title: Admission Through the Emergency Department Is an Independent Risk Factor for Lower Satisfaction With Physician Performance Among Orthopaedic Surgery Patients: A Multicenter Study.
abstract: BACKGROUND
  Patient experience data are increasingly used to guide performance improvement and to determine physician and hospital reimbursement. We studied the relationship between emergency department (ED) admission and patient satisfaction with physicians' performance, and identified other associated predictors.
  
  
  METHODS
  We evaluated 6,524 inpatient Press Ganey patient experience surveys from two academic level I trauma centers over 5 years. We stratified patients by ED admission or other admission and compared the proportions of patients in each group who were satisfied with physician performance. We used logistic regression to control for demographic differences and characteristics of hospitalizations.
  
  
  RESULTS
  Among patients admitted through the ED, 85.18% were satisfied, compared with 89.44% of patients admitted through other pathways (P < 0.001). Admission through the ED predicted decreased satisfaction, with an odds ratio of 0.67 (P = 0.032) after controls were applied through logistic regression.
  
  
  CONCLUSIONS
  Admission through the ED is an independent risk factor for lower satisfaction with physician performance. Understanding the determinants of patient satisfaction will help improve physician-patient interactions and guide quality improvement and value-based reimbursement initiatives.
  
  
  METHODS
  This retrospective survey-based analysis of satisfaction does not fall clearly under any of the Journal's established categories of level of evidence. The most closely aligned choice would be Level III Prognostic.
authors: From the Department of Orthopaedic Surgery, Stanford University Medical Center, Redwood City, CA (Dr. Vorhies and Dr. Bishop), and the Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA (Dr. Weaver).
authors: John S
authors: JS
authors: Vorhies
authors: Michael J
authors: MJ
authors: Weaver
authors: Julius A
authors: JA
authors: Bishop
mesh_terms: D002983:Clinical Competence; D004636:Emergency Service, Hospital; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization; D006801:Humans; D007297:Inpatients / Q000523:psychology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D009985:Orthopedics / Q000592:standards*; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012307:Risk Factors