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Gotschall JW, Fitzsimmons R, Shin DB, Takeshita J. Race, Ethnicity, and Other Patient and Clinical Encounter Characteristics Associated with Patient Experiences of Access to Care. J Patient Exp 2024; 11:23743735241241178. [PMID: 38529206 PMCID: PMC10962025 DOI: 10.1177/23743735241241178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
The Press Ganey (PG) Outpatient Medical Practice Survey measures patients' experiences of healthcare access in the U.S. We aimed to identify differences in experiences of access to care by patient race, ethnicity, and other sociodemographic characteristics, an important first step in informing health policy and ensuring equitable healthcare delivery. We performed a cross-sectional analysis of PG surveys for adult outpatient visits within the University of Pennsylvania Health System from 2014-2017, including 119,373 unique patients. Compared with White patients, Black (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.80-0.87), Asian (OR 0.62; 95% CI 0.58-0.66), and other/unknown race patients (OR 0.83; 95% CI 0.72-0.94) were each less likely to report the maximum score for timely access to care. Patients of all minoritized groups, as well as those whose primary language was not English, reported lower scores in secondary access measures related to communication and respect, compared to White and primarily English-speaking patients, respectively. Efforts to improve the experience of access to care among racial and ethnic minoritized patients are imperative to achieve equity in healthcare delivery.
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Affiliation(s)
- Jeromy W. Gotschall
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel B. Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Keshtkar L, Madigan CD, Ward A, Ahmed S, Tanna V, Rahman I, Bostock J, Nockels K, Wang W, Gillies CL, Howick J. The Effect of Practitioner Empathy on Patient Satisfaction : A Systematic Review of Randomized Trials. Ann Intern Med 2024; 177:196-209. [PMID: 38285985 DOI: 10.7326/m23-2168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Practitioners who deliver enhanced empathy may improve patient satisfaction with care. Patient satisfaction is associated with positive patient outcomes ranging from medication adherence to survival. PURPOSE To evaluate the effect of health care practitioner empathy on patient satisfaction, using a systematic review of randomized trials. DATA SOURCES Ovid MEDLINE, CINAHL, PsycInfo, Cochrane Central Register of Controlled Trials, and Scopus to 23 October 2023. STUDY SELECTION Randomized trials published in any language that evaluated the effect of empathy on improving patient satisfaction as measured on a validated patient satisfaction scale. DATA EXTRACTION Data extraction, risk-of-bias assessments, and strength-of-evidence assessments were done by 2 independent reviewers. Disagreements were resolved through consensus. DATA SYNTHESIS Fourteen eligible randomized trials (80 practitioners; 1986 patients) were included in the analysis. Five studies had high risk of bias, and 9 had some concerns about bias. The trials were heterogeneous in terms of geographic locations (North America, Europe, Asia, and Africa), settings (hospital and primary care), practitioner types (family and hospital physicians, anesthesiologists, nurses, psychologists, and caregivers), and type of randomization (individual patient or clustered by practitioner). Although all trials suggested a positive change in patient satisfaction, inadequate reporting hindered the ability to draw definitive conclusions about the overall effect size. LIMITATIONS Heterogeneity in the way that empathy was delivered and patient satisfaction was measured and incomplete reporting leading to concerns about the certainty of the underpinning evidence. CONCLUSION Various empathy interventions have been studied to improve patient satisfaction. Development, testing, and reporting of high-quality studies within well-defined contexts is needed to optimize empathy interventions that increase patient satisfaction. PRIMARY FUNDING SOURCE Stoneygate Trust. (PROSPERO: CRD42023412981).
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Affiliation(s)
- Leila Keshtkar
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | - Claire D Madigan
- Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom (C.D.M.)
| | - Andy Ward
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | | | - Vinay Tanna
- Wythenshawe Hospital, Manchester Foundation Trust, Manchester, United Kingdom (V.T.)
| | - Ismail Rahman
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
| | | | - Keith Nockels
- Library and Learning Services, University of Leicester, Leicester, United Kingdom (K.N.)
| | - Wen Wang
- School of Business, University of Leicester, Leicester, United Kingdom (W.W.)
| | - Clare L Gillies
- Leicester Real World Evidence Unit, University of Leicester, Leicester, United Kingdom (C.L.G.)
| | - Jeremy Howick
- Stoneygate Centre for Empathic Healthcare, Leicester Medical School, University of Leicester, Leicester, United Kingdom (L.K., A.W., I.R., J.H.)
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Muir KJ, McHugh MD, Merchant RM, Lasater KB. Left Without Being Seen: Nurse Work Environment and Timely Outcomes in New York and Illinois Emergency Departments. J Emerg Nurs 2023:S0099-1767(23)00314-8. [PMID: 38127046 PMCID: PMC11186975 DOI: 10.1016/j.jen.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION This study determined the relationship between the emergency nurse work environment and emergency department patient left without being seen rates and lengths of stay. METHODS Cross-sectional analysis of 215 New York and Illinois emergency departments. The work environment (abbreviated Practice Environment Scale of the Nursing Work Index) was measured by emergency nurses in the 2021 RN4CAST-NY/IL survey and linked with outcomes from Hospital Compare. Regression models estimated the relationship between the nurse work environment and emergency department patient left without being seen rates, median length of stay (in minutes), and median behavioral health patient length of stay. Model coefficients were used to estimate expected additional care minutes gained if emergency department work environments improved. RESULTS "Mixed" work environments had the longest median overall length of stay (3.4 hours) and the highest median left without being seen rates (2.2%), while "poor" work environments had the longest median length of stay for behavioral health patients (6 hours). Improving the emergency department work environment from poor to mixed (and mixed to better) was associated with a 13-minute reduction in overall length of stay (P ≤ .05), a 33-minute reduction in behavioral health length of stay (P ≤ .01), and a 19% reduction in left without being seen rates (P ≤ .01). We estimated 11,824 to 41,071 additional patients could be seen in emergency departments associated with work environment improvements from "poor" to "better," depending on annual patient volumes. DISCUSSION Hospital administrators should consider investing in nurse work environments as a foundation to improve timely outcomes.
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Affiliation(s)
- K. Jane Muir
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Blvd Philadelphia, PA 19104
- National Clinician Scholars Program, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania
- ENA Chapter 118
| | - Matthew D. McHugh
- National Clinician Scholars Program, University of Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania
| | - Raina M. Merchant
- Leonard Davis Institute of Health Economics, University of Pennsylvania
- Department of Emergency Medicine, University of Pennsylvania, Perelman Center for Advanced Medicine, 5 floor, C-Suite, Philadelphia, PA 19104
| | - Karen B. Lasater
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, 418 Curie Blvd Philadelphia, PA 19104
- Leonard Davis Institute of Health Economics, University of Pennsylvania
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Shin JW, Choi BR. Effect of patient-related factors on hospitalization service satisfaction and recommendation intention of medical institutions in Korea. BMC Health Serv Res 2023; 23:716. [PMID: 37391768 DOI: 10.1186/s12913-023-09754-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 06/26/2023] [Indexed: 07/02/2023] Open
Abstract
OBJECTIVE This study examined the factors that influence the 'Overall Satisfaction' and 'Intention to Recommend' of medical institutions used using the Korea Medical Service Experience Survey (2019-2021). DATA SOURCES This study used the data of Medical Service Experience Survey in Korea. The data collected for data analysis were from 2019 to 2021 (Medical service period: 2018.07.01. ~ 2021.06.30). STUDY DESIGN The 2019 Medical Service Experience Survey was conducted from July 8 to September 20, 2019, and a total of 12,507 people (Medical service period: 2018.07.01. ~ 2019.06.30) were collected. The 2020 survey was conducted from July 13 to October 9, 2020, and a total of 12,133 people (Medical service period: 2019.07.01 ~ 2020.06.30.) were collected. The 2021 survey was conducted from July 19 to September 17, 2021), and a total of 13,547 people were collected (Medical service period: 2020.07.01. ~ 2021.06.30). Overall satisfaction and recommendation intentions for medical institutions consist of a Likert 5-point scale. At this time, the Top-box rating model used in the United States was applied. DATA COLLECTIONS/EXTRACTION METHODS In this study, only those who used inpatient services (15 years of age or older) were included because they spent a long time in a medical institution and had an intensive experience, and a total of 1,105 subjects were included in the analysis. PRINCIPAL FINDINGS Self-rated health and the type of bed influenced overall satisfaction with medical institutions. In addition, the type of economic activity, living area, self-rated health, the type of bed, and the type of nursing service affected the intention to recommend. And it was confirmed that overall satisfaction with medical institutions and intention to recommend them were higher in the 2021 survey than in 2019. CONCLUSIONS These results suggest that government policy on resources and systems is important. Through the case of Korea, it was found that the policy of reducing multi-person beds and expansion of integrated nursing service had a significant impact on patients' experience of using medical institutions and improving the quality of care.
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Affiliation(s)
- Jeong Woo Shin
- Korea Institute for Health and Social Affairs, 370 Sicheong-Daero, Sejong, South Korea
| | - Bo Ram Choi
- Department of Health Administration, Hanyang Cyber University, 220 Wangsimni-Ro, Seongdong-Gu, Seoul, South Korea.
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Plusch J, Jane Muir K. "Doc in the Box": The impact of an emergency department move on interprofessional collaboration, patient care, and clinician job satisfaction. Int Emerg Nurs 2023; 67:101267. [PMID: 36863070 DOI: 10.1016/j.ienj.2023.101267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 01/12/2023] [Accepted: 01/24/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Health care organizations undergo unit space reconfiguration (e.g., expansion) projects in order to accommodate rising patient volumes with limited health care space. The purpose of this study was to describe the impact of an emergency department physical space move on clinician-perceived interprofessional collaboration, patient care delivery, and clinician job satisfaction. METHOD A secondary qualitative, descriptive data analysis of 39 in-depth interviews from an ethnography was conducted from August 2019 to February 2021 at an academic medical center emergency department with nurses, physicians, and patient care technicians in the Southeastern United States. The Social Ecological Model was a conceptual guide for the analysis. RESULTS Three study themes, "It's like an old dive bar", "spatial blind spot", and "privacy and aesthetic work environment" emerged from the 39 interviews. Clinicians perceived that the move from a centralized to decentralized work space impacted interprofessional collaboration through divided clinician work spaces. Increased square footage in the new emergency department was beneficial for patient satisfaction but contributed to difficulty monitoring patients for care escalation. However, increased space and individualized patient rooms increased perceived clinician job satisfaction. CONCLUSION Space reconfiguration projects inhealth carecan have positive implications for patient care, but may result in inefficiencies to the health care team and patient care that must be considered. Study findings inform health care work environment renovation projects on an international level.
