Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited. Evaluation of Patient Satisfaction Surveys in Pediatric Orthopaedics Lee S. Segal, MD, Carla Plantikow, MSc, Randon Hall, MBA, MD, Kristina Wilson, MD, MPH, and M. Wade Shrader, MD Background: Patient satisfaction survey scores are increasingly being tied to incentive compensation, impact how we practice medicine, influence decisions on where patients seek care, and in the future may be required for accreditation. The goal of this study is to compare the results of an internal distribution of patient satisfaction surveys at the point of care to responses received by mail in a hospital-based, high-volume pediatric or- thopaedic practice. Methods: A pediatric outpatient survey is used at our institution to evaluate patient satisfaction. Surveys are randomly mailed out to families seen in our clinic by the survey vendor, and the results are determined on a quarterly basis. We distributed the same survey in a similar manner in our clinic. The results of the surveys, external/mailed (EXM) versus internal/point of care (INP) over the same 3-month time period (second quarter 2013) were compared. The survey questions are dichotomized from an ordinal scale into either excellent (9 to 10) or not excellent (0 to 8) commonly used in patient satisfaction methodology. We evaluated the raw data from the INP surveys for the question on provider rating by evaluating the mean score, the standard ex- cellent response (9 to 10), and an expanded excellent response (8 to 10). Results: Response rate was 72/469 (15.4%) for EXM, and 231/ 333 (69.4%) for INP. An excellent response for the “rating your provider” question was 72.2% (EXM) versus 84.8% (INP) (P = 0.015). Our analysis of the raw data (INP) has a mean rating of 9.42. The expanded scale (8 to 10) for an excellent response increased the provider rating to 94.4% (P = 0.001). Waiting time response within 15 minutes was the only item that correlated with rating of provider (P = 0.02). For the majority of the items, the INP responses were consistently higher than the EXM responses, including 6/7 responses that were statistically significant (P < 0.05). Conclusions: As mandated by the Centers for Medicare and Medicaid Services, patient satisfaction surveys will be important in determining health care outcomes. Properly designed and administered surveys provide robust measures of quality. Our study reinforces methodological concerns about patient sat- isfaction surveys distributed in a high-volume pediatric sub- specialty practice. Further research is needed to evaluate the patients’ health care experience and true quality of care in pe- diatric subspecialty ambulatory settings. Key Words: patient satisfaction surveys, health care outcomes, pediatric orthopaedics (J Pediatr Orthop 2014;00:000–000) T he patient care experience or patient satisfaction has become an increasingly important measure of health care quality. In 2001, the Institute of Medicine defined patient-centered care as one of the specific goals for im- provement needed for health care to bridge the quality chasm existing in the present health care environment. 1 The Centers for Medicare and Medicaid Services (CMS) included patient satisfaction as a quality mandate in 2008. 2 Patient satisfaction is thought by several authors to be a complex concept, often dependent on specific patient characteristics and expectations. 3–5 Another important aspect of patient satisfaction is the perception of the care actually received. These include the technical quality of care, the interpersonal skills of the physician, and acces- sibility/availability. 3,5 Measurement of patient satisfaction by patient survey scores are increasingly being tied to incentive compensation, and used for benchmarking of both physicians and hospitals by specialties and geographic areas. Medicare reimbursements to health care facilities could decrease by as much as 2% if hospitals do not meet benchmark patient satisfaction goals determined by the CMS. These surveys may also impact how we practice medicine, influence decisions on where patients seek care, and in the future may be required for accreditation. 2,6–9 An entirely new industry centered on health care–related patient satisfaction surveys has evolved with the man- dates from the CMS to measure patient satisfaction. The literature is replete with concerns regarding patient satisfaction questionnaires. These include the types of surveys used, how surveys are constructed, how the surveys are distributed, 6,10–13 timing of survey dis- tribution, 7,14,15 response rates and nonresponse bias, 12,16–20 costs associated with survey administration and distribution, 6,7 the impact on physician pro- ductivity, 21 and the impact on resident training. 22 From the Center for Pediatric Orthopaedics, Phoenix Children’s Hos- pital, Phoenix, AZ. The authors declare no conflicts of interest. Reprints: Lee S. Segal, MD, Department of Orthopedics and Re- habilitation, University of Wisconsin School of Medicine and Public Health, UWMF Centennial Building, 1685 Highland Avenue, Madison, WI 53705-2281. E-mail: segal@ortho.wisc.edu. Copyright r 2014 by Lippincott Williams & Wilkins ORIGINAL ARTICLE J Pediatr Orthop  Volume 00, Number 00, ’’ 2014 www.pedorthopaedics.com | 1