Thursday, September 27, 2018 1:05 PM–2:05 PM Understanding Anxiety and Depression when Performing Spine Surgery: 122. The engaged patient: patient activation can predict satisfaction with surgical treatment of lumbar and cervical spine disorders

Abstract

BACKGROUND CONTEXT Satisfaction is an important metric to health systems and payers. While satisfaction can be applied broadly to the entire medical care experience, surgeons are often concerned with (and have control over) a patient's satisfaction with his or her own care. The literature suggests that there may be patient characteristics that are associated with patients being more satisfied. Engaged patients are those who 1) believe taking an active role in their care is important, 2) have the knowledge and skills to manage their condition, 3) have the confidence to make necessary behavioral changes, and 4) can persist in those changes in times of stress. These four stages of patient activation are a measure of the engaged patient. Previously, we have demonstrated that spine patients vary on their level of patient activation and that variation can predict engagement in postoperative rehabilitation. Furthermore, we showed that a brief telephone-based intervention can improve patient activation and lead to better health outcomes following lumbar surgery. PURPOSE To determine whether engaged patients (ie, those with high patient activation) are more likely to be satisfied with the results of their surgical treatment. STUDY DESIGN/SETTING Prospectively collected registry of patient reported outcomes in a multi-provider university practice. PATIENT SAMPLE Patient presenting for evaluation prior to surgery (n=854) for cervical or lumbar spine disorders. OUTCOME MEASURES Patients were assessed before and after surgery (6 weeks and 3, 6, and 12 months) using PROMIS health domains. Using the North American Spine Society Patient Satisfaction Index (PSI), patients were characterized as satisfied (ie, treatment met expectations) versus not satisfied (all other responses). Additionally, patients completed the Patient Activation Measure to calculate their stage of activation. METHODS Using repeated measures logistic regression, we compared the likelihood of being satisfied with surgical results across stages of patient activation after adjusting for baseline characteristics (ie, age, gender, race, education, income and marital status). RESULTS While a majority of patients endorsed the highest level of activation (53%), 72 (8%) endorse the lowest stage (ie, did not believe taking an active role was important). The remainder endorsed the second and third stages of activation (13% and 26%, respectively). Preoperative patient activation was weakly correlated (r CONCLUSIONS Even after adjusting for known predictors of satisfaction, patients who are more engaged in their health care are significantly more likely to be satisfied with the outcomes of their surgery. We have demonstrated that patient activation is a mutable construct – people can become more engaged. Clinicians may want to implement proven techniques to increase patient activation in order to improve an important metric to health systems and payers. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.