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Affiliation(s)
- Jamie Plusch
- Medstar Georgetown University Hospital, Washington, DC 20007, USA.
| | - K Jane Muir
- National Clinician Scholars Program, University of Pennsylvania, Philadelphia, PA 19140, USA.
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Pomare C, Gardiner B, Ellis LA, Long JC, Churruca K, Braithwaite J. "The times they are a-changin'": A longitudinal, mixed methods case study of a hospital transformation. PLoS One 2022; 17:e0272251. [PMID: 36282837 PMCID: PMC9595515 DOI: 10.1371/journal.pone.0272251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background Changes to hospital infrastructure are inevitable in ever-evolving healthcare systems. The redevelopment of hospitals and opening of new buildings can be a complex and challenging time for staff as they must find ways to deliver safe and high-quality care while navigating the complexities and uncertainties of change. This study explores the perspectives and experiences of staff and patients before and after the opening of a new hospital building as part of a large public hospital redevelopment in Sydney, Australia. Methods The study comprised a longitudinal mixed methods case study design. Methods included two rounds of staff surveys (n = 292 participants), two rounds of staff interviews (n = 66), six rounds of patient surveys (n = 255), and analysis of hospital data at tri-monthly intervals over two years. Data were compared before (2019) and after (2020) a new hospital building opened at a publicly funded hospital in Sydney, Australia. Results Four key themes and perspectives emerged from the interviews including change uncertainty, communication effectiveness, staffing adequacy and staff resilience. Significant differences in staff perceptions of change readiness over time was identified. Specifically, perceptions that the organisational change was appropriate significantly decreased (2019: 15.93 ± 3.86; 2020: 14.13 ± 3.62; p < .001) and perceptions that staff could deal with the change significantly increased (2019: 17.30 ± 4.77; 2020: 19.16 ± 4.36; p = .001) after the building opened compared to before. Global satisfaction scores from patient survey data showed that patient experience significantly declined after the building opened compared to before (2020: 81.70 ± 21.52; 2019: 84.43 ± 18.46)), t(254) = -64.55, p < 0.05, and improved a few months after opening of the new facilities. This coincided with the improvement in staff perceptions in dealing with the change. Conclusions Moving into a new hospital building can be a challenging time for staff and patients. Staff experienced uncertainty and stress, and displayed practices of resilience to deliver patient care during a difficult period of change. Policy makers, hospital managers, staff and patients must work together to minimise disruption to patient care and experience. Key recommendations for future hospital redevelopment projects outline the importance of supporting and informing staff and patients during the opening of a new hospital building.
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Affiliation(s)
- Chiara Pomare
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
- * E-mail:
| | - Brett Gardiner
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Louise A. Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Janet C. Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW, Australia
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Driver D, Berlacher M, Harder S, Oakman N, Warsi M, Chu ES. The Inpatient Experience of Emerging Adults: Transitioning From Pediatric to Adult Care. J Patient Exp 2022; 9:23743735221133652. [PMID: 36311907 PMCID: PMC9597024 DOI: 10.1177/23743735221133652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The pediatric-to-adult care transition has been correlated with worse outcomes,
including increased mortality. Emerging adults transitioning from child-specific
healthcare facilities to adult hospitals encounter marked differences in
environment, culture, and processes of care. Accordingly, emerging adults may
experience care differently than other hospitalized adults. We performed a
retrospective cohort study of patients admitted to a large urban safety net
hospital and compared all domains of patient experience between patients in 3
cohorts: ages 18 to 21, 22 to 25, and 26 years and older. We found that patient
experience for emerging adults aged 18 to 21, and, to a lesser extent, aged 22
to 25, was significantly and substantially worse as compared to adults aged 26
and older. The domains of worsened experience were widespread and profound, with
a 38-percentile difference in overall experience between emerging adults and
established adults. While emerging adults experienced care worse in nearly all
domains measured, the greatest differences were found in those pertinent to
relationships between patients and care providers, suggesting a substantial
deficit in our understanding of the preferences and values of emerging
adults.
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Affiliation(s)
- Daniel Driver
- Department of Internal Medicine, University of Texas Southwestern
Medical School, Dallas, TX, USA,Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA,Daniel Driver, University of Texas
Southwestern Medical School, 5323 Harry Hines Blvd, Dallas, TX 75390-8811, USA.
| | - Michelle Berlacher
- Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA,Department of Pediatrics, Division of Internal Medicine and
Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Stephen Harder
- Department of Internal Medicine, University of Texas Southwestern
Medical School, Dallas, TX, USA,Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA
| | - Nicole Oakman
- Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA,Department of Pediatrics, Division of Internal Medicine and
Pediatrics, University of Texas Southwestern Medical School, Dallas, TX, USA
| | - Maryam Warsi
- Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA
| | - Eugene S Chu
- Department of Internal Medicine, University of Texas Southwestern
Medical School, Dallas, TX, USA,Division of Hospital Medicine, Parkland Memorial Hospital, Dallas, TX, USA
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Warpe SR, Zadake SN, Ambekar AS. To Evaluate the Factors Influencing Patients Before Selecting Their Orthodontist. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2022. [DOI: 10.1177/03015742221108261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Aim This article aims to “evaluate the factors influencing patient before selecting their orthodontist in India.” Objectives To evaluate the orthodontists’ demographics influence patients to select their orthodontist and to know whether clinic amenities influence patients to select their orthodontist. Material and Method A descriptive, cross-sectional survey conducted through a web-based self-administered questionnaire with 15 questions addressing various aspects of orthodontic treatment necessity. This study included 255 patients between the ages of 12 and 30 who are undergoing orthodontic treatment or have completed their orthodontic treatment. Results and Conclusion A total of 255 participants were there in the study. Patients were influenced by many factors such as skillful orthodontists with updated or recent knowledge, orthodontists’ demographics, and clinic amenities.
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Affiliation(s)
- Smita Raosaheb Warpe
- Maharashtra Institute of Dental Sciences and Research Dental College, Vishwanathpuram, Latur, Maharashtra, India
| | - Sujit Navnath Zadake
- Maharashtra Institute of Dental Sciences and Research Dental College, Vishwanathpuram, Latur, Maharashtra, India
| | - Anand S. Ambekar
- Maharashtra Institute of Dental Sciences and Research Dental College, Vishwanathpuram, Latur, Maharashtra, India
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Tan SB, Tan TT, Tan MP, Loo KK, Lim PK, Ng CG, Loh EC, Lam CL. Contributing and Relieving Factors of Suffering in Palliative Care Cancer Patients: A Descriptive Study. OMEGA-JOURNAL OF DEATH AND DYING 2022; 85:732-752. [DOI: 10.1177/0030222820942642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
To palliate suffering, understanding the circumstances leading to suffering and its amelioration could be helpful. Our study aimed to explore contributing and relieving factors of suffering in palliative care. Adult palliative care stage III or IV cancer in-patients were recruited from University of Malaya Medical Centre. Participants recorded their overall suffering score from 0 to 10 three times daily, followed by descriptions of their contributing and relieving factors. Factors of suffering were thematically analysed with NVIVO. Descriptive data were analysed with SPSS. 108 patients participated. The most common contributing factor of suffering was health factor (96.3%), followed by healthcare factor (78.7%), psychological factor (63.0%) and community factor (20.4%). The most common relieving factor was health factor (88.9%), followed by psychological factor (78.7%), community factor (75.9%) and healthcare factor (70.4%). Self-reported assessment of suffering offers a rapid approach to detect bothering issues that require immediate attention and further in-depth exploration.
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Affiliation(s)
- Seng Beng Tan
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Ting Ting Tan
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Maw Pin Tan
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Kim Kee Loo
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Poh Khuen Lim
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Chong Guan Ng
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Ee Chin Loh
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
| | - Chee Loong Lam
- Department of Medicine, Faculty of Medicine, University of Malaya Medical Centre, Lembah Pantai, Malaysia
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Cai H, Fullam F, MacAllister L, Fogg LF, Canar J, Press I, Weissman C, Velasquez O. Impact of Inpatient Unit Design Features on Overall Patient Experience and Perceived Room-Level Call Button Response. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9747. [PMID: 34574672 PMCID: PMC8469244 DOI: 10.3390/ijerph18189747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 11/17/2022]
Abstract
This study explores the relationship between inpatient unit design and patient experience and how spatial features and visibility impact patients' perception of staff responsiveness. The first part of this study is a retrospective pre-post and cross-sectional study evaluating the impacts of unit design on patient experience at the unit level. This study compares patient experiences based on Press Ganey and HCAHPS surveys in two orthopedic units (existing unit in Atrium building and new unit in Tower) with differing design features at Rush University Medical Center. The chi-square test results show that when moving from the old orthopedic unit to the new unit, almost all patient survey items related to patient experience showed statistically significant improvements. The second part of this study is a room level on the new unit. The ANOVA and Pearson correlation tests revealed that the visibility measure of metric step depth had significant impacts on patients' perception of staff's "promptness in responding to call button" and "help with toileting". This study confirms that inpatient unit design plays a direct role in improvement for patient experience and should be considered as an important area of focus for future development.
