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Lee NS, Keddem S, Sorrentino AE, Jenkins KA, Long JA. Health Equity in the Veterans Health Administration From Veterans' Perspectives by Race and Sex. JAMA Netw Open 2024; 7:e2356600. [PMID: 38373000 PMCID: PMC10877456 DOI: 10.1001/jamanetworkopen.2023.56600] [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] [Received: 08/31/2023] [Accepted: 12/27/2023] [Indexed: 02/20/2024] Open
Abstract
Importance Advancing equitable patient-centered care in the Veterans Health Administration (VHA) requires understanding the differential experiences of unique patient groups. Objective To inform a comprehensive strategy for improving VHA health equity through the comparative qualitative analysis of care experiences at the VHA among veterans of Black and White race and male and female sex. Design, Setting, and Participants This qualitative study used a technique termed freelisting, an anthropologic technique eliciting responses in list form, at an urban academic VHA medical center from August 2, 2021, to February 9, 2022. Participants included veterans with chronic hypertension. The length of individual lists, item order in those lists, and item frequency across lists were used to calculate a salience score for each item, allowing comparison of salient words and topics within and across different groups. Participants were asked about current perceptions of VHA care, challenges in the past year, virtual care, suggestions for change, and experiences of racism. Data were analyzed from February 10 through September 30, 2022. Main Outcomes and Measures The Smith salience index, which measures the frequency and rank of each word or phrase, was calculated for each group. Results Responses from 49 veterans (12 Black men, 12 Black women, 12 White men, and 13 White women) were compared by race (24 Black and 25 White) and sex (24 men and 25 women). The mean (SD) age was 64.5 (9.2) years. Some positive items were salient across race and sex, including "good medical care" and telehealth as a "comfortable/great option," as were some negative items, including "long waits/delays in getting care," "transportation/traffic challenges," and "anxiety/stress/fear." Reporting "no impact" of racism on experiences of VHA health care was salient across race and sex; however, reports of race-related unprofessional treatment and active avoidance of race-related conflict differed by race (present among Black and not White participants). Experiences of interpersonal interactions also diverged. "Impersonal/cursory" telehealth experiences and the need for "more personal/attentive" care were salient among women and Black participants, but not men or White participants, who associated VHA care with courtesy and respect. Conclusions and Relevance In this qualitative freelist study of veteran experiences, divergent experiences of interpersonal care by race and sex provided insights for improving equitable, patient-centered VHA care. Future research and interventions could focus on identifying differences across broader categories both within and beyond race and sex and bolstering efforts to improve respect and personalized care to diverse veteran populations.
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Affiliation(s)
- Natalie S. Lee
- Division of General Internal Medicine, The Ohio State University Wexner Medical Center, Columbus
- Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research, The Ohio State University, Columbus
| | - Shimrit Keddem
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Anneliese E. Sorrentino
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Kevin Ahmaad Jenkins
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
| | - Judith A. Long
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia
- Division of General Internal Medicine, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Shetty PN, Sanghavi KK, Mete M, Giladi AM. Prescription Opioids and Patient-Reported Outcomes and Satisfaction After Carpal Tunnel Release Surgery. Hand (N Y) 2023; 18:772-779. [PMID: 34991385 PMCID: PMC10336819 DOI: 10.1177/15589447211064365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Amount of opioid use correlates poorly with procedure-related pain; however, prescription limits raise concerns about inadequate pain control and impacts on patient-reported quality indicators. There remain no consistent guidelines for postoperative pain management after carpal tunnel release (CTR). We sought to understand how postoperative opioid use impacts patient-reported outcomes after CTR. METHODS This is a pragmatic cohort study using prospectively collected data from all adult patients undergoing uncomplicated primary CTR over 17 months at our center. Patients were categorized as having received or not received a postoperative opioid prescription, and then as remaining on a prescription opioid at 2-week follow-up or not. Questionnaires were completed before surgery and at 2-week follow-up. We collected brief Michigan Hand questionnaire (bMHQ) score, Patient-Reported Outcomes Measurement Information System Global Health score, satisfaction, and pain score. RESULTS Of 505 included patients, 405 received a postoperative prescription and 67 continued use at 2-weeks. These 67 patients reported lower bMHQ, lower satisfaction, and higher postoperative pain compared to those that discontinued. Multivariable regressions showed that receiving postoperative prescriptions did not significantly influence outcomes or satisfaction. However, remaining on the prescription at 2 weeks was associated with significantly lower bMHQ scores, particularly in patients reporting less pain. CONCLUSIONS Patients remaining on a prescription after CTR reported worse outcomes compared to those who discontinued. Unexpectedly, the widest bMHQ score gap was seen across patients reporting lowest pain scores. Further research into this high-risk subgroup is needed to guide policy around using pain and patient-reported outcomes as quality measures.Level of Evidence: Level III.
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Affiliation(s)
- Pragna N. Shetty
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA
| | - Kavya K. Sanghavi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Mihriye Mete
- MedStar Health Research Institute, Hyattsville, MD, USA
| | - Aviram M. Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD, USA
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Noel ME, Kuttner NP, Lebaron Z, Richman EH, Tummala S, Brinkman JC, Chhabra A. What Makes a 5-Star Orthopaedic Sports Medicine Surgeon? An Analysis of Positive Online Patient Reviews. Orthop J Sports Med 2023; 11:23259671231181378. [PMID: 37457044 PMCID: PMC10345912 DOI: 10.1177/23259671231181378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 03/20/2023] [Indexed: 07/18/2023] Open
Abstract
Background The increased focus on patient satisfaction has led to growth in the use of physician rating websites. Purpose To analyze the factors associated with online 5-star patient reviews for orthopaedic sports medicine surgeons. Study Design Cross-sectional study. Methods A total of 70 orthopaedic sports medicine surgeons were randomly selected from the AOSSM website. A search was performed for these surgeons on Yelp.com. All reviews other than 5 stars (of a possible 5 stars) were excluded from the study. Each review was categorized as referring to a surgical or nonsurgical aspect of care, and each comment within the review was categorized as being clinically or nonclinically related. Comments were further subcategorized by specific features such as bedside manner, clinical outcomes, and patient education. Categorical variables were analyzed using the chi-square test. Results Overall, 400 five-star reviews were included in the study, comprising 1225 total positive comments. Of the 400 five-star reviews, 200 (50%) were from surgically treated patients, and 200 (50%) were from nonsurgically treated patients. Of the 1225 positive comments, 505 (41%) were clinically related, and 720 (59%) were nonclinical. The most common positive clinical comments were for clear treatment plans (191 reviews [48%]), good outcomes (173 reviews [43%]), and providing alternative treatment plans (55 reviews [14%]). The most common positive nonclinical comments were for good physician bedside manner (287 reviews [72%]), friendly/professional staff (194 reviews [49%]), and ease of scheduling (68 reviews [17%]). Conclusion The majority of 5-star patient reviews left positive comments regarding nonclinical aspects of care such as physician bedside manner and friendly staff. The most common positive comments regarding clinical aspects concerned good outcomes and clear treatment plans. The overall most common positive comment, in both surgically and nonsurgically treated patients, referred to good bedside manner.
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Affiliation(s)
- Morgan E. Noel
- Department of Orthopedics Wake Forest University, Winston Salem, North Carolina, USA
| | - Nicolas P. Kuttner
- Department of Orthopedics, The Ohio State University, Columbus, Ohio, USA
| | - Zachary Lebaron
- Department of Radiology, Creighton University, Phoenix, Arizona, USA
| | - Evan H. Richman
- Department of Orthopedics, University of Colorado, Aurora, Colorado, USA
| | - Sailesh Tummala
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Joseph C. Brinkman
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Anikar Chhabra
- Department of Orthopedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Stanley J, Hensley M, King R, Baum N. The Relationship between Internet Patient Satisfaction Ratings and COVID-19 Outcomes. Healthcare (Basel) 2023; 11:healthcare11101411. [PMID: 37239695 DOI: 10.3390/healthcare11101411] [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: 01/18/2023] [Revised: 04/07/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Our prior research showed that patient experience-as reported by Google, Yelp, and the Hospital Consumer Assessment of Healthcare Providers and Systems survey-is associated with health outcomes. Upon learning that COVID-19 mortality rates differed among U.S. geographic areas, we sought to determine if COVID-19 outcomes were associated with patient experience. We reviewed daily, U.S.-county-level-accrued COVID-19 infections and deaths during the first year of the pandemic using each locality's mean online patient review rating, correcting for county-level demographic factors. We found doctor star ratings were significantly associated with COVID-19 outcomes. We estimated the absolute risk reduction (ARR) and relative risk reduction (RRR) for each outcome by comparing the real-world-observed outcomes, observed with the mean star rating, to the outcomes predicted by our model with a 0.3 unit higher average star rating. Geographic areas with higher patient satisfaction online review ratings in our models had substantially better COVID-19 outcomes. Our models predict that, had medical practices nationwide maintained a 4-star average online review rating-a 0.3-star increase above the current national average-the U.S may have experienced a nearly 11% lower COVID-19 infection rate and a nearly 17% lower death rate among those infected.
