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

Area of Science:

• Health Services Research
• Patient Experience Measurement
• Psychometrics

Background:

• Patient satisfaction is crucial and increasingly incentivized in healthcare.
• Existing satisfaction questionnaires often exhibit ceiling effects, limiting their utility for improvement.
• Musculoskeletal specialty care visits present an opportunity to evaluate novel satisfaction measures.

Purpose of the Study:

• To evaluate a Guttman-type Satisfaction Scale (GSS) for measuring patient satisfaction after musculoskeletal specialty care.
• To assess the GSS's psychometric properties, including floor and ceiling effects, skewness, and kurtosis.
• To identify factors associated with overall satisfaction and the highest possible scores on the GSS.

Main Methods:

• A cross-sectional study involving 164 patients visiting an orthopedic surgeon.
• Patients completed questionnaires on demographics, depression symptoms, catastrophic thinking, illness concerns, and the GSS.
• Bivariate and multivariable analyses were used to examine associations with GSS scores.

Main Results:

• The GSS demonstrated no floor effect but a 38% ceiling effect, with skewness of -0.08 and kurtosis of 1.3.
• Lower satisfaction was independently associated with increased symptoms of depression (β: -0.03, P = .047).
• Higher GSS scores were associated with being female (OR: 2.12, P = .046) and lower educational attainment (Masters vs. High School: OR: 0.16, P = .007).

Conclusions:

• The Guttman-type Satisfaction Scale (GSS) has a notable ceiling effect (38%), which is lower than some ordinal scales but still high.
• Depression symptoms are a significant factor associated with lower patient satisfaction.
• Further research is needed to develop patient experience measures with reduced ceiling effects.