Race, rank, and satisfaction in general OB/GYN clinics

Objective: The purpose of this study was to test the hypothesis that racial differences in satisfaction can be found among OB/GYN patients on a US naval base. Methods: Cross-sectional surveys assessing satisfaction with services were obtained from 838 patients who were seen in one of the two general OB/GYN clinics (455 in the base hospital clinic and 391 in a satellite clinic). Multiple logistic regression analysis was used to identify subgroups of patients who were not very satisfied with care received. Results: Higher rank patients were more satisfied. When the patients seen in the base hospital were analyzed separately, Asian respondents had significantly lower odds of being very satisfied relative to non-Hispanic white respondents (AOR=.33, p<.01). Separate analysis of the patients seen in the satellite clinic produced only one significant predictor: persons in the highest rank group had adjusted odds of 2.76 relative to the lowest rank (p=.02) Conclusion: Higher ranking patients treated in a naval medical facility (or their family members) may be more satisfied than patients of lower ranks. Asian patients may be less satisfied than others when treated at a larger facility. Patients treated at a satellite clinic tended to be more satisfied than patients seen at the base hospital. Background Patient satisfaction has become widely regarded as an important performance indicator for health systems [1]. Patients are the best judge of those aspects of care that matter the most to them [2]. Therefore, patient-centered health systems seek to achieve high levels of patient satisfaction. However, fewer studies reported in the OB/GYN literature focus on satisfaction than might be expected. Hospital maternity care has been assessed using patient satisfaction [3,4] and patient satisfaction has been used to compare OB/GYN to other providers or specialties [5,6]. An increasing number of studies have evaluated the benefits of particular procedures using patient satisfaction as an outcome measure [7-13]. This report adds to the limited fund of information about the determinants of patient satisfaction among OB/GYN clinic patients. Studies of other types of medical care have found racial disparities in satisfaction [14-16] and better satisfaction with midlevel providers than with MDs in either pediatrics or adult medicine clinics [17]. Organizational issues appear to be important as well: women seen in women’s clinics are more satisfied than those attending mixed-gender clinics [18], patients seeing providers of the same race are more satisfied than those seeing a physician of a different race [19], free-standing clinics may be scored higher than hospital based clinics by patients [1], and clinics achieving a higher level of provider continuity may also attain higher levels of patient satisfaction, provided that patients may change providers when they so desire [20]. Whether any of these relationships hold true for OB/GYN care is not known. Racial disparities in health status, access to care and quality have been demonstrated in many venues; these, therefore, will be the focus of this report. The purpose of this study was to test the hypothesis that racial differences in satisfaction can be found among patients seen in general OB/GYN clinics operated by the Naval Medical Center in San Diego. By using just one health system, most organizational characteristics were ruled out as possible causes of differences in satisfaction. In addition, cost to the patient was not a factor since all care was free to the user. In effect, the military medical care system in a single city provides a natural laboratory for assessing the effects of race on satisfaction with minimal confounding from other variables such as poverty and variations in the availability of providers. Methods Over a two-month period, a convenience sample of 1544 women receiving OB/GYN services at a large military hospital completed a two-page questionnaire. The survey was approved by the Institutional Review Board. No written consents were required. The questionnaire was formatted on a two-sided standard automated data form, which was distributed randomly to patients receiving OB/GYN care at all department clinics, as well as to antepartum and post-partum inpatients. With receipt of the survey, each patient also received written and verbal explanations and instructions from clinic staff. Patients previously completing a questionnaire at any location were excluded from