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Affiliation(s)
| | | | - Ronald King
- Vanguard Communications, Denver, CO 80205, USA
| | - Neil Baum
- Tulane Medical School, Tulane University, New Orleans, LA 70112, USA
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Characterizing Single-star Negative Online Reviews of Orthopaedic Trauma Association Members. J Am Acad Orthop Surg 2023; 31:397-404. [PMID: 36727955 DOI: 10.5435/jaaos-d-22-00631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/14/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The purpose of this study was to characterize factors that contribute to 1-star negative reviews regarding orthopaedic trauma surgeons. METHODS A search was done for Orthopaedic Trauma Association members on Yelp.com, Healthgrade.com, and Vitals.com in New York, Boston, San Francisco, Los Angeles, Dallas, Phoenix, Seattle, Baltimore, Denver, Houston, Philadelphia, and Washington, DC. All single-star reviews (out of a possible 5 stars) were included in this study. Reviews were categorized as either clinical or nonclinical and then further subcategorized. Categorical variables were analyzed using a chi-square test. The rate ratio (the ratio of the rate for nonsurgical divided by surgical reviews) was determined for each category. RESULTS Two hundred eighty-eight single-star reviews were included in the study, comprising 655 total complaints. Of all complaints, 274 (41.8%) were clinically related and 381 (58.2%) were nonclinical. Of the 288 single-star reviews, 96 (33.3%) were from surgically treated patients and 192 (66.7%) were from nonsurgical patients. Most complaints were in reference to nonclinical aspects of care such as physician bedside manner (173 reviews, 60%), not enough time spent with provider (58 reviews, 20%), and wait time (42 complaints, 15%). The most common clinical complaints were for complication (61 reviews, 21%), disagree with decision/plan (49 reviews, 17%), and uncontrolled pain (45 reviews, 16%). Surgical patients had a significantly higher rate of clinical complaints than nonsurgical patients (1.57 vs. 0.64 clinical complaints per review, P < 0.001). Nonsurgical patients had a significantly higher rate of nonclinical complaints than surgical patients (1.43 vs. 1.10 nonclinical complaints per review, P < 0.001). DISCUSSION Most 1-star reviews referenced a nonclinical aspect of care with a physician's bedside manner being the most common complaint. Surgical patients were markedly more likely to reference a clinical aspect of care, such as complications or misdiagnosis compared with nonsurgical patients, who more commonly referenced nonclinical aspects of care.
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Aljuaid M, Al-Sahli B, Edvardsson D, Al-Surimi K. Psychometric Evaluation of the Arabic Version of the Person-Centered Climate Questionnaire: Patient Version (PCQ-P). Healthcare (Basel) 2023; 11:healthcare11020190. [PMID: 36673558 PMCID: PMC9859215 DOI: 10.3390/healthcare11020190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/01/2023] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Adopting a person-centered care approach has transformed different healthcare settings worldwide. However, this concept has gained little attention in many Middle Eastern countries, including Saudi Arabia and other Arab countries. This study aimed to evaluate the psychometric characteristics of the Arabic person-centered climate questionnaire-patient version, measuring to what extent the climate of health care settings is perceived as being person-centered. METHOD This is a psychometric analysis study. The original validated version of the English Person-Centered Climate Questionnaire-Patient version (PCQ-P) was translated into Arabic and tested among a sample of hospital patients (n = 300) in Saudi Arabia using translation and back translation procedures. For psychometric evaluation, statistical analyses of validity and reliability were used, including exploratory factor analysis as well as conformity analysis. RESULTS The Arabic version of the person-centered climate questionnaire-patient version-showed good reliability as the Cronbach's alpha value of the total of 17 items was 0.84, and the Cronbach's alpha values of the three sub-scales (safety, everydayness, and hospitality) were 0.83, 0.56, and 0.68, respectively. Internal consistency results were high in terms cof orrelation coefficient for all 17 items. The exploratory factor analysis identified the three factors (safety, everydayness, and hospitality) responsible for 47.174% of the total variance. CONCLUSION The Arabic version of the PCQ-P showed satisfactory reliability and validity for measuring patients' perceptions of person-centeredness in Arab healthcare settings. This Arabic version will be accessible to those interested in generating and using empirical evidence to promote a patient-centered care approach in Arab healthcare settings. The results of this study can be used as a starting point for assessing and developing a person-centered care culture in Saudi hospitals and other Arab countries in the Middle East.
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Affiliation(s)
- Mohammed Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh P.O. Box 11450, Saudi Arabia
| | - Bashayer Al-Sahli
- King Faisal Specialist Hospital and Research Center, Riyadh P.O. Box 11564, Saudi Arabia
| | - David Edvardsson
- Sahlgrenska Academy, Institute of Health and Care Sciences, University of Gothenburg, P.O. Box 457, SE-405 30 Gothenburg, Sweden
- School of Nursing and Midwifery, La Trobe University, Bundoora, Melbourne, VIC 3086, Australia
| | - Khaled Al-Surimi
- School of Health and Environmental Studies, Hamdan Bin Mohammed Smart University, Dubai P.O. Box 71400, United Arab Emirates
- Correspondence:
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Medical Home Outcomes for School-Aged Children With Chronic Health Care Needs: A Mokken Analysis. Qual Manag Health Care 2023; 32:16-21. [PMID: 35383723 DOI: 10.1097/qmh.0000000000000366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES We examined the structure of the medical home construct as well as the association of having a medical home with school outcomes among children with chronic health conditions. METHODS The current study utilized a combination of structural equation modeling, item response theory, and Mokken scaling techniques to determine how components of a medical home may be prioritized. The components of an operationally defined medical home were the main measures along with number of missed school days and the degree of interference with a child's school. RESULTS Results of the current study provide a clear structure for the components of a medical home using Mokken scaling analyses. These components of a medical home are important as they were associated with fewer missed school days and a lower likelihood of a child's condition interfering with school as reported by parents. CONCLUSION With the results of the current study, providers working with schools can quickly discriminate (1) whether a child has a medical home and (2) understand how to guide parents toward a comprehensive medical home by understanding the hierarchy of medical home components.
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Analysis of Negative Reviews of Orthopedic Oncology Surgeons: An Investigation of Reviews from Healthgrades, Vitals, and Google. Sarcoma 2022; 2022:4351427. [DOI: 10.1155/2022/4351427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/13/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
Background. Physician review websites (PRWs) are increasing in usage and popularity. Our purpose is to characterize one-star reviews of orthopedic oncology surgeons to understand factors in healthcare that contribute to patient satisfaction. Methods. Orthopedic oncology surgeons were randomly selected from the Musculoskeletal Tumor Society. A search for one-star reviews was performed on Google Reviews, Healthgrades, and Vitals.com. Reviews were classified as clinical or nonclinical. Statistical analyses were performed regarding the frequency of reviews and complaints for each category. Results. Of the 7,733 reviews discovered, 908 (11.7%) were identified as one-star reviews. Of 907 usable complaints, 362 (40.8%) were clinical and 545 (59.2%) were nonclinical. The most common nonclinical complaints included bedside manner (65%) and limited time with providers (19%). The most common clinical complaints included complications (26%) and disagreements with the treatment plan (26%). There were 120 surgical and 221 nonsurgical reviews. Surgical patients had a higher rate of clinical complaints. Nonsurgical patients had a higher rate of total complaints. Conclusion. To the best of our knowledge, this is the first study examining PRWs regarding orthopedic oncology surgeons. Most one-star reviews were due to nonclinical complaints from nonsurgical patients. The most common factors are bedside manner, limited time with provider, phone communication issues, and rude/unprofessional conduct.
