The Effect of Social Deprivation on Patient Satisfaction in Otolaryngology Clinics

Abstract

Objectives: Multiple factors have been associated with lower satisfaction scores. We hypothesize that patients with a more deprived socioeconomic status will have different patient satisfaction scores than patients of higher socioeconomic status. Methods: We reviewed Press Ganey satisfaction scores for new, outpatient visits between January 1, 2014, and December 31, 2018. Due to the high ceiling effects of the survey, “satisfaction” was defined as achieving a perfect score of 100. We determined social deprivation using the 2015 Area Deprivation Index (ADI) which serves as a proxy for socioeconomic status derived from zip codes. Patient satisfaction was defined as a binary variable. Univariate and multivariate binary logistic regression analyses were used to identify factors correlated with patient satisfaction. Results: There were 3239 unique new patients with completed surveys. Univariate analysis demonstrated decreased odds of achieving satisfaction for both the Total Score and Provider Sub-Score for each decile increase in ADI (OR 0.94; CI = 0.908-0.981; P = .003 and OR 0.94; CI = 0.91-0.98; P = .002 respectively). Multivariate analysis revealed the odds for reporting satisfaction for each decile increase in ADI were 0.96 for Total Score (CI = 0.921-0.998; P = .038) and 0.96 for Provider Sub-Score (CI = 0.92-0.993; P = .019). Patients in the most deprived quartile, compared to the least deprived, were significantly less likely to be satisfied with their care for both Total Score (OR 0.70; CI = 0.564-0.865; P = .001) and Provider Sub-Score (OR 0.69; CI = 0.558-0.852; P = .001). Conclusions: Increased social deprivation was an independent predictor of lower patient satisfaction in otolaryngology outpatients using the Press Ganey survey. This non-modifiable outcome should be taken into consideration when evaluating patient satisfaction scores and offers further support to the need of addressing and improving healthcare discrepancies in the field of otolaryngology. Level of Evidence: Level 3

Race and Area of Deprivation Index Predict Outcomes of Endoscopic Sinus Surgery for Chronic Sinusitis

“…ADI as a predictor of outcomes has been used in very few studies in rhinology. 31,32 The data in the study indicates that race and ADI are important factors that should be considered when tailoring postoperative care for patients undergoing ESS. Further research is needed to uncover the impact of race and ADI on presentation and outcomes of patients with CRS.…”

Disparities in the Presentation and Management of Pediatric Retropharyngeal Abscess

“…22,23 Within otolaryngology, ADI has been used to examine potential disparities following oral cavity cancer surgery and patient satisfaction in otolaryngology clinics. 24,25 Liao and colleagues demonstrated that ADI is correlated with increased length of stay and cost following pediatric tracheostomy, 26 whereas Cheung and colleagues were unable to find a significant association between ADI and outcomes following pediatric adenotonsillectomy for sleep disordered breathing. 27 There remain, however, no studies which have used the index to investigate inequities in deep-neck infections such as RPA.…”

“…Notable associations with ADI include increased rates of hospital readmission and increased incidence of COVID‐19 22,23 . Within otolaryngology, ADI has been used to examine potential disparities following oral cavity cancer surgery and patient satisfaction in otolaryngology clinics 24,25 . Liao and colleagues demonstrated that ADI is correlated with increased length of stay and cost following pediatric tracheostomy, 26 whereas Cheung and colleagues were unable to find a significant association between ADI and outcomes following pediatric adenotonsillectomy for sleep disordered breathing 27 .…”