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Affiliation(s)
- Hui Cai
- Institute of Health and Wellness Design, Department of Architecture, The University of Kansas, Lawrence, KS 66047, USA;
| | - Francis Fullam
- Health Systems Management, Rush University, Chicago, IL 60612, USA; (F.F.); (J.C.); (I.P.)
| | | | - Louis F. Fogg
- College of Nursing, Rush University, Chicago, IL 60612, USA;
| | - Jeff Canar
- Health Systems Management, Rush University, Chicago, IL 60612, USA; (F.F.); (J.C.); (I.P.)
| | - Irwin Press
- Health Systems Management, Rush University, Chicago, IL 60612, USA; (F.F.); (J.C.); (I.P.)
- Department of Anthropology, University of Notre Dame, Notre Dame, IN 46556, USA
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Cheema MK, Harris K, Nguyen H, Damji KF. Making the most of what you have: improving patient and provider experiences at an eye clinic through interior design. Can J Ophthalmol 2021; 57:e45-e47. [PMID: 34481780 DOI: 10.1016/j.jcjo.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/25/2021] [Accepted: 08/04/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Marvi K Cheema
- Resident, Department of Ophthalmology and Visual Sciences, University of Alberta
| | - Karen Harris
- Manager, Eye Clinic, Alberta Health Services, Edmonton, Alberta
| | - Haily Nguyen
- Ophthalmology Patient Care Manager, Alberta Health Services. Edmonton, Alberta
| | - Karim F Damji
- Chair, Department of Ophthalmology and Visual Sciences, University of Alberta and Zone Clinical Section Head for Ophthalmology, Alberta Health Services, Edmonton, Alberta.
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12
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Han MM, Hsueh J, Chen AX, Greenlee TE, Conti TF, Rose SL, Singh RP, Rachitskaya AV. Ophthalmology Provider Ratings and Patient, Disease, and Appointment Factors. J Patient Exp 2021; 8:23743735211033750. [PMID: 34395846 PMCID: PMC8358496 DOI: 10.1177/23743735211033750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of the current study is to examine how nonmodifiable sociodemographic, disease, appointment, management, and survey factors correlate with provider rating. This was a retrospective cross-sectional study conducted on 29 857 patient Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys collected from January 2017 to January 2019 at a tertiary eye center. We included surveys of patients aged 18 years or older, who answered at least 4 of 6 subfield questions, and completed the survey within 90 days of the appointment. The main outcome was the odds of receiving top box score (TBS) of 10/10 on the survey question regarding overall provider rating. The results showed that the variables with higher odds of TBS included higher overall appointment attendance (odds ratio [OR]: 2.66 [95% CI: 1.23-5.75], P = .013); older patient age (OR 2.44 [95% CI: 2.08-2.87], P < .001]; higher percentage of survey questions completed (OR: 2.02 [95% CI: 1.79-2.27], P < .001); better best corrected visual acuity (OR: 1.85 [95% CI: 1.3-2.64], P = .001); optometry clinic visit (OR: 1.25 [95% CI: 1.15-1.36], P < .001); having procedures (OR: 1.19 [95% CI: 1.04-1.36], P = .013), surgery scheduled (OR: 1.18 [95% CI: 1.03-1.36], P = .020], or refraction done (OR: 1.16 [95% CI: 1.08-1.25], P < .001); being seen by male providers (OR: 1.11 [95% CI: 1.04-1.17], P = .001); and having additional eye testing performed (OR: 1.06 [95% CI: 1.00-1.13], P = .048). Variables associated with lower odds of TBS included longer time to complete survey (OR: 0.42 [95% CI: 0.3-0.58], P = .001); new patient encounter (OR: 0.62 [95% CI: 0.58-0.65], P < .001); and glaucoma (OR: 0.66 [95% CI: 0.59-0.75], P < .001), cornea (OR: 0.79 [95% CI: 0.71-0.87], P < .001), or comprehensive clinic visits (OR: 0.86 [95% CI: 0.79-0.94], P < .001). Thus, nonmodifiable factors may affect the provider rating, and these factors should be studied further and accounted for when interpreting the results of patient experience surveys.
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Affiliation(s)
- Michael M Han
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jessica Hsueh
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Andrew X Chen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler E Greenlee
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thais F Conti
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Susannah L Rose
- Office of Patient Experience, Center for Bioethics, Clinical Transformation, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Rishi P Singh
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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13
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Jimenez FE, Rich RK, Puumala SE, Kentfield M, Schoenholtz L, Brittin J. Effects of a Decentralized Nursing Model on Patient Outcomes in Two Rural Community Hospitals. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2021; 14:157-173. [PMID: 33882751 DOI: 10.1177/19375867211006491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To assess hypothesized effects of decentralized nursing models on adult inpatient outcomes, patient medical records and satisfaction surveys were analyzed from two rural community hospitals that transitioned from centralized to decentralized nursing unit designs in 2015. BACKGROUND The objective to place nurses closer to patients precipitates broad use of decentralized nursing unit designs over models with centralized nurse stations. Decentralized models have been hypothesized to improve patient outcomes, but few studies have empirically measured effects. METHODS A cross-sectional, pre-post study used regression and interrupted time series models of adult inpatient data. Encounter-level patient records and survey responses across both sites were analyzed for a change in length of stay (LOS) and patient satisfaction from the preperiod (centralized) to the postperiod (decentralized). RESULTS LOS decreased in the postperiod compared to the preperiod at one site, and there was no change in LOS at the other. Patient satisfaction mostly improved at both hospitals in the decentralized model; however, most upward trends started prior to the move, with no change postmove. Patient satisfaction significantly improved regarding quietness at night and overall hospital rating at one hospital and decreased regarding receiving help as soon as wanted at the other hospital. These changes occurred at the time of the move but may not be solely attributable to the decentralized nursing model. CONCLUSIONS Overall, the results were mixed. One hospital experienced positive changes while the other did not, suggesting factors apart from nursing unit design are important to assess.
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Affiliation(s)
| | | | - Susan E Puumala
- Master of Public Health Program, 158382School of Health Sciences, University of South Dakota, Vermillion, SD, USA
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Provider Personal and Demographic Characteristics and Patient Satisfaction in Orthopaedic Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202104000-00004. [PMID: 33835991 DOI: 10.5435/jaaosglobal-d-20-00198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patient satisfaction has increasingly been used to assess physician performance and quality of care. Although there is evidence that patient satisfaction is associated with patient-reported health outcomes and communication-related measures, there is debate over the use of patient satisfaction in reimbursement policy. Patient characteristics that influence satisfaction have been studied, but the effects of personal and demographic characteristics of physicians on patient satisfaction have yet to be explored. METHODS Outpatient satisfaction scores from 11,059 patients who rated 25 orthopaedic surgeons from a single institution were studied. In this study, we sought to explore the relationship between nonmodifiable physician characteristics, such as sex and race, and patient satisfaction with outpatient orthopaedic surgery care, as expressed in the Press Ganey Satisfaction Scores. Univariate logistic regression models were used to test the associations between each provider characteristic and patient satisfaction on the Press Ganey patient satisfaction questionnaire. RESULTS Three nonmodifiable physician personal and demographic characteristics were markedly associated with lower patient satisfaction scores across overall satisfaction, communication, and empathy domains: (1) female gender, (2) Asian ethnicity, and (3) being unmarried. Asian ethnicity reduced the odds of receiving a 5-star rating for likelihood to recommend the provider by nearly 40%, but none of these nonmodifiable physician personal and demographic characteristics affected the likelihood to recommend the practice. DISCUSSION Sex, ethnicity, and marital status are nonmodifiable provider characteristics, each associated with markedly lower odds of receiving a 5-star rating on Press Ganey patient satisfaction survey. These data reveal inherent patient biases that negatively affect physician-patient interactions and may exacerbate the lack of diversity in orthopaedic surgery. More research is necessary before using patient satisfaction ratings to evaluate surgeons or as quality measures that affect reimbursement policies.
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North F, Pecina JL, Tulledge-Scheitel SM, Chaudhry R, Matulis JC, Ebbert JO. Is a switch to a different electronic health record associated with a change in patient satisfaction? J Am Med Inform Assoc 2021; 27:867-876. [PMID: 32357370 PMCID: PMC7309264 DOI: 10.1093/jamia/ocaa026] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 02/09/2020] [Accepted: 02/28/2020] [Indexed: 11/14/2022] Open
Abstract
Objective Financial impacts associated with a switch to a different electronic health record (EHR) have been documented. Less attention has been focused on the patient response to an EHR switch. The Mayo Clinic was involved in an EHR switch that occurred at 6 different locations and with 4 different “go-live” dates. We sought to understand the relationship between patient satisfaction and the transition to a new EHR. Materials and Methods We used patient satisfaction data collected by Press Ganey from July 2016 through December 2019. Our patient satisfaction measure was the percent of patients responding “very good” (top box) to survey questions. Twenty-four survey questions were summarized by Press Ganey into 6 patient satisfaction domains. Piecewise linear regression was used to model patient satisfaction before and after the EHR switch dates. Results Significant drops in patient satisfaction were associated with the EHR switch. Patient satisfaction with access (ease of getting clinic on phone, ease of scheduling appointments, etc.) was most affected (range of 6 sites absolute decline: -3.4% to -8.8%; all significant at 99% confidence interval). Satisfaction with providers was least affected (range of 6 sites absolute decline: -0.5% to -2.8%; 4 of 6 sites significant at 99% confidence interval). After 9-15 months, patient satisfaction with access climbed back to pre-EHR switch levels. Conclusions Patient satisfaction in several patient experience domains dropped significantly and stayed lower than pre–“go-live” for several months after a switch in EHR. Satisfaction with providers declined less than satisfaction with access.