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Chen K, Lodaria K, Jackson HB. Patient satisfaction with telehealth versus in-person visits during COVID-19 at a large, public healthcare system. J Eval Clin Pract 2022; 28:986-990. [PMID: 36148479 PMCID: PMC9538919 DOI: 10.1111/jep.13770] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/28/2022]
Abstract
RATIONALE During the coronavirus disease pandemic, audio-only and video telehealth visits became more widely available, but the relative patient satisfaction between telehealth and in-person modalities is not well-described. AIMS AND OBJECTIVES Our objective was to compare patient satisfaction with audio-only, video, and in-person adult primary care visits at a large, urban public healthcare system. METHODS In this cross-sectional study, we used aggregated data from Press Ganey patient satisfaction surveys at 17 primary care facilities at New York City Health + Hospitals for visits between 1 June 2021 to 30 November 2021. We compared mean scores for questions common to surveys for each modality in domains of Access, Care Provider, and Overall Assessment using pairwise comparisons with two-tailed t-tests. RESULTS There were 7,183/79,562 (9.0%) respondents for in-person visits and 1,009/15,092 (6.7%) respondents for telehealth visits. Compared to respondents for in-person visits, respondents for telehealth visits were more likely to be aged 35-64 years, Asian, and speak English as their primary language, and less likely to be ≥65 years old, Black or other race, and speak Spanish or another language as their primary language (p < 0.001). Patients reported higher mean satisfaction for Access measures for telehealth visits than in-person visits (p < 0.001). For Care Provider satisfaction questions, video visits generally had higher mean scores than in-person and, in turn, audio-only visits. For Overall Assessment questions, video visits had higher mean scores than in-person and, subsequently, audio-only visits. CONCLUSION Of the visit modalities, video visits had the highest mean satisfaction scores across all domains. Telehealth may improve experiences with access, but audio-only visits may provide poorer visit experiences.
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Affiliation(s)
- Kevin Chen
- Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York, New York, USA.,Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York, USA
| | - Komal Lodaria
- Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York, New York, USA
| | - Hannah B Jackson
- Office of Ambulatory Care and Population Health, New York City Health + Hospitals, New York, New York, USA.,Division of General Internal Medicine and Clinical Innovation, New York University Grossman School of Medicine, New York, New York, USA
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Powell SK, Saali A, Frere J, Magill E, Krystal H, Serafini RA, Sultana S, Dale B, Ali M, Kumar V, Datta D, Hernandez-Antonio J, Aronson A, Meah YS, Gluhoski V, Katz CL. Design of and outcomes in a student-run free mental health clinic serving the uninsured in East Harlem. BMC Psychiatry 2022; 22:501. [PMID: 35883038 PMCID: PMC9321276 DOI: 10.1186/s12888-022-04112-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 07/05/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Safety-net clinics are an important source of low-cost or free mental healthcare to those with limited financial resources. Such clinics are often staffed by trainees in early stages of their career. Only limited data exist on best practices in treatment-implementation and on clinical outcomes attained in such clinics. The primary purpose of this article is to describe the design of an outpatient psychiatry student-run free clinic (SRFC) serving uninsured individuals in New York City's East Harlem neighborhood and to analyze the quality of services provided and the clinical outcomes attained. METHODS The authors conducted a retrospective chart review of n = 69 patients treated in the EHHOP Mental Health Clinic (E-MHC) to describe the demographic and clinical characteristics of the study population. Utilizing Health Effectiveness Data and Information Set metrics, they estimated the likelihoods of patients meeting metric quality criteria compared to those in other New York State (NYS) insurance groups. The authors derived linear mixed effect and logistic regression models to ascertain factors associated with clinical outcomes. Finally, the authors collected patient feedback on the clinical services received using a customized survey. RESULTS Almost all patients were of Hispanic ethnicity, and about half of patients had more than one psychiatric disorder. The clinical service performance of the E-MHC was non-inferior on most measures examined. Factors associated with symptom improvement were the number of treatment sessions and certain demographic and clinical variables. Patients provided highly positive feedback on the mental healthcare services they received. CONCLUSIONS SRFCs can provide quality care to vulnerable patients that leads to clinically meaningful reductions in psychiatric symptoms and is well-received by patients.
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Affiliation(s)
- Samuel K. Powell
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Alexandra Saali
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Justin Frere
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Elizabeth Magill
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Hannah Krystal
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Randal A. Serafini
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Syeda Sultana
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Brandon Dale
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Muhammad Ali
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Vedika Kumar
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Debjyoti Datta
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | | | - Anne Aronson
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Yasmin S. Meah
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Vicki Gluhoski
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
| | - Craig L. Katz
- grid.59734.3c0000 0001 0670 2351Icahn School of Medicine at Mount Sinai, New York, NY 10029 USA
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Chang AA, Siropaides CH, Chou CL. Improving Communication Skills: A Roadmap for Humanistic Health Care. Med Clin North Am 2022; 106:727-737. [PMID: 35725237 DOI: 10.1016/j.mcna.2022.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article outlines frameworks that enable health care providers to take steps to improve their health care communication skills, including not only outward-facing conversational tools but also personal awareness. Such awareness includes recognition of bias and emotional reactions, their behavioral consequences, and how to intervene when necessary. The authors describe the intrinsic and extrinsic motivators to improving communication skills, followed by a review of foundational communication microskills and suggestions on how to improve them through the perspectives of the clinician as a self-learner, the clinician with external coaching, and the administrator/leader.
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Affiliation(s)
- Andrew A Chang
- Department of Medicine, State University of New York Downstate, NYC Health + Hospitals/Kings County, 451 Clarkson Avenue, E Building 7th Floor Adult Primary Care, Brooklyn, NY 11203, USA.
| | - Caitlin H Siropaides
- Department of Internal Medicine, Section of Supportive and Palliative Care, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Calvin L Chou
- Department of Medicine, University of California and Veterans Affairs Healthcare System, VA Medical Center, 4150 Clement St (136MP), San Francisco, CA 94121, USA
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Kara P, Valentin JB, Mainz J, Johnsen SP. Composite measures of quality of health care: Evidence mapping of methodology and reporting. PLoS One 2022; 17:e0268320. [PMID: 35552561 PMCID: PMC9098058 DOI: 10.1371/journal.pone.0268320] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 04/27/2022] [Indexed: 11/19/2022] Open
Abstract
Background Quality indicators are used to quantify the quality of care. A large number of quality indicators makes assessment of overall quality difficult, time consuming and impractical. There is consequently an increasing interest for composite measures based on a combination of multiple indicators. Objective To examine the use of different approaches to construct composite measures of quality of care and to assess the use of methodological considerations and justifications. Methods We conducted a literature search on PubMed and EMBASE databases (latest update 1 December 2020). For each publication, we extracted information on the weighting and aggregation methodology that had been used to construct composite indicator(s). Results A total of 2711 publications were identified of which 145 were included after a screening process. Opportunity scoring with equal weights was the most used approach (86/145, 59%) followed by all-or-none scoring (48/145, 33%). Other approaches regarding aggregation or weighting of individual indicators were used in 32 publications (22%). The rationale for selecting a specific type of composite measure was reported in 36 publications (25%), whereas 22 papers (15%) addressed limitations regarding the composite measure. Conclusion Opportunity scoring and all-or-none scoring are the most frequently used approaches when constructing composite measures of quality of care. The attention towards the rationale and limitations of the composite measures appears low. Discussion Considering the widespread use and the potential implications for decision-making of composite measures, a high level of transparency regarding the construction process of the composite and the functionality of the measures is crucial.
