Patient Satisfaction, Treatment Experience, and Disability Outcomes in a Population‐Based Cohort of Injured Workers in Washington State: Implications for Quality Improvement

Abstract

Objective. To determine what aspects of patient satisfaction are most important in explaining the variance in patients' overall treatment experience and to evaluate the relationship between treatment experience and subsequent outcomes. Data Sources and Setting. Data from a population‐based survey of 804 randomly selected injured workers in Washington State filing a workers' compensation claim between November 1999 and February 2000 were combined with insurance claims data indicating whether survey respondents were receiving disability compensation payments for being out of work at 6 or 12 months after claim filing. Study Design. We conducted a two‐step analysis. In the first step, we tested a multiple linear regression model to assess the relationship of satisfaction measures to patients' overall treatment experience. In the second step, we used logistic regression to assess the relationship of treatment experience to subsequent outcomes. Principal Findings. Among injured workers who had ongoing follow‐up care after their initial treatment (n=681), satisfaction with interpersonal and technical aspects of care and with care coordination was strongly and positively associated with overall treatment experience (p<0.001). As a group, the satisfaction measures explained 38 percent of the variance in treatment experience after controlling for demographics, satisfaction with medical care prior to injury, job satisfaction, type of injury, and provider type. Injured workers who reported less‐favorable treatment experience were 3.54 times as likely (95 percent confidence interval, 1.20–10.95, p=.021) to be receiving time‐loss compensation for inability to work due to injury 6 or 12 months after filing a claim, compared to patients whose treatment experience was more positive.

Legal Representation and Dissatisfaction with Workers’ Compensation: Implications for Claimant Adjustment

“…For example, injured workers in Washington State who were dissatisfied with their medical care ("less than excellent" overall treatment experience) were over 3.5 times more likely to receive time-loss compensation for work disability 6-12 months after claim filing, relative to patients who reported an "excellent" care experience (Wickizer et al 2004b). Similarly, lower levels of overall WC satisfaction (satisfaction with quality and thoroughness of medical treatment, treatment by employer, WC process, and legal system) were significantly associated with higher levels of pain-related disability 21 months post-claim settlement among low back pain claimants, after adjustment for important demographic and WC variables .…”

Evaluation of Self-Reported Work Ability and Usefulness of Interventions Among Sick-Listed Patients

“…Previous studies have shown that patients' treatment satisfaction may be related to expectations and preferences for treatment, adherence to treatment and treatment success (24, 31, 37, 38). For example, Wickizer et al (38) found that, among injured employees, those who reported less satisfaction with treatment were more likely to receive compensation for inability to work.…”

Quality of Care for Work-Associated Carpal Tunnel Syndrome

“…Prior studies in workers' compensation settings have assessed the timeliness of initial visits and claims, the completeness of claim forms, visit frequency among those off work, populationbased rates of spinal imaging and opioid prescribing, disability duration, and patient satisfaction. 11,[38][39][40][41][42][43] In Washington State, disability days declined by 20% after policymakers gave physicians financial incentives to communicate with employers, prescribe appropriate activity, and assess barriers to return to work. 40 Our work affirms that activity assessment and management warrant improvement.…”