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Affiliation(s)
- Frederick North
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L Pecina
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sidna M Tulledge-Scheitel
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajeev Chaudhry
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John C Matulis
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jon O Ebbert
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Rich RK, Jimenez FE, Puumala SE, DePaola S, Harper K, Roy L, Brittin J. From Fable to Reality at Parkland Hospital: The Impact of Evidence-Based Design Strategies on Patient Safety, Healing, and Satisfaction in an Adult Inpatient Environment. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:65-82. [PMID: 33176490 DOI: 10.1177/1937586720970198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This research aimed to evaluate the quantitative effects of new hospital design on adult inpatient outcomes. BACKGROUND Tenets of evidence-based healthcare design, notably single-patient acuity-adaptable and same-handed rooms, decentralized nursing stations, onstage offstage layout, and access to nature were expected to promote patient healing and increase patient satisfaction, while decreasing adverse events. METHODS Patient healing was operationalized through length of stay (LOS) and patient safety through three adverse events: falls, hospital-acquired infections (HAI), and medication-related events. Standard patient surveys captured patient satisfaction. Patient records from 2013 through 2017 allowed for equivalent time periods surrounding the move to the new hospital in August 2015. Stratified by hospital division where significant, pre/post comparisons utilized proportional hazards or logistic regression models as appropriate; interrupted time series analyses afforded longitudinal interpretations. RESULTS Observed higher postmove LOS was due to previously increasing trends, not increases after the move. In surgical and trauma units, a constant increase in falls was unaffected by the move. Medication events decreased consistently over time; medication events with harm dropped significantly after the move. No change in HAI was found. Significant improvement on most relevant patient satisfaction items occurred after the move. Call button response decreased immediately after the move but subsequently improved. CONCLUSION Results did not clearly indicate a net change in adult inpatient outcomes of healing and safety due to the hospital design. There was evidence that the new hospital improved patient satisfaction outcomes related to the environment, including comfort, noise, temperature, and aesthetics.
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Affiliation(s)
| | | | - Susan E Puumala
- School of Health Sciences, University of South Dakota, Vermillion, SD, USA
| | - Sheila DePaola
- 21114Parkland Health and Hospital System, Dallas, TX, USA
| | - Kathy Harper
- Formerly of Parkland Health and Hospital System, Dallas, TX, USA
| | - Lonnie Roy
- 21114Parkland Health and Hospital System, Dallas, TX, USA
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Takeshita J, Wang S, Loren AW, Mitra N, Shults J, Shin DB, Sawinski DL. Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Netw Open 2020; 3:e2024583. [PMID: 33165609 PMCID: PMC7653497 DOI: 10.1001/jamanetworkopen.2020.24583] [Citation(s) in RCA: 319] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The Press Ganey Outpatient Medical Practice Survey is used to measure the patient experience. An understanding of the patient- and physician-related determinants of the patient experience may help identify opportunities to improve health care delivery and physician ratings. OBJECTIVE To evaluate the associations between the patient experience as measured by scores on the Press Ganey survey and patient-physician racial/ethnic and gender concordance. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of Press Ganey surveys returned for outpatient visits within the University of Pennsylvania Health System between 2014 and 2017 was performed. Participants included adult patient and physician dyads for whom surveys were returned. Data analysis was performed from January to June 2019. EXPOSURES Patient-physician racial/ethnic and gender concordance. MAIN OUTCOMES AND MEASURES The primary outcome was receipt of the maximum score for the "likelihood of your recommending this care provider to others" question in the Care Provider domain of the Press Ganey survey. Secondary outcomes included each of the remaining 9 questions in the Care Provider domain. Generalized estimating equations clustering on physicians with exchangeable intracluster correlations and cluster-robust standard errors were used to investigate associations between the outcomes and patient-physician racial/ethnic and gender concordance. RESULTS In total, 117 589 surveys were evaluated, corresponding to 92 238 unique patients (mean [SD] age, 57.7 [15.6] years; 37 002 men [40.1%]; 75 307 White patients [81.6%]) and 747 unique physicians (mean [SD] age 45.5 [10.6] years; 472 men [63.2%]; 533 White physicians [71.4%]). Compared with racially/ethnically concordant patient-physician dyads, discordance was associated with a lower likelihood of physicians receiving the maximum score (adjusted odds ratio [OR], 0.88; 95% CI, 0.82-0.94; P < .001). Black (adjusted OR, 0.73; 95% CI, 0.68-0.78; P < .001) and Asian (adjusted OR, 0.55; 95% CI, 0.50-0.60; P < .001) patient race were both associated with lower patient experience ratings. Patient-physician gender concordance was not associated with Press Ganey scores (adjusted OR, 1.00; 95% CI, 0.96-1.04; P = .90). CONCLUSIONS AND RELEVANCE In this study, higher Press Ganey survey scores were associated with racial/ethnic concordance between patients and their physicians. Efforts to improve physician workforce diversity are imperative. Delivery of health care in a culturally mindful manner between racially/ethnically discordant patient-physician dyads is also essential. Furthermore, Press Ganey scores may differ by a physician's patient demographic mix; thus, care must be taken when publicly reporting or using Press Ganey scores to evaluate physicians on an individual level.
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Affiliation(s)
- Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Shiyu Wang
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alison W. Loren
- Hematology/Oncology Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Justine Shults
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Daniel B. Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Deirdre L. Sawinski
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Finn RM, Voelkel J, Bellolio MF, Jeffery MM, Wiswell J. Pediatric Ice Pop Administration to Improve Patient Experience Scores. Mayo Clin Proc Innov Qual Outcomes 2020; 4:410-415. [PMID: 32793868 PMCID: PMC7411169 DOI: 10.1016/j.mayocpiqo.2020.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Abstract
OBJECTIVE To assess the impact on patient experience scores of giving an ice pop (Popsicle, Good Humor-Breyers, Oakland, CA) to patients in a pediatric emergency department (ED). PATIENTS AND METHODS A prospective two-center trial was conducted at a tertiary academic pediatric ED and a community ED from January 1, 2018, through March 31, 2018. The intervention arm gave an ice pop to all eligible patients 0 to 14 years of age on even-numbered days versus conventional practice on odd-numbered days. Press Ganey top box scores were then compared. RESULTS Of 4574 pediatric (0 to 14 years of age) patient visits, patient experience surveys were delivered to 1346 families (29.4%) and 152 were returned (11.3%). Eighty-four surveys were returned for even-numbered day visits and 68 for odd-numbered day visits. There was a significant increase in patient experience scores associated with ice pop administration days for questions that asked about doctor's concern for comfort 70.2% versus 57.4% (P=.05), doctor's courtesy 76.2% versus 61.8% (P=.04), and doctor taking time to listen 72.6% versus 57.4% (P=.03). CONCLUSION A low-cost intervention resulted in significantly increased patient experience scores in select domains. Popsicle administration was a simple intervention which was easily instituted in both academic and community ED settings. Further study should explore the durability of the effect.
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Affiliation(s)
- Ryan M. Finn
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - Jacob Voelkel
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
| | - M. Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Molly M. Jeffery
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Jeffrey Wiswell
- Department of Emergency Medicine, Mayo Clinic Health System, La Crosse, WI
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Hao R, Chou Y, Wan Y, Jiang X, Li X. Patient satisfaction with the ocular surface individualized medical program. Eur J Ophthalmol 2020; 31:2746-2754. [PMID: 32722934 DOI: 10.1177/1120672120945653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To improve the medical management system and the quality of medical treatment, this study aimed to assess patient satisfaction related to an ocular surface individualized medical program for dry eye, and identified patient needs that should be addressed in future. METHODS We enrolled 166 patients from the dry eye clinic at the Peking University Third Hospital from December 2017 to May 2019. An investigator followed up with all patients by telephone 2 months after the first assessment of overall patient satisfaction, expectations, and experiences. We determined patient satisfaction using a questionnaire and analyzed the results. Multivariate linear regression analysis was used to assess the predictors of overall patient satisfaction. RESULTS The overall patient satisfaction with the ocular surface individualized medical program skewed toward a positive assessment. Ten variables were significantly associated with overall patient satisfaction: two involving fulfilment of expectations, seven involving patient-reported experiences, and one involving socio-demographics. The most important predictor of overall patient satisfaction was patient-reported experiences with the treatment outcome (β = 0.281, p < 0.001), followed by experiences with medical staff services (β = 0.240, p = 0.002), examination services (β = 0.198, p = 0.002), and interpretation and professionalism (β = 0.168, p = 0.04), expectations fulfilment (β = 0.147, p = 0.025), as well as age (β = -0.13, p = 0.014). Free response-style negative patient feedback suggested that examination wait time and environment needed improvement. CONCLUSION Overall, the ocular surface individualized medical program is effective and is able to achieve satisfaction for most patients. The examination procedures and environment require improvements, and treatment must be made more patient-centric to improve satisfaction.
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Affiliation(s)
- Ran Hao
- Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China
| | - Yilin Chou
- Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China
| | - Yu Wan
- Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China
| | - Xiaodan Jiang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China
| | - Xuemin Li
- Department of Ophthalmology, Peking University Third Hospital, Beijing, P.R. China
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Hwang J, Vu GT, Tran BX, Nguyen THT, Nguyen BV, Nguyen LH, Nguyen HLT, Latkin CA, Ho CSH, Ho RCM. Measuring satisfaction with health care services for Vietnamese patients with cardiovascular diseases. PLoS One 2020; 15:e0235333. [PMID: 32584904 PMCID: PMC7316281 DOI: 10.1371/journal.pone.0235333] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/13/2020] [Indexed: 11/28/2022] Open
Abstract
Patient satisfaction is a useful predictor of adherence and outcomes of cardiovascular diseases (CVDs) treatment. This study explored the satisfaction of Vietnamese CVDs inpatients and outpatients using a scale specifically designed for CVDs patients and examined the factors associated with satisfaction towards CVDs treatment services. Interviews of 600 patients at the Hanoi Heart Hospital were conducted. We developed a measurement scale for both inpatient and outpatient services. Multivariate Tobit regression was used to determine the associated factors with patient satisfaction. For inpatients, Cronbach’s alpha reported for the domains were in the range of 0.72–0.97, while for outpatients, Cronbach’s alpha was within 0.61–0.97. Overall, patients were more satisfied with inpatient services (Mean = 81.8, SD = 5.8) than outpatient services (Mean = 79.7, SD = 5.2, p<0.05). In inpatients, the highest complete satisfaction was in “Attitude of Nurse” item (42.0%), the highest satisfaction score was in “Care and treatment” domain (Mean = 85.6, SD = 9.7) and the lowest in “Hospital facilities” domain (Mean = 78.3; SD = 9.2). Among outpatients, the highest complete satisfaction was in “Attitude of physicians when examining, guiding and explaining to the patient” item (19.7%), the highest satisfaction score was in “Attitude of medical staff” domain (Mean = 82.8; SD = 7.9) and the lowest in “Waiting time” domain (Mean = 76.6; SD = 8.2). People not having health insurances had significantly higher scores in “Waiting time”, “Hospital facilities” and “Attitude of staff” domains (for outpatients) and in “Health service accessibility”, “Hospital facilities” domains (for inpatients) as well as higher total satisfaction score than those having health insurance. Findings discovered through the application of the newly developed instrument showed low satisfaction regarding hospital facilities for inpatients and waiting time for outpatients, suggesting renovation efforts, while inferiority regarding patient satisfaction of health insurance covered patients compared to those without implied policy reform possibility. Further enhancement and validation of the developed instrument was required.