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Affiliation(s)
- Pinar Kara
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- * E-mail:
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jan Mainz
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
- Psychiatry, Aalborg University Hospital, Aalborg, Denmark
- Department for Community Mental Health, University of Haifa, Haifa, Israel
- Department of Health Economics, University of Southern Denmark, Odense, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research (DACS), Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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13
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Richman EH, Ogbaudu E, Pollock JR, Brinkman JC, Moore ML, Arthur JR, Karlen JW. Characterizing Negative Online Reviews of Pediatric Orthopaedic Surgeons. J Pediatr Orthop 2022; 42:e533-e537. [PMID: 35200216 DOI: 10.1097/bpo.0000000000002121] [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: 02/07/2023]
Abstract
BACKGROUND The growing focus on subjective patient experiences has created an increase in popularity for physician rating websites. The purpose of this study was to characterize extremely negative reviews of pediatric orthopaedic surgeons. METHODS Pediatric orthopaedic surgeons were randomly selected using the Pediatric Orthopaedic Society of North America comprehensive list of surgeons. A search was then performed on Healthgrades.com, Vitals.com, and Yelp.com for 1-star reviews. Reviews were classified into clinical and nonclinical categories. Statistical analyses were performed regarding the frequency of reviews and complaints for each respective category. RESULTS Of the 279 one-star reviews categorized, 248 reviews (88.9% of reviews) included nonclinical complaints, and 182 reviews (65.2% of reviews) included clinical complaints. Nonsurgical patients were associated with 255 reviews, and the remaining 24 were related to surgical patients. Of the 430 comments within reviews, 248 referenced nonclinical aspects of care, and 182 referenced clinical care. Clinical factors most frequently noted included clinical disagreement (37%), unclear treatment plan (25%), complication (17%), misdiagnosis (15%), uncontrolled pain (13%), and delay in care (8%). The most addressed nonclinical factors included physician bedside manner (68%), time spent with provider (21%), wait time (18%), unprofessional staff (17%), scheduling issues (9%), cost (8%), and billing (8%). Compared with surgical reviews, nonsurgical reviews were more likely to contain nonclinical complaints (rate ratio: 1.5; P<0.05) and less likely to contain clinical complaints (rate ratio: 0.7; P<0.05). The most common complaint by surgical patients was complications (91.7%). CONCLUSIONS To our knowledge, this is the first study to examine the factors associated with negative reviews of pediatric orthopaedic surgeons. The majority of reviews of pediatric orthopaedic surgeons were left by nonsurgical patients and were related to nonclinical aspects of care. We also found surgeon-dependent factors such as poor physician bedside manner, unclear treatment plan, or parents' disagreement with treatment plan were the most common reasons for negative reviews. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Evan H Richman
- Creighton University School of Medicine-Phoenix Regional Campus
| | | | | | | | | | | | - Judson W Karlen
- Department of Orthopaedic Surgery, Phoenix Children's Hospital, Phoenix
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14
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Williams PAH, Lovelock B, Cabarrus T. A Sense of Coherence approach to improving patient experience using information infrastructure modelling. JMIR Form Res 2022; 6:e35418. [PMID: 35307641 PMCID: PMC9044153 DOI: 10.2196/35418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/03/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background Health care provider organizations are complex and dynamic environments. Consequently, how the physical and social environment of such organizations interact with an individual is a primary driver of an individual’s experience. Increasingly, the capabilities required for them to successfully interact with those within their care are critically dependent on the information infrastructure they have in place, which enables people, both patients and staff, to work optimally together to deliver their clinical and operational objectives. Objective This study aims to design a framework to address the challenge of how to assemble information systems in health care to support an improved sense of coherence for patients, as well as potentially innovate patients’ experiences, by connecting and orchestrating the synergy among people, processes, and systems. Methods It is necessary to understand the needs of health care providers and patients to address this challenge at a level relevant to information process design and technology development. This paper describes the design science research method used to combine the sense of coherence, which is a core concept within the Antonosky salutogenic approach to health and well-being, with an established information infrastructure maturity framework, demonstrating the coalescence of 2 distinct conceptual perspectives on care delivery. This paper provides an approach to defining a positive and supportive health care experience and linking this to the capabilities of an information- and technology-enabled environment. Results This research delivers a methodology for describing the patient experience in a form relevant to information infrastructure design, articulating a pathway from information infrastructure to patient experience. It proposes that patient experience can be viewed pragmatically in terms of the established sense of coherence concept, with its ability to identify and guide resources to modulate a patient’s environmental stressors. This research establishes a framework for determining and optimizing the capability of a facility’s information infrastructure to support the sense of coherence defined by the experiences of its patients. Conclusions This groundbreaking research provides a framework for health care provider organizations to understand and assess the ability of their information infrastructure to support and improve the patient experience. The tool assists providers in defining their technology-dependent operational goals around patient experience and, consequently, in identifying the information capabilities needed to support these goals. The results demonstrate how a fundamental shift in thinking about the use of information infrastructure can transform the patient experience. This study details an approach to describing information infrastructure within an experience-oriented framework that enables the impact of technology on experience to be designed explicitly. The contribution to knowledge is a new perspective on modeling how information infrastructure can contribute to supportive health-promoting environments. Furthermore, it may significantly affect the design and deployment of future digital infrastructures in health care.
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Affiliation(s)
- Patricia Anne Helen Williams
- Flinders-Cisco Digital Health Design Lab, Flinders Digital Health Research Centre, College of Science and Engineering, Flinders University, Tonsley CampusGPO Box 2100, Adelaide, SA, AU
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15
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Manik R, Carlos RC, Duszak R, Sadigh G. Costs Versus Quality in Imaging Examination Decisions. J Am Coll Radiol 2022; 19:450-459. [PMID: 35122720 DOI: 10.1016/j.jacr.2021.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Emerging price transparency tools allow consumers to access individualized out-of-pocket cost (OOPC) estimates, but many lack quality metrics. The aim of this study was to evaluate how potential patients weigh imaging OOPC versus measures of quality when selecting an imaging center for a hypothetical health condition (back pain). METHODS Surveying 1,310 Amazon Mechanical Turk volunteers, the authors evaluated how potential patients weigh MRI OOPC ($50 vs $400 vs unknown cost at the time of the examination, with billed OOPC responsibility varying between $50 and $3,500) versus service quality surrogates using three different quality indicators (examination results accuracy, physician recommendation of an imaging center on the basis of familiarity, and facility online star ratings) in their decisions when selecting a radiology center for imaging of two hypothetical clinical conditions (mild and severe back pain), using ranking-based conjoint analyses. RESULTS A total of 1,025 eligible respondents completed the survey. Respondents expressed higher preference for perceived quality over cost in hypothetical severe back pain scenarios, resulting in a relative importance of 65.8% (95% confidence interval [CI], 62.2%-69.4%) for improved imaging results accuracy from 87% to 96%, 63.9% (95% CI, 60.3%-67.5%) for provider recommendations of the facility, and 80.1% (95% CI, 74.2%-85.9%) for an increase in online review star ratings from 2.5 to 4.5 (out of 5) compared with an increased cost from $50 to $400. For mild back pain, there was no statistical difference in respondents' preference for perceived quality and cost. CONCLUSIONS Incorporating quality metrics into price transparency tools is important. Further research is needed to identify metrics that are most comparable and easily obtainable across imaging centers that remain important to patients.
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Affiliation(s)
- Ritika Manik
- Emory College of Arts and Sciences, Emory University, Atlanta, Georgia
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Gelareh Sadigh
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia.
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16
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Mahlknecht A, Abuzahra ME, Piccoliori G, Engl A, Sönnichsen A. Are quality promotion initiatives in Austrian and Italian general practices associated with higher patient satisfaction and quality of life? Results from the interventional study 'IQuaB'. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e397-e409. [PMID: 33151008 DOI: 10.1111/hsc.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
The objective was to assess the changes in quality of life (QoL) and patient satisfaction of chronically ill patients in general practices in Salzburg (Austria) and South Tyrol (Italy) after implementation of a combined intervention addressing quality of care of general practitioners (GPs). Furthermore, the correlation between QoL/patient satisfaction and quality of care provided by the GPs (measured by a quality score based on quality indicators [QIs]) was investigated. The non-controlled pre-post study involved GPs and patients with chronic conditions. The intervention consisted of self-audit, benchmarking and quality circles. QIs were extracted in the participating practices in 2012 (preintervention) and 2014 (postintervention). Before and after the intervention, a patient survey was conducted including EQ-5D (measuring health-related QoL), a patient participation scale and parts of the European Task Force on Patient Evaluations of General Practice questionnaire (measuring patient satisfaction). Mann-Whitney U-tests, chi-square tests and Spearman's rank correlation were applied for statistical analysis. Fifty-six GPs participated in the study. 1,710 patients returned the questionnaire in 2012, and 1,374 in 2014. Mean EQ-5D index (QoL) was similar in Salzburg and South Tyrol in both years: 2012 Salzburg 0.85 (95% CI 0.84-0.87), South Tyrol 0.85 (95% CI 0.84-0.86); 2014 Salzburg 0.84 (95% CI 0.83-0.86), South Tyrol 0.84 (95% CI 0.83-0.86). Patient satisfaction was higher in Salzburg than in South Tyrol at baseline (EUROPEP: mean percentage of best response 61.5% vs. 49.1%, p < 0.000) and also at follow-up (61.9% vs. 49.2%; p < 0.000). No significant correlation between quality score and QoL/patient satisfaction was detected. Thus, the impact of the intervention was not significant within the intermediate time periods analysed in the study. Improvements in quality of care do not necessarily also improve patient-relevant outcomes, which are probably more associated with other factors than with medical quality (e.g. availability of the GP, waiting times and communication-related issues).
