding et al 11 found higher overall satisfaction and satisfaction with discharge planning were associated with lower readmission rates. Similarly, Glickman and colleagues 12 analyzed Press Ganey patient satisfaction survey data for cardiac admissions. In their study, higher patient satisfaction was linked to better adherence to clinical guidelines and lower mortality rates. These findings From the Departments of *Medicine and †Public Health and Preventive Medi- cine, Oregon Health & Science University; and ‡Devers Eye Institute, Leg- acy Health Systems, Portland, OR. No financial support or other benefits from commercial sources were received for this work. The authors declare no conflict of interest. Correspondence: Jennifer H. Ku, MPH, Oregon Health & Science University, Mailcode CEI 3375 Terwilliger Blvd, Portland, OR 97239. E-mail: kuj@ohsu.edu. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 1076-1608 DOI: 10.1097/RHU.0000000000000263 ORIGINAL ARTICLE 256 www.jclinrheum.com JCR: Journal of Clinical Rheumatology • Volume 21, Number 5, August 2015 Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.