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Affiliation(s)
- Jongnam Hwang
- Division of Social Welfare and Health Administration, Wonkwang University, Iksan, Korea
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
- * E-mail:
| | | | - Bang Van Nguyen
- Department of Hemato-Toxico-Radiology and Occupational Disease, Hospital 103, Military Medical University, Hanoi, Vietnam
| | - Long Hoang Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam
| | | | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States of America
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore, Singapore
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, Singapore
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Zadake SN, Kangane SK, Ambekar AS, Kondle M, Kalekar R. Factors Affecting Satisfaction with the Process of Orthodontic Treatment in Young Adults: A Questionnaire Study. JOURNAL OF INDIAN ORTHODONTIC SOCIETY 2020. [DOI: 10.1177/0301574219887503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Recently, there has been an increase in adults undergoing orthodontic treatment in both the public and the private sector. Satisfaction during and after the orthodontic treatment process has not been widely discussed so far, however, and few research studies have emphasized patient satisfaction with treatment outcome and the factors affecting patient satisfaction.Aim: To investigate factors affecting patient satisfaction with the process of orthodontic treatment in young adults.Material and methods: Fifty-eight patients (33 girls and 25 boys with a mean age of 25.05 years, SD 2.83) were included in the survey. All patients were young adults who had completed their orthodontic treatment with fixed appliances and were taken from two centers (a teaching hospital and a private practice). Data was collected using online survey forms and was analyzed using content thematic analysis. Five main factors were identified related to patient satisfaction with the process of orthodontic treatment: communication, faculty (orthodontist), physical surroundings, consultation/appointments, and impact of appliance treatment.Results: Effective communication was the most prominent factor among all five factors considered, especially detailed explanation given during treatment and making patients feel comfortable under their care. Median values were generally high for satisfaction with treatment results. There was a clear correlation ( p < 0.001) between patient satisfaction and treatment outcome. Age, sex and treatment time did not have any correlation with treatment satisfaction.Conclusion: In general, young adults were observed to be satisfied with the treatment process, and good communication played a dominant role in this. Though there were many differences in working models between public and private sectors, many similarities were observed when comparing the factors between the two centers.
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Affiliation(s)
- Sujit Navnath Zadake
- Maharashtra Institute of Dental Sciences and Research Dental College, Vishwanathpuram, Latur, Maharashtra, India
| | - Suresh K. Kangane
- Maharashtra Institute of Dental Sciences and Research Dental College, Vishwanathpuram, Latur, Maharashtra, India
| | - Anand S. Ambekar
- Maharashtra Institute of Dental Sciences and Research Dental College, Vishwanathpuram, Latur, Maharashtra, India
| | - Mahendra Kondle
- Maharashtra Institute of Dental Sciences and Research Dental College, Vishwanathpuram, Latur, Maharashtra, India
| | - Radhika Kalekar
- Maharashtra Institute of Dental Sciences and Research Dental College, Vishwanathpuram, Latur, Maharashtra, India
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Joyce K. Smart textiles: transforming the practice of medicalisation and health care. SOCIOLOGY OF HEALTH & ILLNESS 2019; 41 Suppl 1:147-161. [PMID: 31599985 DOI: 10.1111/1467-9566.12871] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Smart textile medical devices are forms of clothing that use sensors and fabrics to monitor bodily processes and communicate with data systems through wireless transmission. To investigate the co-evolution of digital technologies and health care practices, this study draws on focus group and fieldwork data to analyse the sociological implications of the creation of two smart textile devices: one - the bellyband - will replace the tocodynamometer and foetal heart rate monitor during labour and birth in hospitals and the other - the babyband - will replace the cardiopulmonary monitor in neonatal intensive care units. Analysis of potential users' views of smart textiles demonstrates the contemporary contours of medicalisation and surveillance medicine. Smart textiles blur the boundary between hospital/medicine and home/daily life. In this blurring, medicalisation becomes "cozy" or "comfortable" and surveillance takes on a friendly form. Smart textile medical devices thus fit into broader trends in health care in which hospitals are designed to be homelike and intimate even as patients and devices become fully integrated into data systems.
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Affiliation(s)
- Kelly Joyce
- Sociology Department, Center for Science, Technology and Society, Drexel University, Philadelphia, PA, USA
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Alkazemi MF, Bayramzadeh S, Alkhubaizi NB, Alayoub A. The physical environment and patient satisfaction ratings on social media: an exploratory study. FACILITIES 2019. [DOI: 10.1108/f-11-2018-0138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this study is to explore the role of the physical environment in patient satisfaction ratings as communicated in narratives on the social media platform such as Facebook.
Design/methodology/approach
Publicly available Facebook reviews (n = 4,502) of a reputable healthcare system in the USA were analyzed. A thematic analysis was conducted to explore architectural elements of the physical environment that play a role in patient satisfaction.
Findings
Facebook reviews were examined for the presence of design-related factors within the physical environment. Of the 627 posts (14 per cent) with relevant content, 56 involved factors related to the physical environment. The factors include: location, parking, cleanliness, privacy, waiting rooms, music and temperature. The results showed that environmental and design-related factors are part of patient satisfaction in hospitals.
Research limitations/implications
Not all Facebook reviews contain narrative information. Nevertheless, the impact of the built environment can manifest in online reviews of healthcare systems. Future patient satisfaction research should examine variables related to the built environment on social media ratings.
Practical implications
Social media feedback about the physical environment can help in understanding factors influencing patient satisfaction, which can have an implication for architectural design.
Social implications
The patient satisfaction is related to the physical environment of healthcare facilities. Some social media narratives reflect it and can be used to improve patient satisfaction.
Originality/value
Although some studies examine social media narratives on patient satisfaction, fewer studies examine these narratives in relation to the built environment. Created by a team of interdisciplinary researchers, this study provides a novel approach to examine social media ratings.
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Rotman LE, Alford EN, Shank CD, Dalgo C, Stetler WR. Is There an Association Between Physician Review Websites and Press Ganey Survey Results in a Neurosurgical Outpatient Clinic? World Neurosurg 2019; 132:e891-e899. [PMID: 31382063 DOI: 10.1016/j.wneu.2019.07.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent studies suggest a poor association between physician review websites and the validated metrics used by the Centers for Medicare and Medicaid Services. The purpose of this study was to evaluate the association between online and outpatient Press Ganey (PG) measures of patient satisfaction in a neurosurgical department. METHODS We obtained PG survey results from one large academic institution's outpatient neurosurgery clinic. Popular physician review websites were searched for each of the faculty captured in the PG data. Average physician rating and percent Top Box scores were calculated for each physician. PG data were separated into new and established clinic visits for subset analysis. Spearman's rank correlation coefficients were calculated to determine associations. RESULTS Twelve neurosurgeons were included. Established patients demonstrated greater PG scores as compared with new patients, with an average physician rating increase of 0.55 and an average Top Box increase of 12.5%. Online physician ratings were found to demonstrate strong agreement with PG scores for the entire PG population, new patient subset, and established patient subset (ρ = 0.77-0.79, P < 0.05). Online Top Box scores demonstrated moderate agreement with overall PG Top Box scores (ρ = 0.59, P = 0.042), moderate agreement with the new patient population Top Box scores (ρ = 0.56, P = 0.059), and weak agreement with established patient population Top Box scores (ρ = 0.38, P = 0.217). CONCLUSIONS Our findings demonstrated a strong agreement between PG ratings and online physician ratings and a poorer correlation when comparing PG Top Box scores with online physician Top Box scores, particularly in the established patient population.
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Affiliation(s)
- Lauren E Rotman
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Elizabeth N Alford
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher D Shank
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Caitlin Dalgo
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William R Stetler
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Sheikh MM, Qayyum R, Panda M. Relationship of Physicians' Rapport with Patients' Satisfaction and Psychological Well-being During Hospitalization. Cureus 2019; 11:e4991. [PMID: 31497422 PMCID: PMC6707819 DOI: 10.7759/cureus.4991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective The purpose of this study was to assess the association between the psychological well-being and satisfaction of patients with physicians during their hospitalization. Methods This cross-sectional study was conducted at a local hospital using the following surveys: Brief Inventory of Thriving (BIT), tool to assess inpatient satisfaction with care from hospitalists (TAISCH) survey, and Erlanger Internal Patient satisfaction survey addressing demographic questions and questions on physicians' quality of care and etiquette. Mixed linear regression models were created to examine the effect of psychological well-being on patient satisfaction. Models were adjusted for age, race, and gender, and all analyses were performed in R 3.1.1 using the 'lme4' package with statistical significance set at p<0.05. Results A total of 360 patients were enrolled in this analysis and the mean age of the cohort was 54.5 years. In the unadjusted analysis, each unit increase in BIT score was associated with a 0.3% (95% CI:0.19-0.4, p<0.001) increase in mean satisfaction score using the five-domain questionnaire and a 0.25% (95%CI:0.16-0.34, p<0.01) increase in mean satisfaction score using the TAISCH questionnaire. Multivariable models, after adjusting confounding variables, also showed the direct and statistically significant relationship between patients' level of psychological well-being and patient satisfaction. Each unit increase in BIT score was associated with a 0.31% (95% CI:0.20-0.43, p<0.001) and 0.26% (95% CI:0.17-0.36, p<0.001) increase in mean satisfaction scores across the five-domain questionnaire and TAISCH questionnaire. Conclusions There is a positive correlation between the level of patients' psychological well-being and satisfaction with his/her physician with a statistical significance. With patient-specific strategies, we can further improve patient rapport with their physicians, resulting in positive patient outcomes.