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Affiliation(s)
- Angelika Mahlknecht
- Institute of General Practice, College of Health Care Professions, Bolzano, Italy
- Institute of General Practice, Family Medicine and Preventive Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Muna E Abuzahra
- Institute for General Medicine and Evidence-based Health Services Research, Medical University of Graz, Graz, Austria
| | - Giuliano Piccoliori
- Institute of General Practice, College of Health Care Professions, Bolzano, Italy
- South Tyrolean Academy of General Practice, Bolzano, Italy
| | - Adolf Engl
- Institute of General Practice, College of Health Care Professions, Bolzano, Italy
- South Tyrolean Academy of General Practice, Bolzano, Italy
| | - Andreas Sönnichsen
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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17
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Feng Y, Gravelle H. Patient Self-Reported Health, Clinical Quality, and Patient Satisfaction in English Primary Care: Practice-Level Longitudinal Observational Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1660-1666. [PMID: 34711367 DOI: 10.1016/j.jval.2021.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/20/2021] [Accepted: 05/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To examine the association of self-reported health of patients in general practices, as measured by the EQ-5D-5L, with practice clinical quality and patient-reported satisfaction with accessibility and consultations. METHODS We used data from the General Practitioner (GP) Patient Survey to construct a practice-level EQ-5D-5L index as the health outcome. Key explanatories were patient-reported measures of satisfaction with access and consultations (also derived from the GP Patient Survey) and clinical quality measured by the achievement of clinical quality indicators reported in the Quality and Outcomes Framework. We estimated practice-level linear panel data models with random and fixed practice effects and practice and patient covariates using 2012/13 to 2016/17 data on more than 7500 English general practices. RESULTS Bivariate correlations of the EQ-5D-5L index with quality measures were 0.048 for clinical quality, 0.071 for satisfaction with access, and 0.107 for satisfaction with GP consultations (all with P<.001). In both fixed effects regressions, which allow for unobserved time invariant practice characteristics, and random effects regressions which do not, the EQ-5D-5L index was positively associated with 1-year lags of patient satisfaction with access and GP consultations. Patient-reported health was positively associated with clinical quality in the fixed effects regressions. The implied effects were small in all cases. CONCLUSION Practice-level EQ-5D-5L is positively associated with clinical quality and with 1-year lags of patient-reported satisfaction with access and GP consultations.
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Affiliation(s)
- Yan Feng
- Institute of Population Health Sciences, Queen Mary University of London, England, UK.
| | - Hugh Gravelle
- Centre for Health Economics, University of York, England, UK
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18
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Gliedt JA, Walker RJ, Lu K, Dawson AZ, Egede LE. The Relationship Between Patient Satisfaction and Healthcare Expenditures in Adults with Spine Related Disorders: An Analysis of the 2008 to 2015 Medical Expenditures Panel Survey (MEPS). Spine (Phila Pa 1976) 2021; 46:1409-1417. [PMID: 33826590 PMCID: PMC8463412 DOI: 10.1097/brs.0000000000004047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE The aim of this study was to investigate the relationship between patient satisfaction (PS) and healthcare expenditures (HCE) in adults with spine related disorders (SRDs). SUMMARY OF BACKGROUND DATA SRDs are widespread and pose a high cost to society. PS and HCE have yet to be studied in this population. METHODS Fifteen thousand eight hundred fifty adults with SRDs from the Medical Expenditures Panel Survey (MEPS) (2008-2015) were analyzed. The MEPS medical conditions files were used to identify SRDs based on International Classification of Diseases-9 codes. Frequencies and percentages of sample demographics were calculated. HCE was measured as total direct payments for care provided during the survey year. A composite PS score was constructed using a 0 to 10 rating of their healthcare providers combined with the frequency in which patients felt they were listened to, were given understandable explanations, were respected, and were given enough time. Mean unadjusted HCE were calculated for each year and by quartile of PS. A two-part model consisting of a probit model and subsequent generalized linear model with gamma distribution was performed, adjusting for relevant covariates. Margins command was used to calculate incremental estimates of HCE. RESULTS Mean unadjusted HCE increased annually from $7057 (95% confidence interval [CI], $6516, $7597) in 2008 to $9820 (95% CI, $8811, $10,830) in 2015 for adults with SRDs. Adjusting for predisposing factors, individuals in second, third, and fourth quartiles of PS were significantly different from the first quartile. Adjusting for predisposing and enabling factors, only fourth quartile was significantly different from first quartile. After adjusting for predisposing, enabling and need factors, second, third, and fourth quartiles were no longer significantly different from the first quartile. CONCLUSION Expenditures have increased over time in adults with SRDs. PS is significantly associated with expenditures after controlling for predisposing and enabling factors, but not significant after controlling for need factors. Need factors appear to explain the relationship between lower levels of PS and higher HCE in adults with SRDs.Level of Evidence: 2.
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Affiliation(s)
- Jordan A. Gliedt
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kaiwei Lu
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z. Dawson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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19
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Investigating the Relationship between Ambulatory and Hospital Patient Experience Scores in a Neurosurgery Practice. Healthcare (Basel) 2021; 9:healthcare9091153. [PMID: 34574927 PMCID: PMC8469641 DOI: 10.3390/healthcare9091153] [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] [Received: 07/14/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Patient experience is critically important on both clinical and business levels to healthcare organizations, medical groups, and physician practices. We sought to understand whether a relationship exists between patient satisfaction scores in different settings for medical providers who practice in multiple settings (such as in the ambulatory setting and the hospital) within a system. Press Ganey (PG) ambulatory and hospital-based patient satisfaction surveys of a neurosurgery practice were retrospectively compared. Questions and sections related to the care provider, likelihood to recommend, and overall experience were examined. The ambulatory dataset included 2270 surveys, and the hospital dataset included 376. Correlation analysis of hospital survey patients who also completed an ambulatory survey (N = 120) was conducted, and weak, yet statistically significant, negative correlations between hospital “Likelihood to Recommend” and ambulatory “Care Provider Overall” (r = −0.20421, p = 0.0279), “Likelihood to Recommend” (r = −0.19622, p = 0.0356), and “Survey Overall” (r = −0.28482, p = 0.0019) were found. Our analyses found weak, yet significant, negative correlations between ambulatory and hospital PG scores. This could suggest that patient perception established in ambulatory and clinic settings could translate to a patient’s perception of their hospital experience and subsequent satisfaction scores.
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20
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Mendoza BA, Fortier MA, Trinh LN, Schmid LN, Kain ZN. Factors impacting parental and child satisfaction in the perioperative setting. Paediatr Anaesth 2021; 31:932-943. [PMID: 34096658 DOI: 10.1111/pan.14236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/28/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022]
Abstract
Understanding the different modifiable and non-modifiable factors and their positive or negative influence on parental and child satisfaction is essential to providing high-quality perioperative care. The purpose of this review is to focus on the perioperative environment and to report the various modifiable and non-modifiable factors that are associated with satisfaction. We found that factors such as quality of clinician-patient communication, clinician attitudes, teamwork, shared decision-making, and improved perioperative information were associated with increased parent and child satisfaction. Interventions such as preparation programs integrating role-play, teaching of coping skills, and family-centered programs were highly rated by parents and children. Healthcare providers and institutions should consider the above variables when treating children and their parents in the perioperative setting.
