The State of Chiropractic 2021: Part 1 – Patient Satisfaction

The following is part one of a multi-part series discussing the state of chiropractic care as we end the year 2021.  This synopsis details and grades chiropractic management of injury in terms of four key healthcare performance indicators:

1. Patient Satisfaction
2. Clinical Outcomes (Results)
3. Cost-effectiveness
4. Safety

*Data for this post was provided in part by over 190 peer reviewed/published articles (referenced below) and a dataset compiled by the ChiroUp network – an analysis of 631,970 clinical diagnoses collected from more than 2,200 evidence based chiropractic providers between July 2019 and June 2021.  Patient satisfaction and clinical outcome metrics were derived from an emailed anonymous follow-up sent to all patients of the dataset with an overall response rate of 20.01%.

Patient Satisfaction

Within context of satisfaction, the chiropractic profession has historically performed well. (2-8)  When studied, patient satisfaction has scored in the 80th percentile, with those surveyed rating their experience as satisfied or very satisfied (2).  Surveys collected by ChiroUp between 2019 and 2021 suggest similar levels of satisfaction in terms of case management and treatment. (1) This finding only reinforces the conclusions out of JMPT by Nyiendo et al.

      “With one exception, satisfaction was higher for patients attending chiropractors [as compared to family medicine physicians]”. (8)

Another study out of Spine found that patient satisfaction nearly doubled when chiropractic manipulative therapy was added to a standard medical care model. (9)

Another metric with which consumer satisfaction is measured is the Net Promotor Score (NPS).  NPS is widely considered the gold standard for measuring consumer satisfaction and loyalty.  (10-12) These scores – as they relate to healthcare providers – are calculated from the likelihood that someone would recommend their provider to others (most often on a scale of 0-10).

Patients surveyed on the 2021 ChiroUp network dataset displayed that chiropractors were graded with an exceptionally high NPS score overall:

Studies of NPS and its relation to standard medical care have consistently landed on the scale in the favorable range but it is easy to see that, in general, those patients who seek chiropractic care leave significantly higher NPS scores by comparison to their experience in standard medical care.  (21-23)

Online Satisfaction Reviews – Google/Yelp

NPS, while valuable and statistically significant, may be irrelevant to the average consumer.  Online reviews, as a concept, are much more familiar.  Online ratings provide a simple and easy to understand evaluation of customer satisfaction as it relates to healthcare.

Despite NPS being a different metric than online reviews, research has shown that NPS scores and online reviews of healthcare providers (Google/Yelp/Healthgrades/etc.) tend to mirror their NPS scores. (26,27) Pulling data from the 2021 ChiroUp dataset supports this correlation.

Analysis of datasets released by Yelp reinforce the finding that chiropractic physicians receive higher than average scores by their patients than other healthcare specialties as a whole (26-29):

These findings are similarly supported by datasets released by Healthgrades as well. (30)

Summary

As the data suggests, patients in general tend to consistently report high levels of satisfaction after receiving treatment from a chiropractic physician.  Whether it is NPS, Google, Yelp, or Healthgrades, those patients who sought chiropractic care are overwhelmingly happy they did.  If you are experiencing pain perhaps treatment with chiropractic can leave you filling similarly satisfied.

And with that I will wrap up part one of the state of chiropractic in 2021.  There is a bevy of more excellent information on this dataset/research and I look forward to sharing it with you over the next couple of weeks.  Come back for our next topic Clinical Outcomes/Results.  Thank you and as always if you have any questions or comments please feel free to call the office at (816) 831-1300.