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Affiliation(s)
| | - Rehan Qayyum
- Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, USA
| | - Mukta Panda
- Internal Medicine, University of Tennessee College of Medicine, Health and Science Center, Chattanooga, USA
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Sanford Z, Weltz AS, Zahiri HR, Park A. Demographic-related variables impact subjective experiences of patient wait times and perceived attention afforded in surgical outpatient clinic encounters. Am J Surg 2019; 219:27-32. [PMID: 31010578 DOI: 10.1016/j.amjsurg.2019.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/29/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Patient satisfaction remains a key component in successful delivery of high-quality healthcare. In this study, we attempted to better understand how patient demographics might influence perception of clinic wait times and determine factors that may positively influence perception of a clinic experience. METHODS A prospective study was conducted assessing patient satisfaction during outpatient surgical clinics in minimally invasive, breast, plastic/reconstructive, and orthopaedic surgery between May and September 2017. Patient demographics, subjective and objective assessments of wait time and physician encounter, and qualitative assessments of physician and patient interaction were collected. RESULTS 150 patients were enrolled with median age between 45 and 54 years old. Patients perceived mean wait times of 22.5 min and contact with physician as 12.3 min. Objective measures of wait and physician-contact times were 30.8 min and 10.7 min. These trends persisted despite surgical specialty and new versus returning patient class. Widowed patients perceived receiving less attention by doctors (p<.05), retirees believed they spent less time with their physician (p<.05), and associate's degree holders as highest education status had greater differences in perceived-versus-actual contact time with their doctor (p<.05). Clinic patients reported high satisfaction scores (>96%) quantifying physician eye-contact (99.3%), attention (99.8%), clarity of clinical communication (98.7%), interest in answering questions (99.2%), and reasonability (98.2%) highly. Patients described their physicians as excellent (99.4%) and were likely to refer their provider to others (99.9%). CONCLUSION Our findings suggest qualitative factors of patient encounters including eye contact, attention, communication, interest, and subjective perceptions of time bear more weight in the final assessment of patient satisfaction with care than quantitative factors such as actual wait time and duration of time with provider. This is irrespective of differences in perceived wait and contact times between different groups.
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Affiliation(s)
- Zachary Sanford
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Adam S Weltz
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, USA
| | - H Reza Zahiri
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, USA
| | - Adrian Park
- Department of Surgery, Anne Arundel Medical Center, Annapolis, MD, USA.
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Boylan MR, Slover JD, Kelly J, Hutzler LH, Bosco JA. Are HCAHPS Scores Higher for Private vs Double-Occupancy Inpatient Rooms in Total Joint Arthroplasty Patients? J Arthroplasty 2019; 34:408-411. [PMID: 30578151 DOI: 10.1016/j.arth.2018.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Private hospital rooms have a number of potential advantages compared to shared rooms, including reduced noise and increased control over the hospital environment. However, the association of room type with patient experience metrics in total joint arthroplasty (TJA) patients is currently unclear. METHODS For private versus shared rooms, we compared our institutional Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores in patients who underwent primary TJA over a 2-year period. Regression model odds ratios (ORs) were adjusted for surgeon, date of surgery, and length of stay. RESULTS Patients in private rooms were more likely to report a top-box score for overall hospital rating (85.6% vs 79.4%, OR = 1.53, P = .011), hospital recommendation (89.3% vs 83.0%, OR = 1.78, P = .002), call button help (76.0% vs 68.7%, OR = 1.40, P = .028), and quietness (70.4% vs 59.0%, OR = 1.78, P < .001). There were no significant differences on surgeon metrics including listening (P = .225), explanations (P = .066), or treatment with courtesy and respect (P = .396). CONCLUSION For patients undergoing TJA, private hospital rooms were associated with superior performance on patient experience metrics. This association appears specific for global and hospital-related metrics, with little impact on surgeon evaluations. With the utilization of HCAHPS data in value-based initiatives, placement of TJA patients in private rooms may lead to increased reimbursement and higher hospital rankings. LEVEL OF EVIDENCE Level III, retrospective cohort.
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Affiliation(s)
- Matthew R Boylan
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Joan Kelly
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Lorraine H Hutzler
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
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Siddiqui Z, Bertram A, Berry S, Niessen T, Allen L, Durkin N, Feldman L, Herzke C, Qayyum R, Pronovost P, Brotman DJ. Geographically Localized Medicine House-Staff Teams and Patient Satisfaction. J Patient Exp 2019; 6:46-52. [PMID: 31236451 PMCID: PMC6572937 DOI: 10.1177/2374373518771361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Geographically localized care teams may demonstrate improved communication between team members and patients, potentially enhancing coordination of care. However, the impact of geographically localized team on patient experience scores is not well understood. OBJECTIVE To compare experience scores of patients on resident teams home clinical units with patients assigned to them off of their home units over a 10-year period. PARTICIPANTS Patients admitted to any of the 4 chief resident staffed internal medicine inpatient service were included. Patients admitted to the house-staff teams' home clinical unit comprised the exposure group and their patients off of their home units comprised the control patients. MEASUREMENT Top-box experience scores calculated from the physician Hospital Consumer Assessment of Healthcare and Provider Systems (HCAHPS) and Press Ganey patient satisfaction surveys. RESULTS There were 3012 patients included in the study. There were no significant differences in experience scores with physician communication, nursing communication, pain, or discharge planning between the 2 groups. Patients did not report satisfaction more often with the time physicians spent with them on localized teams (48.6% vs 47.5%; P = .54) or that staff were better at working together (63.2% vs 61.3%; P = .29). This did not change during a 45-month period when the proportion of patients on home units exceeded 75% and multidisciplinary rounds were started. CONCLUSION Patients cared for by geographically localized teams did not have better patient experience. Other factors such as physician communication skills or limited time spent in direct care may overshadow the impact of having localized teams. Further research is needed to better understand organizational, team, and individual factors impacting patient experience.
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Affiliation(s)
- Zishan Siddiqui
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Amanda Bertram
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Stephen Berry
- Division of Infectious Diseases, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Timothy Niessen
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Lisa Allen
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Nowella Durkin
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Leonard Feldman
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Carrie Herzke
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Rehan Qayyum
- Division of Hospital Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Peter Pronovost
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, USA
| | - Daniel J Brotman
- Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, MD, USA
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Abstract
OBJECTIVE Hospitalized patients placed in isolation due to a carrier state or infection with resistant or highly communicable organisms report higher rates of anxiety and loneliness and have fewer physician encounters, room entries, and vital sign records. We hypothesized that isolation status might adversely impact patient experience as reported through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, particularly regarding communication. DESIGN Retrospective analysis of HCAHPS survey results over 5 years. SETTING A 1,165-bed, tertiary-care, academic medical center. PATIENTS Patients on any type of isolation for at least 50% of their stay were the exposure group. Those never in isolation served as controls. METHODS Multivariable logistic regression, adjusting for age, race, gender, payer, severity of illness, length of stay and clinical service were used to examine associations between isolation status and "top-box" experience scores. Dose response to increasing percentage of days in isolation was also analyzed. RESULTS Patients in isolation reported worse experience, primarily with staff responsiveness (help toileting 63% vs 51%; adjusted odds ratio [aOR], 0.77; P = .0009) and overall care (rate hospital 80% vs 73%; aOR, 0.78; P < .0001), but they reported similar experience in other domains. No dose-response effect was observed. CONCLUSION Isolated patients do not report adverse experience for most aspects of provider communication regarded to be among the most important elements for safety and quality of care. However, patients in isolation had worse experiences with staff responsiveness for time-sensitive needs. The absence of a dose-response effect suggests that isolation status may be a marker for other factors, such as illness severity. Regardless, hospitals should emphasize timely staff response for this population.
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Moving into a new hospital tower: The MOVEE model. Nurs Manag (Harrow) 2018; 49:12-16. [PMID: 30499854 DOI: 10.1097/01.numa.0000546206.32456.be] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Factors Driving Patient Perception of Quality Care After Primary Total Hip and Total Knee Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e061. [PMID: 30656258 PMCID: PMC6324905 DOI: 10.5435/jaaosglobal-d-18-00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Differences in female and male patient perception of care and satisfaction following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) were assessed via Hospital Consumer Assessment of Healthcare Providers and Systems survey, demographic, and clinical data. Methods: After institutional review board approval, a retrospective review of the Hospital Consumer Assessment of Healthcare Providers and Systems survey responses at a private, academic, level-I trauma center was performed from January 2011 to December 2013. Inclusion criteria were primary THA and TKA patients who were 18 years or older and returned the survey. Results: Overall, 1,166 THA and 1,411 TKA were included, with 55.0% of female THA patients and 64.5% of male THA patients highly satisfied (P = 0.002). The mean overall hospital rating was 7.2 for female THA and 7.8 for male THA (P = 0.003) patients. No significant differences was found in the TKA cohort. For all cohorts, the Nurse Communication with Nurses domain reported the greatest correlation with overall hospital rating (range, ρ = 0.418 to ρ = 0.502; P < 0.0001). Discussion: This series indicated that initiatives to improve patient care and patient perception of care should focus on nurse-patient communication, hospital staff responsiveness, the care transition process, and hospital environment. Patient sex was a significant factor in the overall satisfaction for THA, with female patients reporting significantly lower ratings than male patients.
