Journal of Dentistry, Oral Disorders & Therapy

A structured patient Satisfaction Survey (SS) was prepared in order to be sent by means of the HCPTMMS. The satisfaction surveys were sent and data was received using a HIPPA-compliant website by the one study investigator. The study data were protected by health information defined by HIPAA (1996), The 2009 Health Information Technology for Economic and Clinical Health (HITECH) and the Omnibus Rule were followed for this study.

The questions evaluated in this study from the SS were:
A) Were you seen within an acceptable time of your appointment? Answer options are: "Kept waiting longer than 15 minutes", "kept waiting around 10 minutes", "Seen within 5 minutes", and "Seen immediately."
B) Would you recommend your provider to friends and family if they require similar treatment? Yes, No or maybe.
C) Howore 3 was neutral; core 4 was satisfied; and, score 5 was strongly satisfied.
D) How would you rate your overall experience at UTHSC College of Dentistry on a scale of 1-5 where score 1 was strongly dissatisfied; score 2 was dissatisfied; score 3 was neutral; core 4 was satisfied; and, score 5 was strongly satisfied.

The data comprise of frequency of answers, and due to small sample size, the scores were treated as categorical values. We used Fisher’s Exact chi-square test to examine the differences in frequency distributions at the statistical level of p < 0.01 (Stata 14.2, College Station, TX). The analysis for the four questions were analyzed for each procedure and by female and male patients after dental treatment.

This study consisted of the evaluation of the SS of 4 questions (section SS) for 3 procedures (GS, CP, and NP (section HCPTMMS). Three-hundred and sixty-two Satisfaction Surveys (SS) were sent after the completion of the following procedures: General Surgery (GS); Conventional Prosthodontics (CP); and, nonsurgical periodontal treatment (NP). The overall percentage of survey response was 17.96% (n= 65). The percentage of survey responses received for all the SS sent for each procedure being evaluated werethe following: 29.41% for GS; 12.71% for CP; and, 19.04% for NP (Table 1). For question “A” (Were you seen within an acceptable time?), of the total SS responses for the GS group (n=11), the majority of the participants (n= 7) were female, when compared to male (n= 4). When comparing best response for the SS responses among gender, 42.9% of the females showed superior percentage for the 2 highest categories (seen immediately and seen within 5 minutes) when compared to 25% of the males, which also had the same percentage for the 2 highest categories (seen immediately and within 5 minutes). When adding females and males, the overall highest percentage was 66.7% (n= 10) for "seen immediately" (Table 2). In the GS group, 50% of the males reported having to wait more than 15 minutes before being seen by their provider (Table 2). For question "A", of the total SS responses for the CP group (n=15), the majority of the participants were female (n= 10), when compared to male (n= 5). When comparing best response (seen immediately) for the SS responses among gender, 60% of the males showed superior percentage when compared to 40% of the females. When adding females and males, the overall highest percentage was 46.7% (n= 7) for “seen immediately”. In the CP group, both, female and male responders showed highest percentage of “seen immediately” by their provider (Table 2). When examining the patient’s waiting time by procedure, the authors found no difference in gender, and across procedures, the patterns were similar. For question “B”, of the total SS responses for all 3 procedures (GS, CP and NP), 93.84% (n= 61) of the respondents answered “yes”, 4.61% (n= 3) responded “may be” and only one respondent (1.53%) would not recommend their provider to friends and family. When evaluating the statistical significance within the SS responses for question “B”, it was shown that there was statistical significance between answers “Yes” and “May be” (p < 0.0001); and, “Yes” and “No” (p < 0.0001)responses when applying the z-statistics test (Table 3). The overall score for the SS responses (N = 65) for the question: How would you rate your provider? (C), was compiled

from all three procedures (GS, CP, NP) studied (Table 4). From the total SS responses for the GS group (n=11), the majority of the participants (n= 7) were female, when compared to male (n=4). Among thehighest scores (score 5) of the SS responses among gender, 100% (n= 4) of the males showed superior percentage when compared to 57.1% (n= 4) of the females. When adding females and males, the overall highest percentage was 72.7% (n= 8) for score 5 (Table 4). For question “C”, of the total SS responses for the CP group (n=15), the majority of the participants (n= 10) were female, when compared to male (n= 5). When comparing highest scores (score 5) for the SS responses among gender, 80% (n= 8) of the females showed superior percentage when compared to 40% (n= 2) of the males. When adding females and males, the overall highest percentage was 66.7% (n= 10) for score 5 (Table 4).