Sources

1. Bertelsman TJ, Steele BC, Gower JG. 2021 ChiroUp Network Dataset: Statistical Reporting of 631,970 Clinical Diagnoses Collected from 2212 Evidence-Based Chiropractic Providers Between July 2019- June 2021. Accessed on 07/30/2021 from Link
2. Sawyer CE, Kassak K. Patient satisfaction with chiropractic care. Journal of Manipulative and Physiological Therapeutics. 1993 Jan 1;16(1):25-32. Link
3. Gemmell HA, Hayes BM. Patient satisfaction with chiropractic physicians in an independent physicians’ association. Journal of manipulative and physiological therapeutics. 2001 Nov 1;24(9):556-9. Link
4. Hertzman-Miller RP, Morgenstern H, Hurwitz EL, Yu F, Adams AH, Harber P, Kominski GF. Comparing the satisfaction of low back pain patients randomized to receive medical or chiropractic care: results from the UCLA low-back pain study. American Journal of Public Health. 2002 Oct;92(10):1628-33. Link
5. Nyiendo J, Haas M, Goldberg B, Sexton G. Patient characteristics and physicians’ practice activities for patients with chronic low back pain: a practice-based study of primary care and chiropractic physicians. Journal of manipulative and physiological therapeutics. 2001 Feb 1;24(2):92-100. Link
6. Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. Journal of Manipulative and physiological Therapeutics. 2000 May 1;23(4):239-45. Link
7. Gaumer G. Factors associated with patient satisfaction with chiropractic care: survey and review of the literature. Journal of manipulative and physiological therapeutics. 2006 Jul 1;29(6):455-62. Link
8. ​​Nyiendo J, Haas M, Goodwin P. Patient characteristics, practice activities, and one-month outcomes for chronic, recurrent low-back pain treated by chiropractors and family medicine physicians: a practice-based feasibility study. Journal of Manipulative and physiological Therapeutics. 2000 May 1;23(4):239-45. Link
9. Goertz CM, Long CR, Hondras MA, Petri R, Delgado R, Lawrence DJ, Owens EF, Meeker WC. Adding chiropractic manipulative therapy to standard medical care for patients with acute low back pain: results of a pragmatic randomized comparative effectiveness study. Spine. 2013 Apr 15;38(8):627-34. Link
10. QualtricsXM. What is NPS? Your ultimate guide to Net Promoter Score. QualtricsXM. Link
11. Reichheld FF. The one number you need to grow. Harvard business review. 2003 Dec 1;81(12):46-55.
12. Liyakasa K. Customer Experience Is Critical in Net Promoter Benchmarks. CRM Magazine. 2012 Jun;16(6):16-. Link
13. Stein N, Brooks K. A fully automated conversational artificial intelligence for weight loss: longitudinal observational study among overweight and obese adults. JMIR diabetes. 2017 Nov 1;2(2):e8590. Link
14. Wilberforce M, Batten E, Challis D, Davies L, Kelly MP, Roberts C. The patient experience in community mental health services for older people: a concept mapping approach to support the development of a new quality measure. BMC health services research. 2018 Dec;18(1):1-1. Link
15. Powell RE, Stone D, Hollander JE. Patient and health system experience with implementation of an enterprise-wide telehealth scheduled video visit program: mixed-methods study. JMIR medical informatics. 2018;6(1):e10. Link
16. Busby M, Matthews R, Burke F, Mullins A, Shumacher K. Is any particular aspect of perceived quality associated with patients tending to promote a dental practice to their friends and colleagues? Br Dent J. 2015;218(6):E12. doi:10.1038/sj.bdj.2015.229
17. Kinney WC. A simple and valuable approach for measuring customer satisfaction. Otolaryngology—Head and Neck Surgery. 2005 Aug;133(2):169-72. Link
18. Koladycz R, Fernandez G, Gray K, Marriott H. The Net Promoter Score (NPS) for insight into client experiences in sexual and reproductive health clinics. Global Health: Science and Practice. 2018 Oct 3;6(3):413-24. Link
19. NBCE. Practice Analysis of Chiropractic 2015. Chapter 1. National Board of Chiropractic Examiners. Link
20. Stochkendahl MJ, Rezai M, Torres P, Sutton D, Tuchin P, Brown R, Côté P. The chiropractic workforce: a global review. Chiropractic & manual therapies. 2019 Dec;27(1):1-9. Link
21. Grigore. What is a Good Net Promoter Score? (2021 NPS Benchmark). Retently. 2021 Apr. Link
22. VisitPay. What’s Your Score? Why Net Promoter Score Matters in Healthcare [ebook]. VisitPay. 2021 Mar. Link
23. WD Partners. Healthcare: Who Survives?. WD Partners Inc. 2019. Link
24. Shalen P. Primary Care Providers. Spine-Health. 2000 Nov. Link
25. Hedges L, Couey C. How Patients Use Online Reviews. Software Advice. 2020 Apr. Link
26. Tashfeen Ekram T. Healthcare NPS is high: How to make even more out of PX. Beckers Hospital Review. 2017 Dec. Link
27. Yelp dataset. Link
28. Kadry B, Chu LF, Kadry B, Gammas D, Macario A. Analysis of 4999 online physician ratings indicates that most patients give physicians a favorable rating. Journal of medical Internet research. 2011;13(4):e95. Link
29. Ornstein C. ProPublica. As reported in: Shots. Heath News from NPR. On Yelp, Doctors Get Reviewed Like Restaurants — And It Rankles. 08/06/2015. Accessed on 08/20/2021 at https://www.npr.org/sections/health-shots/2015/08/06/429624187/on-yelp-doctors-get-reviewed-like-restaurants-and-it-rankles
30. Daskivich T, Luu M, Noah B, Fuller G, Anger J, Spiegel B. Differences in online consumer ratings of health care providers across medical, surgical, and allied health specialties: observational study of 212,933 providers. Journal of medical Internet research. 2018 May 9;20(5):e9160. Link