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Grøndahl VA, Kirchhoff JW, Andersen KL, Sørby LA, Andreassen HM, Skaug EA, Roos AK, Tvete LS, Helgesen AK. Health care quality from the patients' perspective: a comparative study between an old and a new, high-tech hospital. J Multidiscip Healthc 2018; 11:591-600. [PMID: 30410346 PMCID: PMC6200069 DOI: 10.2147/jmdh.s176630] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose Previous studies show that the hospital environment and the behavior of health care personnel may predict patients’ perceptions of care quality. The aim of the study was to explore changes in perceived care quality from the patients’ perspective (QPP) when hospital services are relocated from an old to a new high-tech hospital and to describe what is important for patients in the high-tech hospital. Patients and methods A comparative cross-sectional design was used. The questionnaire QPP, which is based on a theoretical model of the quality of care comprising four quality dimensions, was used. Data were collected in 2015 (old hospital) and 2016 (new hospital), with 253 and 324 respondents, respectively, by consecutive sampling. Comparative statistics was used to test differences between patients’ care quality perceptions (perceived reality [PR] and subjective importance [SI]) (P≤0.05). Results The patients rated PR of all four quality dimensions (the care organization’s physical-technical conditions and sociocultural approach and the caregivers’ medical-technical competence and identity-oriented approach) higher in the new hospital. However, only the two quality dimensions concerning the care organization were rated significantly more highly. On an item level, five of the 27 items scored significantly higher on patients’ SI than on patients’ PR of the care in the new hospital, indicating a quality deficiency from the patients’ perspective. This comprised receiving effective pain relief, receiving examination and treatment within an acceptable waiting time, receiving useful information on self-care, receiving useful information on which doctors were responsible for their medical care, and having a comfortable bed. Conclusion The increase in care QPP was associated with improved environmental conditions, and no significant improvement in care quality was associated with the health care personnel. The results indicate that being in a high-tech environment does not improve patients’ perceptions of care quality provided by health care personnel. The results gave valuable information for quality improvement in clinical practice, based on the patients’ perspective.
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Affiliation(s)
| | - Jörg W Kirchhoff
- Faculty of Health and Welfare, Østfold University College, Halden, Norway,
| | | | | | | | - Eli-Anne Skaug
- Faculty of Health and Welfare, Østfold University College, Halden, Norway,
| | | | - Liv Solveig Tvete
- Faculty of Health and Welfare, Østfold University College, Halden, Norway,
| | - Ann Karin Helgesen
- Faculty of Health and Welfare, Østfold University College, Halden, Norway,
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Miedema E, Lindahl G, Elf M. Conceptualizing Health Promotion in Relation to Outpatient Healthcare Building Design: A Scoping Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2018; 12:69-86. [PMID: 30203663 DOI: 10.1177/1937586718796651] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE: This review explored different conceptualizations of health promotion in the context of, and in relation to, outpatient building design. BACKGROUND: Today's healthcare organizations are implementing holistic healthcare approaches such as health promotion, while simultaneously increasing their outpatient services. These health promotion approaches, focused on empowering people to take control of their health, are expected to have implications for the outpatient healthcare building design. Yet there is limited knowledge what these may be. A review of the literature on the current state of the art is thus needed to enable and support dialog on future healthcare building design. METHOD: A scoping review of 4,506 papers, collected from four databases and three scientific journals in 2015, resulted in 14 papers relating health promotion to building design and outpatient healthcare. From the subsequent content analysis, multiple common themes and subthemes emerged. RESULTS: The review reveals diverse range of health promotion interpretations, three health promotion perspectives (health behavior, health equity, and sense of coherence), associated design approaches, design objectives, health-related outcomes, building features, and solutions. CONCLUSIONS: While diverse health promotion perspectives might merely represent variations in focus, these differences become problematic when relating to building design. To support further dialogs on development of health promotion in, and in relation to, the build environment, there is a need to strengthen the health promotion vocabulary. Further research is needed to compare different design approaches and how these can be combined to minimize contradicting implications for building design.
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Affiliation(s)
- Elke Miedema
- 1 Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Göran Lindahl
- 1 Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Marie Elf
- 1 Division of Building Design, Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden.,2 School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
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Siddiqui Z, Berry S, Bertram A, Allen L, Hoyer E, Durkin N, Qayyum R, Wick E, Pronovost P, Brotman DJ. Does Patient Experience Predict 30-Day Readmission? A Patient-Level Analysis of HCAHPS Data. J Hosp Med 2018; 13:681-687. [PMID: 30261085 DOI: 10.12788/jhm.3037] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hospital-level studies have found an inverse relationship between patient experience and readmissions. However, based on typical survey response time, it is unclear if patients are able to respond to surveys before they get readmitted and whether being readmitted might be a driver of poor experience scores (reverse causation). OBJECTIVE Using patient-level Hospital Consumer Assessment of Healthcare Providers and Systems (HCHAPS) and Press Ganey data to examine the relationship between readmissions and experience scores and to distinguish between patients who responded before or after a subsequent readmission. DESIGN Retrospective analysis of 10-year HCAHPS data. SETTING Single tertiary care academic hospital. PARTICIPANTS Patients readmitted within 30 days of an index hospitalization who received an HCAHPS survey linked to index admission comprised the exposure group. This group was divided into those who responded prior to readmission and those who responded after readmission. Nonreadmitted patients comprised the control group. ANALYSIS Multivariable-logistic regression to analyze the association between HCHAPS and Press Ganey scores and 30-readmission status, adjusted for patient factors. RESULTS Only 15.8% of the readmitted patients responded to the survey prior to readmission, and their scores were not significantly different from the nonreadmitted patients. The patients who responded after readmission were significantly more dissatisfied with physicians (doctors listened 73.0% vs 79.2%, aOR 0.75, P < .0001), staff responsiveness, (call button 50.0% vs 59.1%, aOR 0.71, P < .0001) pain control, discharge plan, noise, and cleanliness of the hospital. CONCLUSIONS Our findings suggest that poor patient experience may be due to being readmitted, rather than being predictive of readmission.
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Affiliation(s)
- Zishan Siddiqui
- Division of General Internal Medicine, Johns Hopkins Medicine Baltimore, Maryland, USA.
| | - Stephen Berry
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Amanda Bertram
- Division of General Internal Medicine, Johns Hopkins Medicine Baltimore, Maryland, USA
| | - Lisa Allen
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Erik Hoyer
- Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Nowella Durkin
- Division of General Internal Medicine, Johns Hopkins Medicine Baltimore, Maryland, USA
| | - Rehan Qayyum
- Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elizabeth Wick
- Division of General Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Peter Pronovost
- Division of General Internal Medicine, Johns Hopkins Medicine Baltimore, Maryland, USA
| | - Daniel J Brotman
- Division of General Internal Medicine, Johns Hopkins Medicine Baltimore, Maryland, USA
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Wong L, Ryan FS, Christensen LR, Cunningham SJ. Factors influencing satisfaction with the process of orthodontic treatment in adult patients. Am J Orthod Dentofacial Orthop 2018; 153:362-370. [DOI: 10.1016/j.ajodo.2017.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/01/2017] [Accepted: 07/01/2017] [Indexed: 10/17/2022]
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Rogo-Gupta LJ, Haunschild C, Altamirano J, Maldonado YA, Fassiotto M. Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology. Womens Health Issues 2018; 28:281-285. [PMID: 29429946 DOI: 10.1016/j.whi.2018.01.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 12/27/2017] [Accepted: 01/05/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Patient satisfaction is gaining increasing attention as a quality measure in health care, but the methods used to assess it may negatively impact women physicians. OBJECTIVE Our objective was to examine the relationship between physician gender and patient satisfaction with outpatient gynecology care as measured by the Press Ganey patient satisfaction survey. STUDY DESIGN This cross-sectional study analyzed 909 Press Ganey patient satisfaction surveys linked to outpatient gynecology visits at a single academic institution (March 2013-August 2014), including self-reported demographics and satisfaction. Surveys are delivered in a standardized fashion electronically and by mail. Surveys were completed by 821 unique patients and 13,780 gynecology visits occurred during the study period. The primary outcome variable was likelihood to recommend (LTR) a physician. We used χ2 tests of independence to assess the effect of demographic concordance on LTR and two generalized estimating equations models were run clustered by physician, with topbox physician LTR as the outcome variable. Analysis was performed in SAS Enterprise Guide 7.1 (SAS, Inc., Cary, NC). RESULTS Nine hundred nine surveys with complete demographic data were completed by women during the study period (mean age, 49.3 years). Age- and race-concordant patient-physician pairs received significantly higher proportions of top LTR score than discordant pairs (p = .014 and p < .0001, respectively). In contrast, gender-concordant pairs received a significantly lower proportion of top scores than discordant pairs (p = .027). In the generalized estimating equations model adjusting for health care environment, only gender remained statistically significant. Women physicians had significantly lower odds (47%) of receiving a top score (odds ratio, 0.53; 95% CI, 0.37-0.78; p = .001). CONCLUSIONS Women gynecologists are 47% less likely to receive top patient satisfaction scores compared with their male counterparts owing to their gender alone, suggesting that gender bias may impact the results of patient satisfaction questionnaires. Therefore, the results of this and similar questionnaires should be interpreted with great caution until the impact on women physicians is better understood.