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Affiliation(s)
- Beverly A Mendoza
- Center on Stress & Health, University of California School of Medicine, Irvine, USA.,Department of Anesthesiology and Perioperative Care, University of California, Irvine, CA, USA
| | - Michelle A Fortier
- Center on Stress & Health, University of California School of Medicine, Irvine, USA.,Department of Pediatric Psychology, Children's Hospital of Orange County, Orange, CA, USA.,Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA.,Department of Psychological Science, University of California, Irvine, CA, USA
| | - Lily N Trinh
- Center on Stress & Health, University of California School of Medicine, Irvine, USA
| | - Lauren N Schmid
- Center on Stress & Health, University of California School of Medicine, Irvine, USA.,Hahn School of Nursing and Health Science, University of California, San Diego, CA, USA
| | - Zeev N Kain
- Center on Stress & Health, University of California School of Medicine, Irvine, USA.,Department of Anesthesiology and Perioperative Care, University of California, Irvine, CA, USA.,Department of Pediatrics, CHOC Children's, Orange, CA, USA.,Yale Child Study Center, Yale University, New Haven, CT, USA
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21
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Bollinger M, Pyne J, Goudie A, Han X, Hudson TJ, Thompson JW. Enrollee Experience with Providers in the Arkansas Medicaid Expansion Program. J Gen Intern Med 2021; 36:1673-1681. [PMID: 33532967 PMCID: PMC8175535 DOI: 10.1007/s11606-020-06552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patient ratings of their healthcare experience as a quality measure have become critically important since the implementation of the Affordable Care Act (ACA). The ACA enabled states to expand Medicaid eligibility to reduce uninsurance nationally. Arkansas gained approval to use Medicaid funds to purchase a qualified health plan (QHP) through the ACA marketplace for newly eligible beneficiaries. OBJECTIVE We compare patient-reported satisfaction between fee-for-service Medicaid and QHP participants. DESIGN The Consumer Assessment of Healthcare Providers and Systems (CAHPS) was used to identify differences in Medicaid and QHP enrollee healthcare experiences. Data were analyzed using a regression discontinuity design. PARTICIPANTS Newly eligible Medicaid expansion participants enrolled in Medicaid during 2013 completed the Consumer Assessment of Health Providers and Systems (CAHPS) survey in 2014. Survey data was analyzed for 3156 participants (n = 1759 QHP/1397 Medicaid). MEASURES Measures included rating of personal and specialist provider, rating of all healthcare received, and whether the provider offered to communicate electronically. Demographic and clinical characteristics of the enrollees were controlled for in the analyses. METHODS Regression-discontinuity analysis was used to evaluate differential program effects on positive ratings as measured by the CAHPS survey while controlling for demographic and health characteristics of participants. KEY RESULTS Adjusted logistic regression models for overall healthcare (OR = 0.71, 95%CI = 0.56-0.90, p = 0.004) and personal doctor (OR = 0.68, 95%CI = 0.53-0.87, p = 0.002) predicted greater satisfaction among QHP versus Medicaid participants. Results were not significant for specialists or for use of electronic communication with provider. CONCLUSIONS Using a quasi-experimental statistical approach, we were able to control for observed and unobserved heterogeneity showing that among participants with similar characteristics, including income, QHP participants rated their personal providers and healthcare higher than those enrolled in Medicaid. Access to care, utilization of care, and healthcare and health insurance literacy may be contributing factors to these results.
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Affiliation(s)
- Mary Bollinger
- Department of Psychiatry, Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.
| | - Jeff Pyne
- Department of Psychiatry, Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Anthony Goudie
- Arkansas Center for Health Improvement (ACHI), Little Rock, AR, USA
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Xiaotong Han
- Department of Psychiatry, Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Teresa J Hudson
- Department of Psychiatry, Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Joseph W Thompson
- Arkansas Center for Health Improvement (ACHI), Little Rock, AR, USA
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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22
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Lieser MJ, Watts DD, Cooper T, Chipko J, Carrick MM, Berg GM, Wilson NY, Wyse RJ, Garland JM, Fakhry SM. Critical Role of Trauma and Emergency Surgery Physicians in Patient Satisfaction: An Analysis of Consumer Assessment of Healthcare Providers and Systems, Hospital Version Data from 186,779 Patients and 168 Hospitals in a National Healthcare System. J Am Coll Surg 2021; 232:656-663. [PMID: 33524542 DOI: 10.1016/j.jamcollsurg.2020.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Trauma and emergency surgery patients are unique with regard to the sudden and unexpected nature of their hospitalization and this can adversely affect patient satisfaction, but, to our knowledge, no large study exists examining this issue. The purpose of this study was to investigate the major factors that affect satisfaction scores in trauma and emergency surgery patients. STUDY DESIGN Consumer Assessment of Healthcare Providers and Systems, Hospital Version survey data from patients discharged in 2018-2019 from facilities in a national hospital system were obtained. Patients were categorized as trauma, emergency surgery, or direct admit surgery (elective surgery). Individual Consumer Assessment of Healthcare Providers and Systems, Hospital Version question scores were regressed on the score for "overall rating" to determine the primary, secondary, and tertiary satisfaction drivers. RESULTS There were 186,779 patients from 168 hospitals included. As expected, the primary determinant of patient satisfaction was nursing communication for all groups. However, trauma and emergency surgery patients differed from elective surgery patients in that physician communication was the second most important factor in patient satisfaction, accounting for 12.0% (trauma) and 8.6% (emergency surgery) of the total variability in the overall rating beyond the variability explained by the primary driver. If physician communication received low ratings, it was unlikely that high scores in other metrics could compensate to bring the overall score above the 50th percentile. CONCLUSIONS Acute care surgeons appear to play a uniquely important role in support of Consumer Assessment of Healthcare Providers and Systems, Hospital Version scores. These data emphasize the importance of physician communication, particularly when a prehospital physician-patient relationship does not exist. Future research should explore specific mechanisms by which physicians effectively communicate with patients.
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Affiliation(s)
| | - Dorraine D Watts
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | - Tabatha Cooper
- Data Analytics Research and Reporting, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | | | | | | | - Nina Y Wilson
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | - Ransom J Wyse
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | - Jeneva M Garland
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN
| | - Samir M Fakhry
- Center for Trauma and Acute Care Surgery Research, Clinical Operations Group, HCA Healthcare, Nashville, TN.
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Nakayama G, Masumoto S, Haruta J, Maeno T. Measuring family caregivers' experience of interprofessional care for patients and families: development of the Japanese version of the Caregivers' Experience Instrument. Fam Pract 2020; 37:854-861. [PMID: 32589192 DOI: 10.1093/fampra/cmaa059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Improving individuals' experience of care is now a critical goal of health care systems. Although a number of instruments have been developed to measure experience of care, few instruments measure family caregivers' experience of interprofessional care for patients and families. OBJECTIVE To develop the Japanese version of the Caregivers' Experience Instrument (J-IEXPAC CAREGIVERS) and to investigate its validity in assessing quality of integrated care for both patients with chronic conditions and their family caregivers, from the caregivers' perspective, in Japan. METHODS We used a cross-sectional questionnaire survey to test the validity and internal consistency of J-IEXPAC CAREGIVERS. Four hundred family caregivers were recruited in three municipalities. We evaluated the feasibility, structural validity, internal consistency and hypothesis testing for construct validity of the scale. RESULTS A total of 274 (68.5%) questionnaires were analysed. Confirmatory factor analysis showed acceptable model fit for the hypothesized two-factor model according to fit indices, as identified for the original version: attention for the patient and attention for the caregiver. Cronbach's alpha for score in J-IEXPAC CAREGIVERS with 12 items was high (0.92). Spearman's rank correlation coefficient between overall caregiver satisfaction and J-IEXPAC CAREGIVERS score was 0.71. Family caregivers who experienced home-visit services had significantly (P = 0.001) higher total scores than those who did not. CONCLUSIONS This pilot study showed that the J-IEXPAC CAREGIVERS is valid and reliable. This scale can be useful for evaluating quality of integrated care, with focus on family caregivers and patients with chronic conditions in Japan.
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Affiliation(s)
- Gen Nakayama
- Department of Primary Care and Medical Education, Graduate School of Comprehensive Human Sciences, Tsukuba, Japan
| | - Shoichi Masumoto
- Department of Family Medicine, General Practice and Community Health, Faculty of Medicine, Tsukuba, Japan
| | - Junji Haruta
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.,Medical Education Center, School of Medicine, Keio University, Tokyo, Japan
| | - Tetsuhiro Maeno
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Fiano RM, Merrick GS, Innes KE, Mattes MD, LeMasters TJ, Shen C, Sambamoorthi U. Associations of multimorbidity and patient-reported experiences of care with conservative management among elderly patients with localized prostate cancer. Cancer Med 2020; 9:6051-6061. [PMID: 32628817 PMCID: PMC7433828 DOI: 10.1002/cam4.3274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 12/21/2022] Open
Abstract
Background Many elderly localized prostate cancer patients could benefit from conservative management (CM). This retrospective cohort study examined the associations of patient‐reported access to care and multimorbidity on CM use patterns among Medicare Fee‐for‐Service (FFS) beneficiaries with localized prostate cancer. Methods We used linked Surveillance, Epidemiology, and End Results cancer Registry, Medicare Claims, and the Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) survey files. We identified FFS Medicare Beneficiaries (age ≥ 66; continuous enrollment in Parts A & B) with incident localized prostate cancer from 2003 to 2013 and a completed MCAHPS survey measuring patient‐reported experiences of care within 24 months after diagnosis (n = 496). We used multivariable models to examine MCAHPS measures (getting needed care, timeliness of care, and doctor communication) and multimorbidity on CM use. Results Localized prostate cancer patients with multimorbidity were less likely to use CM (adjusted odds ratio (AOR)=0.42 (0.27‐ 0.66), P < .001); those with higher scores on timeliness of care (AOR = 1.21 (1.09, 1.35), P < .001), higher education attainment (3.21 = AOR (1.50,6.89), P = .003), and impaired mental health status (4.32 = AOR (1.86, 10.1) P < .001) were more likely to use CM. Conclusion(s) Patient‐reported experience with timely care was significantly and positively associated with CM use. Multimorbidity was significantly and inversely associated with CM use. Addressing specific modifiable barriers to timely care along the cancer continuum for elderly localized prostate cancer patients with limited life expectancy could reduce the adverse effects of overtreatment on health outcomes and costs.