For question “C”, of the total SS responses for the NP group (n=39), the majority of the participants (n= 25) were female, when compared to male (n= 14). When comparing highest scores (score 5) for the SS responses among gender, 76% (n= 19) of the females showed superior percentage when compared to

64.3% (n= 9) of the males. When adding females and males, the overall highest percentage was 71.8% (n= 28) for score 5 (Table 4). When adding all three procedure SS responses for question “C”, the majority of the participants (n= 42) were female, when compared to male (n= 23). When comparing highest scores (score 5) for the SS responses among gender, 65.2% (n= 15) of the males showed superior percentage when compared to 73.8% (n= 31) of the females. When adding females and males, the overall highest percentage was 70.8% (n= 46) for score 5. When evaluating the statistical significance within the groups, it was shown that there was statistical superiority when comparing different groups; however, there was no statistical significance. The p values within the scores for each of the procedures conducted were 0.661, 0.077, 0.646, for groups GS, CP & NP, respectively (Table 4). A similar pattern was observed for patient’s overall experience at UT (Table 5). Overall, 25.9% patients reported satisfied, and 69% of patients reported strongly satisfied. There was no statistically significant difference in the score distribution by gender. For question “D” (How would you rate your overall experience at UT?), of the total SS responses for the GS group (n=10), the majority of the participants were female (n= 7), when compared to male (n= 3). When comparing highest scores (score 5) for the SS responses among gender, 57.1% (n= 4) of the females showed superior percentage when compared to 66.7% (n= 2) of the males. When adding females and males, the overall highest percentage was 60% (n= 6) for score 5 (Table 3). This procedure showed 28.6% (n=2) females that gave scored 3 (Table 5).

For question “D”, of the total SS responses for the CP group (n= 14), the majority of the participants were female (n= 9), when compared to male (n= 5). When comparing highest scores (score 5) for the SS responses among gender, 77.8% (n= 7) of the females showed superior percentage when compared to 60% (n= 3) of the males. When adding females and males, the overall highest percentage was 71.4% (n= 10) for score 5 (Table 5).For question “D”, of the total SS responses for the NP group (n= 34), the majority of the participants were female (n= 23), when compared to male (n= 11). When comparing highest scores (score 5) for the SS responses among gender, 73.89 (n= 17) of the females showed superior percentage when compared to 63.6% (n= 7) of the males. When adding females and males, the overall highest percentage was 70.6% (n= 24) for score 5 (Table 3). For this procedure, a female (n = 1) gave score 3 (Table 5). When adding all three procedure SS responses for question “D”, the majority of the participants (n= 39) were female, when compared to male (n= 19). When comparing highest scores (score 5) for the SS responses among gender, 71.8% (n= 28) of the females showed superior percentage when compared to 63.2% (n= 12) of the males. When adding females and males, the overall highest percentage was 69% (n= 40) for score 5. When evaluating the statistical significance within the groups, it was shown that there was statistical superiority when comparing different groups; however, there was no statistical significance. The p values within the scores for each of the procedures conducted were 1.00, 0.580, 0.620, for groups GS, CP & NP, respectively (Table 5).