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Affiliation(s)
- Lisa J Rogo-Gupta
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California.
| | - Carolyn Haunschild
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Yvonne A Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, California
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Voigt J, Mosier M, Darouiche R. Private Rooms in Low Acuity Settings: A Systematic Review of the Literature. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2017; 11:57-74. [PMID: 28831819 DOI: 10.1177/1937586717702597] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Determine if the peer-reviewed evidence supports single-patient ward bedrooms in low-acuity care settings within a hospital. BACKGROUND New evidence exists since the 2006 Facility Guideline Institute guideline recommended single-bedded rooms (SBRs) in low-acuity care settings. Additionally, prior studies evaluated high-acuity care settings (e.g., critical care) in their recommendations on SBRs. There is a need to reevaluate the evidence. METHODS A systematic review of the literature was completed including electronic and hand searches of references. A data extraction form was utilized. Two reviewers evaluated the studies independently. Studies that were included examined the effect of single-patient rooms on medical surgical ward beds only. Each study was graded using accepted clinical evidence grading instruments. RESULTS Over 1,400 records were identified. After excluding studies, a total of 49 records were graded. The highest quality evidence identified (Center for Evidence-Based Medicine [CEBM]: 2a, 2b, and Grading of Recommendations, Assessment, Development, and Evaluation [GRADE] C) did not support the use of single-patient rooms for reducing infections, for minimizing patient falls, for reducing medication errors, or for patient satisfaction. Operational efficiencies were improved with SBRs but only addressed the maternity ward. The lowest quality evidence (CEBM: 4/5 and GRADE D) supported the use of single-patient rooms. CONCLUSIONS Based on CEBM and GRADE assessments, there is a lack of high-quality data supporting the use of low-acuity SBRs throughout the entire hospital. Furthermore, it is recommended that more research be conducted on the effect of SBRs, so higher quality evidence is developed.
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Affiliation(s)
- Jeffrey Voigt
- 1 Medical Device Consultants of Ridgewood, LLC, Ridgewood, NJ, USA
| | - Michael Mosier
- 2 Department of Mathematics and Statistics, Washburn University, Topeka, KS, USA
| | - Rabih Darouiche
- 3 Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
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Davidson KW, Shaffer JA, Ye S, Falzon L, Emeruwa IO, Sundquist K, Inneh IA, Mascitelli SL, Manzano WM, Vawdrey DK, Ting HH. Interventions to improve hospital patient satisfaction with healthcare providers and systems: a systematic review. BMJ Qual Saf 2017; 26:596-606. [PMID: 27488124 PMCID: PMC5290224 DOI: 10.1136/bmjqs-2015-004758] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 07/07/2016] [Accepted: 07/14/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many hospital systems seek to improve patient satisfaction as assessed by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. A systematic review of the current experimental evidence could inform these efforts and does not yet exist. METHODS We conducted a systematic review of the literature by searching electronic databases, including MEDLINE and EMBASE, the six databases of the Cochrane Library and grey literature databases. We included studies involving hospital patients with interventions targeting at least 1 of the 11 HCAHPS domains, and that met our quality filter score on the 27-item Downs and Black coding scale. We calculated post hoc power when appropriate. RESULTS A total of 59 studies met inclusion criteria, out of these 44 did not meet the quality filter of 50% (average quality rating 27.8%±10.9%). Of the 15 studies that met the quality filter (average quality rating 67.3%±10.7%), 8 targeted the Communication with Doctors HCAHPS domain, 6 targeted Overall Hospital Rating, 5 targeted Communication with Nurses, 5 targeted Pain Management, 5 targeted Communication about Medicines, 5 targeted Recommend the Hospital, 3 targeted Quietness of the Hospital Environment, 3 targeted Cleanliness of the Hospital Environment and 3 targeted Discharge Information. Significant HCAHPS improvements were reported by eight interventions, but their generalisability may be limited by narrowly focused patient populations, heterogeneity of approach and other methodological concerns. CONCLUSIONS Although there are a few studies that show some improvement in HCAHPS score through various interventions, we conclude that more rigorous research is needed to identify effective and generalisable interventions to improve patient satisfaction.
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Affiliation(s)
- Karina W. Davidson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
- Value Institute, New York-Presbyterian Hospital, New York, NY
| | - Jonathan A. Shaffer
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
- Department of Psychology, University of Colorado Denver, Denver, CO
| | - Siqin Ye
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
| | - Iheanacho O. Emeruwa
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
| | - Kevin Sundquist
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical College, New York, NY
| | - Ifeoma A. Inneh
- Value Institute, New York-Presbyterian Hospital, New York, NY
| | | | | | | | - Henry H. Ting
- Value Institute, New York-Presbyterian Hospital, New York, NY
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Affiliation(s)
- Peter Cram
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, ON, Canada.
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Irfan Dhalla
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Janice L Kwan
- Division of General Internal Medicine and Geriatrics, Sinai Health System and University Health Network, Toronto, ON, Canada
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Abstract
Simulation in multiple contexts over the course of a 10-week period served as a core learning strategy to orient experienced clinicians before opening a large new urban freestanding emergency department. To ensure technical and procedural skills of all team members, who would provide care without on-site recourse to specialty backup, we designed a comprehensive interprofessional curriculum to verify and regularize a wide range of competencies and best practices for all clinicians. Formulated under the rubric of systems integration, simulation activities aimed to instill a shared culture of patient safety among the entire cohort of 43 experienced emergency physicians, physician assistants, nurses, and patient technicians, most newly hired to the health system, who had never before worked together. Methods throughout the preoperational term included predominantly hands-on skills review, high-fidelity simulation, and simulation with standardized patients. We also used simulation during instruction in disaster preparedness, sexual assault forensics, and community outreach. Our program culminated with 2 days of in-situ simulation deployed in simultaneous and overlapping timeframes to challenge system response capabilities, resilience, and flexibility; this work revealed latent safety threats, lapses in communication, issues of intake procedure and patient flow, and the persistence of inapt or inapplicable mental models in responding to clinical emergencies.
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Mistry JB, Chughtai M, Elmallah RK, Le S, Bonutti PM, Delanois RE, Mont MA. What Influences How Patients Rate Their Hospital After Total Hip Arthroplasty? J Arthroplasty 2016; 31:2422-2425. [PMID: 27155998 DOI: 10.1016/j.arth.2016.03.060] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/25/2016] [Accepted: 03/30/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Centers for Medicare and Medicaid Services are now using results from patient satisfaction surveys, such as Press Ganey, for reimbursement. It is unknown what factors influence scores on satisfaction surveys in post-total hip arthroplasty (THA) patients. The purpose of this study was to evaluate what influences these scores in THA patients. Specifically, we aimed to evaluate: (1) how pain control affects the patients' perception of their orthopedist, nursing staff, and overall hospital satisfaction; (2) the individual impact of these factors on overall hospital satisfaction after THA; and (3) the impact of lengths of stay, age, body mass index (BMI), and American Society of Anesthesiology (ASA) scores on overall satisfaction. METHODS To assess whether pain management influences patients' perception of the orthopedist, a correlation analysis was performed between pain control and perception of their doctor. Similar analyses were performed to determine the relationship between pain management and patients' perception of their treating nurse, as well as overall satisfaction. A multiple regression analysis was performed to determine which of the aforementioned factors have the greatest impact on overall satisfaction. To determine the impact of length of stay on overall hospital satisfaction, a correlation analysis was performed between these 2 variables. Similar analyses were performed for age, BMI, and ASA scores. RESULTS Patients' perception of pain control was significantly positively correlated with the perception of their orthopedist, nurse, and overall hospital satisfaction. Multiple regression analysis demonstrated that patients' perception of nurses and orthopedists yielded a significantly positive influence on overall hospital satisfaction. A significant negative correlation existed between lengths of stay and hospital satisfaction. There were no significant correlations between age, BMI, and ASA scores and overall hospital rating. CONCLUSION Post-THA patients associate pain management with hospital satisfaction, as well as their perception of their treating nurses and orthopedists. Overall satisfaction was most impacted by patients' perception of their nurse, followed by their orthopedist. In addition, there was an association between shorter length of stay and higher overall satisfaction. These results are of paramount importance because by recognizing factors that affect scores on satisfaction surveys, orthopedic surgeons can direct efforts to improve post-THA satisfaction and optimize reimbursements.
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Affiliation(s)
- Jaydev B Mistry
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Morad Chughtai
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Randa K Elmallah
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sidney Le
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | | | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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Can We Reduce the Utilization of Home-Visiting Nurse Services After Primary Total Joint Arthroplasty? J Arthroplasty 2016; 31:50-3. [PMID: 27113944 DOI: 10.1016/j.arth.2016.02.078] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Home-visiting nurse services (HVNSs) after total joint arthroplasty (TJA) are touted as advantageous compared with inpatient rehabilitation. No study has established the utility of HVNSs compared with discharge home without services. METHODS A retrospective single-surgeon consecutive series of 509 primary TJA patients compared discharge disposition, length of stay, complications, and patient satisfaction between 2 cohorts. The cohorts were defined by the elimination of routine HVNSs. RESULTS Surprisingly, without routine HVNSs, more patients were discharged home (95% vs 88.3% with routine HVNSs) and mean length of stay significantly decreased. Complication rate was similar (2.9% vs 3.9% with routine HVNSs). Patient satisfaction remained favorable. We estimated that eliminating HVNSs avoids excess costs of $1177 per hip and $1647 per knee arthroplasty. CONCLUSIONS With dramatically diminished HVNS utilization after primary TJA, there was an associated decrease in length of stay and no increase in complication rate suggesting no compromise of patient care with significant cost savings.
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Siddiqui ZK, Brotman DJ. The authors reply "Changes in patient satisfaction related to hospital renovation: The experience with a new clinical building". J Hosp Med 2015; 10:764-5. [PMID: 26503084 DOI: 10.1002/jhm.2430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/27/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Zishan K Siddiqui
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Daniel J Brotman
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
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Zilm F, Haas AJ, Hamilton K, Allison D, Griffin CH. In reference to "Changes in patient satisfaction related to hospital renovation: The experience with a new clinical building". J Hosp Med 2015; 10:764. [PMID: 26503085 DOI: 10.1002/jhm.2429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/07/2015] [Accepted: 05/12/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Frank Zilm
- Academy of Architecture for Health Foundation, Kansas City, Missouri
| | - Anthony J Haas
- American College of Healthcare Architects, Olathe, Kansas
| | - Kirk Hamilton
- Department of Architecture, Texas A&M University, Center for Health Systems & Design, College Station, Texas
| | - David Allison
- Department of Graduate Studies in Architecture + Health, Clemson University, Clemson, South Carolina
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