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Affiliation(s)
- Ryan M Fiano
- Wheeling Hospital, Urologic Research Institute, Schiffler Cancer Center, Wheeling, WV, USA.,West Virginia Clinical and Translational Science Institute, Morgantown, WV, USA
| | - Gregory S Merrick
- Wheeling Hospital, Urologic Research Institute, Schiffler Cancer Center, Wheeling, WV, USA
| | - Kim E Innes
- Department of Epidemiology, West Virginia University, Morgantown, WV, USA
| | - Malcolm D Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Traci J LeMasters
- West Virginia University School of Pharmacy, Pharmaceutical Systems & Policy, Morgantown, WV, USA
| | - Chan Shen
- Penn State Health Milton S Hershey Medical Center, Hershey, PA, USA
| | - Usha Sambamoorthi
- West Virginia University School of Pharmacy, Pharmaceutical Systems & Policy, Morgantown, WV, USA
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25
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Egede LE, Walker RJ, Nagavally S, Thakkar M, O'Sullivan M, Stulac Motzel W. Redesigning primary care in an academic medical center: lessons, challenges, and opportunities. Postgrad Med 2020; 132:636-642. [PMID: 32441180 DOI: 10.1080/00325481.2020.1773685] [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: 10/24/2022]
Abstract
PURPOSE To evaluate patient access, provider productivity, and patient satisfaction during a 24-month redesign process of an academic medical center, which requires balance between clinical and educational missions. METHODS A series of activities were conducted to optimize primary care across 17 attending physicians, 6 Advanced Practice Providers (APPs), and 39 residents. Patient access was defined as the next available appointment for either existing/established patients or new patients. Productivity was measured using panel sizes for each provider. Patient satisfaction was based on the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS). RESULTS Despite decreasing clinical effort to allow faculty and APPs to participate in education and research, there was an overall increase in access for both new and established patients, and an increase the percent of each providers' panel that was full from 78.89% in 2017 to 115.29% in 2019. When comparing panel sizes for the 11 faculty present before and after strategic changes, we found significant increase in both overall panel size, and actual to expected ratios between 2017 and 2019. In addition, throughout the time period, patient satisfaction remained high with no significant changes. CONCLUSIONS While this project was limited to one site, the inclusion of a set of well-planned metrics, and tracking of processes over time can provide insight for ongoing primary care redesign efforts at similar sites seeking to balance the academic mission with clinical productivity and high patient satisfaction.
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Affiliation(s)
- Leonard E Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin , Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin , Milwaukee, WI, USA
| | - Rebekah J Walker
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin , Milwaukee, WI, USA.,Center for Advancing Population Science, Medical College of Wisconsin , Milwaukee, WI, USA
| | - Sneha Nagavally
- Center for Advancing Population Science, Medical College of Wisconsin , Milwaukee, WI, USA
| | - Madhuli Thakkar
- Center for Advancing Population Science, Medical College of Wisconsin , Milwaukee, WI, USA
| | - Monica O'Sullivan
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin , Milwaukee, WI, USA
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Rantala A, Ekwall A, Forsberg A. Significant others’ perceptions of being taken seriously by the Swedish Ambulance Service when the patient is assessed as nonurgent. Scand J Caring Sci 2019; 34:1028-1037. [DOI: 10.1111/scs.12811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 11/28/2019] [Indexed: 01/10/2023]
Affiliation(s)
- Andreas Rantala
- Department of Health Sciences at Lund University Lund Sweden
- Emergency Department Helsingborg General Hospital Helsingborg Sweden
| | - Anna Ekwall
- Department of Health Sciences at Lund University Lund Sweden
| | - Anna Forsberg
- Department of Health Sciences at Lund University Lund Sweden
- Department of Transplantation and Cardiology Skåne University Hospital Lund Sweden
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27
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Kerber K, Kolahdooz F, Otway M, Laboucan M, Jang SL, Lawrence S, Aronyk S, Quinn M, Irlbacher-Fox S, Milligan C, Broadhead S, DeLancey D, Corriveau A, Sharma S. Opportunities for improving patient experiences among medical travellers from Canada's far north: a mixed-methods study. BMJ Open 2019; 9:e030885. [PMID: 31806609 PMCID: PMC6924833 DOI: 10.1136/bmjopen-2019-030885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES This paper explores patient experiences and identifies barriers and opportunities for improving access to healthcare for patients from the Canadian north who travel to receive medical care in a Southern province. DESIGN A mixed-methods, cross-sectional study involved one-on-one interviews, focus group discussions and key informant interviews. PARTICIPANTS 52 one-on-one interviews with Northwest Territories (NWT) patients and patient escorts and two focus group discussions (n=10). Fourteen key informant interviews were conducted with health workers, programme managers and staff of community organisations providing services for out-of-province patients. A Community Advisory Board guided the development of the questionnaires and interpretation of results. RESULTS Respondents were satisfied with the care received overall, but described unnecessary burdens and bureaucratic challenges throughout the travel process. Themes relating to access to healthcare included: plans and logistics for travel; level of communication between services; clarity around jurisdiction and responsibility for care; indirect costs of travel and direct costs of uninsured services; and having a patient escort or advocate available to assist with appointments and navigate the system. Three themes related to healthcare experiences included: cultural awareness, respect and caring, and medical translation. Respondents provided suggestions to improve access to care. CONCLUSIONS Patients from NWT need more information and support before and during travel. Ensuring that medical travellers and escorts are prepared before departing, that healthcare providers engage in culturally appropriate communication and connecting travellers to support services on arrival have the potential to improve medical travel experiences.
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Affiliation(s)
- Kate Kerber
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Fariba Kolahdooz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Meeka Otway
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Melinda Laboucan
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Se Lim Jang
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sue Lawrence
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Suzanne Aronyk
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew Quinn
- Regional Public Health Office, Beaufort-Delta Health and Social Services, Inuvik, Northwest Territories, Canada
| | - Stephanie Irlbacher-Fox
- Hotıì ts'eeda Northwest Territories SPOR Support Unit, Yellowknife, Northwest Territories, Canada
| | - Crystal Milligan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Broadhead
- Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, Northwest Territories, Canada
| | - Debbie DeLancey
- Hotıì ts'eeda Northwest Territories SPOR Support Unit, Yellowknife, Northwest Territories, Canada
| | - Andre Corriveau
- Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, Northwest Territories, Canada
| | - Sangita Sharma
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Hussein AI, Bekampis CF, Jermyn RT. Review of Opioid Prescribing in the Osteopathic and Ambulatory Setting. J Osteopath Med 2019; 119:820-832. [PMID: 31790128 DOI: 10.7556/jaoa.2019.134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The opioid epidemic in the United States is one of the largest modern health crises in the nation's history. The crisis has been cultivated in academic journals, driven by the medical-pharmaceutical complex, and fueled by campaigns representing the most prestigious health care organizations and advocacy groups. Comprehensive guidelines for proper prescribing have been released in addition to state-sponsored prescription drug-monitoring programs (PDMPs) in response to overprescribing habits. When considering opioid treatment for a patient, physicians should document a thorough history of pain, give an appropriate physical examination, and complete a risk assessment using the proper diagnostic tools. Considering the osteopathic philosophy and approach to chronic pain, physicians should account for an integrative treatment approach for improved patient outcomes when considering applying the osteopathic philosophy to chronic pain management. A successful treatment plan can integrate cognitive behavioral therapy and promote self-healing by treating somatic dysfunctions with osteopathic manipulative treatment. This literature review discusses how to treat patients with chronic pain and how to properly use and prescribe opioids. The researchers analyzed the history and current status of the opioid epidemic, examined opioid management in the outpatient setting, reviewed the current domestic and international opioid prescribing guidelines, and discussed the incorporation of the osteopathic philosophy to manage chronic pain.