Non-response bias and differences in response rates may interfere in the real evaluation of a survey. A higher non-response rate to satisfaction surveys may result in a less chance to obtain a true representation of all the patient’s feelings of satisfaction [13]. In addition, a high non-response rate may impair statistical power and the validity of the study [14]. Rodeghier showed that even when the response rates of a survey fall below 50%, if the sample characteristics are similar to the population characteristics, it would improve the confidence that the sample results reflect the feelings of the population [15,16], showed that it is not valid to focus on response rates alone in determining the quality of survey data. In the present study, the patient population used in this was from the UTHSC College of Dentistry. These patients were all being submitted to dental treatment and with similar concerns and needs, therefore, we believe that in spite of the low response rate, the sample is representative of the population being studied. One of the advantages for using a HCPTMMS for conducting the satisfaction survey is that the survey can be conducted at the patient’s convenience. The patient does not need to come to the clinic or stay extra-time after their appointment to fill-out a survey (written or digital). It has been shown that surveys that are distributed internally (i.e. to employees) generally have a much higher response rate than those distributed to external audiences (i.e. patients). Internal surveys will generally receive a 30-40% response rate (or more) on average, compared to an average 10-15% response rate for external surveys[17]. The present study is considered an external survey, which is in agreement with Custom insight [17], showing a response rate slightly above (17.95%) the acceptable response rate (10-15%) for externally distributed surveys.The possible low response rate obtained in this study could have been due to the patient information not being fully updated in the patient’s dental charts after the patients consented to participate in this study. This could have resulted in using a phone number that was not able to receive messages, precluding the patient in being allocated into the non-response category, when the patient did not receive the message, and could not have; therefore, responded to it. An advantage of using a phone application to obtain satisfaction surveys from student doctor cases optimizes faculty evaluations due to the ability of faculty to enter the HIPPA compliant online based system, at their convenience and in a timely fashion. In addition, the HCPTMMS showed to be effective and efficient for faculty evaluation of student doctor’s clinical performance using a patient satisfaction survey of the treatment rendered. Had this same evaluation been conducted in a paper format, the time lapse and inconvenience of data collection would probably make this system non-efficient and time consuming. While there isn’t a consensus between the literatures on the definition for patient satisfaction in healthcare, [18] suggested a definition which includes patient emotions, feelings and their perception of delivered healthcare services. Alternatively, other authors defined patient satisfaction as a degree of congruency between patient expectations of ideal care and their perceptions of real care received. This is in agreement with the Commission on Dental Accreditation (CODA) accreditation standards for dental education programs [19], which recommends the use of comprehensive patient-centered care, by assuring that the patients’ preferences and their social, economic, emotional, physical and cognitive circumstances are sensitively considered [19]. The current study used technology to evaluate patient satisfaction in the one of the recommendations of the CODA standards for evaluation of patient centered care.The overall SS conducted for all the categories showed that the UTHSC College of Dentistry, by making use of a HCPTMMS, was able to collect SS from patients that can be used as a novel clinical evaluation tool of the patient’s overall and specific satisfaction to treatment. This method of evaluation gives faculty a view of outcome of treatment that is synchronized with CODA accreditation standards of using technology to enhance evaluation methods. Considering this is a method that makes use of electronic devices that are owned by a great majority of the population3, the authors suggest that this method of obtaining patient SS is the most convenient, when compared to paper SS and SS conducted by means of local electronic devices, when the patient needs to spend extra posttreatment time at the dental facility to respond to a satisfaction survey. This is in agreement with the literature[12]. This is the first study that used a HCPTMMS to obtain patient treatment satisfaction surveys for rating the student doctor on his/her clinical performance. The use of non-parametric statistics provides better validation of the data presented in our study. Additional studies are necessary in order to validate this method of evaluating student doctor’s clinical performance by their clinical faculty, by comparing the clinical evaluation with and without using the HCPTMMS.

The HCPTMMS satisfaction survey is a novel method that can be incorporated into faculty’s student doctor clinical evaluation, using technology to obtain patient’s satisfaction to treatment rendered.

The authors would like to thank Ms. Colette Steward, clinical research associate, Dr. Patricia Dingeldein, Assistant Professor in General Practice of Dentistry and Mr. Frank Pancratz, for their assistance during the implementation of this project. The authors are grateful for the University of Tennessee Alumni Foundation for funding this project. In addition, the authors would like to thank Dr. David Holmes, DDS; Dr. Jon Askonas, and Dr. Hansen Tsui for their support in establishing the HCPTMMS at the UTHSC College of Dentistry for the implementation of this study.

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