Bias in Patient Experience Scores in Radiation Oncology: A Multicenter Retrospective Analysis

OBJECTIVE: Patient experience scores are increasingly important in measuring quality of care and determining reimbursement from payers, including the Hospital Value Based Purchasing Program and the Radiation Oncology Model. However, the role of bias in patient experience scores in oncology is unknown, raising the possibility that such payment structures may inadvertently perpetuate bias in reimbursement. Therefore, we characterized patient-, physician-, and practice-level predictors of patient experience scores in patients undergoing radiation therapy. METHODS: We retrospectively reviewed patient experience surveys for radiation oncology patients treated at two large multi-site academic cancer centers. The outcome was responses on four survey questions. Co-variates included self-reported patient demographics, physician characteristics, practice setting characteristics, and wait time rating linked to each survey. We fitted multivariable ordinal regression models to identify predictors of receiving a higher score on each of the survey questions. RESULTS: 2,868 patients completed surveys and were included in the analysis. Patient experience scores were generally high, with >90% of respondents answering 5/5 on the 4 survey items. Physician gender was not associated with any measured patient experience outcomes (all p-values>0.4). Independent predictors of higher score included a wait-time experience classified as “good” as compared to “not good” (all q-values