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AAOS Now

Published 6/1/2020
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Kaitlyn D’Onofrio

Goal Awareness May Improve Patient Experience

Goal-directed spine care appears to affect satisfaction, decisions

Editor’s note: The following content was published in the AAOS Now Special Edition and distributed in June 2020. The content was originally scheduled for the AAOS Now Daily Edition, which publishes each year onsite at the AAOS Annual Meeting but this year’s meeting in March was canceled due to COVID-19. Despite the cancellation, members can access virtual content from the Annual Meeting by visiting the Academy’s Annual Meeting Virtual Experience webpage.

A prospective cohort study that was presented as part of the Annual Meeting Virtual Experience explored patient-reported goals for outpatient orthopaedic and spine care visits, as well as the impact of patient-healthcare professional goal awareness on patient satisfaction.

“Goal-directed care, rather than disease-focused care, has been well adopted in end-of-life care and chronic disease management but scarcely discussed in the setting of high-value orthopaedic or spine care,” study author Chad M. Patton, MD, MS, medical director of spine surgery at Anne Arundel Medical Center-Luminis Health, told AAOS Now. “It would seem likely that meeting the health goals of patients would positively impact overall satisfaction with care, which prompted our question as a first step: Would simply asking patients about their goals improve overall patient satisfaction?”

The study included consecutive patients aged 18 years or older who were seeking new specialist care at an orthopaedic spine clinic. Each patient was questioned about his or her goal(s) for the clinical visit; together, the patient and either a fellowship-trained spine surgeon or independent nonsurgical spine nurse practitioner discussed the goal(s), which were recorded in the patient’s medical record. Examples of goals included “increase my mobility,” “maintain my ability to work,” “learn about spine surgery,” and “get a second opinion.” The main outcome measure was frequency of patient goals, stratified by whether the patient was seeing a surgeon or nurse practitioner. The secondary outcome was monthly aggregate Press Ganey patient satisfaction top-box scores before and after the intervention was implemented.

Goals differ based on who gives treatment

Of the 329 patients included in the first four months of the study, 115 (35 percent) received care from a fellowship-trained spine surgeon and 214 (65 percent) from a nurse practitioner. The average number of goals reported at the first encounter was five (range, 0–13 goals). The top-reported goals were to reduce pain (89.1 percent), learn about causes of symptoms (66.3 percent), increase mobility (57.1 percent), return to activities enjoyed (48.9 percent), improve sleep (42.6 percent), and improve overall spine health or posture (41.6 percent).

The frequency with which goals were reported varied by whether patients were seen by a fellowship-trained spine surgeon or nurse practitioner, and patient goals appeared to affect eventual treatment recommendations, Dr. Patton explained.

“For example, patient goals of ‘learn about exercises for my spine’ were unlikely to have a surgical condition or receive recommendations for surgery. Meanwhile, goals of ‘return to activities or social events I enjoy’ or ‘learn about surgery’ tended to have diagnoses of spinal stenosis and eventual recommendations for surgical treatment,” he said. “While these findings may seem intuitive, we realized that patient goals may actually hold additional value in triaging patients to the best [healthcare professional] type. Particularly in spine care, where patients with a variety of conditions can see a variety of [healthcare professional] types, matching patient goals with expertise in an efficient manner is imperative in the delivery of high-value care.”

“Compared to our pre-implementation scores, we found that our Press Ganey patient satisfaction scores significantly improved postimplementation for both the spine surgeon and nurse practitioner,” Dr. Patton added. Before implementation, patient satisfaction scores for spine surgeon and nurse practitioner were 87.3 percent and 91.8 percent, respectively; after implementation, they increased to 95.6 percent and 96.6 percent, respectively.

The authors concluded that although patient goals may differ based on the type of professional who provides care, most patients believe that improving pain and function is of significant importance. Their findings further suggest that patients’ and professionals’ goal awareness may positively impact the patient experience.

“Further areas of exploration will include an evaluation of patient satisfaction across other subspecialties and adaptation into our appointment scheduling process,” said Dr. Patton. “We are excited to continue to study this topic further.”

Dr. Patton’s coauthors of Poster 336, “Patient Goal-directed Care in an Orthopedic Spine Specialty Clinic,” are Zachary Sanford, MD; Elizabeth Keller; Andrew Broda, BS; Justin Turcotte, PhD, MBA; and Karen Pipkin, MS, ACNP-C, FNP-C.

Kaitlyn D’Onofrio is the associate editor for AAOS Now. She can be reached at kdonofrio@aaos.org.