Factors Associated With Patient Satisfaction Measured Using a Guttman-Type Scale

Journal of Patient Experience, vol. 7, pp. 1211–1218

Abstract

Patient experience measures such as satisfaction are increasingly tracked and incentivized. Satisfaction questionnaires have notable ceiling effects that may limit learning and improvement. This study tested a Guttman-type (iterative) Satisfaction Scale (GSS) after a musculoskeletal specialty care visit in the hope that it might reduce the ceiling effect. We measured floor effects, ceiling effects, skewness, and kurtosis of GSS. We also assessed factors independently associated with GSS and the top 2 possible scores. In this cross-sectional study, 164 patients seeing an orthopedic surgeon completed questionnaires measuring (1) a demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit (GSS). Bivariate and multivariable analyses sought associations of the explanatory variable with total GSS and top 2 scores of GSS. Accounting for potential confounding using multivariable analysis, lower satisfaction was independently associated with greater symptoms of depression (β: −0.03; 95% CI: −0.05 to −0.00; P = .047). The top 2 scores of the GSS were independently associated with women (compared to men: odds ratio [OR]: 2.12, 99% CI: 1.01-4.45, P = .046) and lower level of education (masters’ degree compared to high school; OR: 0.16, 95% CI: 004-0.61, P = .007). The GSS had no floor effect, a ceiling effect of 38%, a skewness of −0.08, and a kurtosis of 1.3. The 38% ceiling effect of the iterative (Guttman-style) satisfaction measure is lower than ordinal satisfaction scales, but still undesirably high. Alternative approaches for reducing the ceiling effect of patient experience measures are needed.

Authors 6

1. Yvonne Versluijs Aachen Department of Trauma Surgery

   The University of Texas at Austin · Leiden University Medical Center

   Affiliation as printed

   Department of Surgery and Perioperative Care, Dell Medical School—The University of Texas at Austin, Austin, TX, USA

   Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands

2. Laura E. Brown Aachen Department of Trauma Surgery

   Leiden University Medical Center

   Affiliation as printed

   Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands

3. Mauna Rao

   The University of Texas at Austin

   Affiliation as printed

   Department of Surgery and Perioperative Care, Dell Medical School—The University of Texas at Austin, Austin, TX, USA

4. Amanda Inez Gonzalez

   The University of Texas at Austin

   Affiliation as printed

   Department of Surgery and Perioperative Care, Dell Medical School—The University of Texas at Austin, Austin, TX, USA

5. Matthew D. Driscoll

   The University of Texas at Austin

   Affiliation as printed

   Department of Surgery and Perioperative Care, Dell Medical School—The University of Texas at Austin, Austin, TX, USA

6. David Ring corresponding

   The University of Texas at Austin

   Affiliation as printed

   Department of Surgery and Perioperative Care, Dell Medical School—The University of Texas at Austin, Austin, TX, USA