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


  • Thomas M. Wickizer,

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    • Address correspondence to Thomas Wickizer, Ph.D., Professor, Department of Health Services, Box 357660, University of Washington, Seattle, WA 98195-7660. Gary Franklin, M.D., M.P.H., is with the Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, and the Washington State Department of Labor and Industries, Olympia. Deborah Fulton-Kehoe, M.P.H., and Terri Smith-Weller are with the Department of Environmental and Occupational Health Sciences, University of Washington. Judith A. Turner, Ph.D., is with the Departments of Psychiatry and Behavioral Sciences and Rehabilitation Medicine, University of Washington. Robert Mootz, D.C., is with the Washington State Department of Labor and Industries.

  • Gary Franklin,

  • Deborah Fulton-Kehoe,

  • Judith A. Turner,

  • Robert Mootz,

  • Terri Smith-Weller

  • The survey on which this study was based was funded by the Washington State Department of Labor and Industries. Partial support for the preparation of this article was provided by the Robert Wood Johnson Foundation through a grant from the Health Care Financing and Organization (HCFO) Program.


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.