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Doubova SV, Infante-Castañeda C, Roder-DeWan S, Pérez-Cuevas R. User experience and satisfaction with specialty consultations and surgical care in secondary and tertiary level hospitals in Mexico. BMC Health Serv Res 2019; 19:872. [PMID: 31752851 PMCID: PMC6873740 DOI: 10.1186/s12913-019-4706-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the association between user experience and satisfaction with specialty consultations and surgical care at the Mexican Institute of Social Security (IMSS) secondary and tertiary level hospitals. METHODS We conducted secondary data analysis of the cross-sectional 2017 IMSS National Satisfaction Survey. The dependent variables were user satisfaction with outpatient consultation and with surgery. The study's independent variables were user experience with these services. The Lancet Global Health Commission on High Quality Health Systems in the Sustainable Development Era framework was used to guide the analysis. For each dependent variable a double-weighted Poisson regression model with robust variance was performed and considered clustering of the observations within 111 secondary level and 25 tertiary level hospitals. RESULTS The study included 6713 outpatient consultation users and 528 surgery users. 83% of users attending outpatient consultations and 86.6% of users who underwent inpatient surgery at IMSS hospitals were satisfied with the service received. The common patient negative experiences with specialty consultations and surgical care were long waiting time (40%) and lack of hospital cleanliness (20%). An additional concern was the lack of clinical examination during the consultation (25%). Shorter waiting times, health provider courtesy, good communication, clinical examination, and hospital cleanliness were associated with patient satisfaction with specialty consultations. Having the surgery without prior postponement(s) and without complications increased the probability of patient satisfaction. CONCLUSION Patient satisfaction with hospital outpatient consultations and surgical care may be raised by focusing on improvement strategies to enhance positive patient experiences with care.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Zip Code: 06720, Mexico City, Mexico.
| | | | - Sanam Roder-DeWan
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
| | - Ricardo Pérez-Cuevas
- Center for Health Systems Research, National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, Zip Code: 62100, CuernavacaCity, Mexico.,Division of Social Protection and Health, Jamaica Country Office, InterAmerican Development Bank, 6 Montrose road, Kingston, Jamaica
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Khanna K, Diab M. Patient Satisfaction: Inception, Impact, and Correlation with Outcomes. J Bone Joint Surg Am 2019; 101:e115. [PMID: 31567669 DOI: 10.2106/jbjs.18.01499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Krishn Khanna
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California
| | - Mohammad Diab
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California
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Joseph C, Garruba M, Melder A. Patient satisfaction of telephone or video interpreter services compared with in-person services: a systematic review. AUST HEALTH REV 2019; 42:168-177. [PMID: 30021688 DOI: 10.1071/ah16195] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/17/2017] [Indexed: 11/23/2022]
Abstract
Objective This review was conducted to identify and synthesise the evidence around the use of telephone and video interpreter services compared with in-person services in healthcare. Methods A systematic search of articles published in the English language was conducted using PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Database of Abstracts of Reviews of Effects (DARE), Joanna Briggs, Google Scholar and Google. Search terms included 'interpreter', 'patient satisfaction', 'consumer satisfaction' and 'client satisfaction'. Any study that did not compare in-person interpreter services with either telephone or video interpreter services was excluded from analysis. Studies were screened for inclusion or exclusion by two reviewers, using criteria established a priori. Data were extracted via a custom form and synthesised. Results The database search yielded 196 studies, eight of which were included in the present review. The search using an Internet search engine did not identify any relevant studies. Of the studies included, five used telephone and three used video interpreter services. All studies, except one, compared levels of satisfaction regarding in-person interpretation and telephone or video interpretation. One study compared satisfaction of two versions of video interpretation. There is evidence of higher satisfaction with hospital-trained interpreters compared with ad hoc (friend or family) or telephone interpreters. There is no difference in satisfaction between in-person interpreting, telephone interpreting or interpretation provided by the treating bilingual physician. Video interpreting has the same satisfaction as in-person interpreting, regardless of whether the patient and the physician are in the same room. Higher levels of satisfaction were reported for trained telephone interpreters than for in-person interpreters or an external telephone interpreter service. Conclusions Current evidence does not suggest there is one particular mode of interpreting that is superior to all others. This review is limited in its translational capacity given that most studies were from the US and in a Spanish-speaking cohort. What is known about the topic? Access to interpreters has been shown to positively affect patients who are not proficient in speaking the local language of the health service. What does this paper add? This paper adds to the literature by providing a comprehensive summary of patient satisfaction when engaging several different types of language interpreting services used in healthcare. What are the implications for practitioners? This review provides clear information for health services on the use of language interpreter services and patient satisfaction. The current body of evidence does not indicate a superior interpreting method when patient satisfaction is concerned.
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Affiliation(s)
- Corey Joseph
- Centre for Clinical Effectiveness, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Vic. 3168, Australia.
| | - Marie Garruba
- Centre for Clinical Effectiveness, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Vic. 3168, Australia.
| | - Angela Melder
- Centre for Clinical Effectiveness, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Vic. 3168, Australia.
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Mueller EL, Cochrane AR, Lynch DO, Cockrum BP, Wiehe SE. Identifying patient-centered outcomes for children with cancer and their caregivers when they seek care in the emergency department. Pediatr Blood Cancer 2019; 66:e27903. [PMID: 31309720 DOI: 10.1002/pbc.27903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/23/2019] [Accepted: 06/04/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children with cancer have high utilization of the emergency department (ED), but little is known about which outcomes are most important to them and their caregivers when they seek care in the ED. PROCEDURE A qualitative evaluation of ED experience for children with cancer and their caregivers was performed using self-reported interactive toolkits. Eligible participants included children with cancer (ages 11-19) and caregivers of children with cancer whose child received cancer therapy within the last year and had an ED visit within the last 2 years. Eligible participants received toolkits by mail and received incentives if they completed the toolkit. Toolkits were transcribed, thematically coded, and iteratively analyzed using Nvivo 11.0 software. RESULTS There were 26 toolkits received-seven by children aged 11-17 years and 19 by caregivers (11 with children aged 2-7 years, eight with children aged 11-17 years). About half were from within 1 h of their treating institution. The most important outcomes to this population included system-level issues (eg, cleanliness of space, timeliness of evaluation) and oncology-provider- and ED-provider-level issues (eg, ability to access port-a-caths, quality of communication). Participants also identified outcomes that were within the control of the patient/caregiver, such as improving their sense of preparedness. CONCLUSION The important outcomes to children with cancer and their caregivers when they seek care in the ED are distinct from current quality metrics. Future research should focus on the development and validation of a patient-centered outcomes tool.
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Affiliation(s)
- Emily L Mueller
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana.,Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Anneli R Cochrane
- Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, Indianapolis, Indiana.,Section of Pediatric Hematology Oncology, Department of Pediatrics, Indiana University, Indianapolis, Indiana
| | - Dustin O Lynch
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, Indiana
| | - Brandon P Cockrum
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, Indiana
| | - Sarah E Wiehe
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, Indiana.,Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
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Trinh LN, Fortier MA, Kain ZN. Primer on adult patient satisfaction in perioperative settings. Perioper Med (Lond) 2019; 8:11. [PMID: 31548883 PMCID: PMC6751608 DOI: 10.1186/s13741-019-0122-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 08/19/2019] [Indexed: 02/08/2023] Open
Abstract
The topic of patient satisfaction has gained increasing importance over the past decade. Due to the impact of patient satisfaction on health care quality, understanding factors that predict satisfaction is vital. The purpose of this review is to examine the literature and identify factors related to patient perioperative satisfaction as well as predictive variables that, if modified, can enhance satisfaction scores of patients undergoing surgery. Our review reports that patient satisfaction scores are affected by modifiable factors such as clinician-patient communication, information provision to patients, and operational function of a hospital. Non-modifiable factors affecting patient satisfaction scores include patient demographics such as gender, age, and education. In order to enhance patient perioperative satisfaction, we suggest that anesthesiologists and surgeons focus their efforts on enhancing their communication skills and providing information that is appropriately tailored to the understanding of their patients.
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Affiliation(s)
- Lily N Trinh
- 1Center on Stress & Health, University of California School of Medicine, Irvine, USA
| | - Michelle A Fortier
- 1Center on Stress & Health, University of California School of Medicine, Irvine, USA.,2Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | - Zeev N Kain
- 1Center on Stress & Health, University of California School of Medicine, Irvine, USA.,3Department of Anesthesiology and Perioperative Care, University of California, Irvine, USA.,4Yale Child Study Center, Yale University, New Haven, CT USA.,5Health Policy Research Institution (HPRI), University of California, Irvine, USA
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Cheng Y, Wang F, Zhang L, Zhang P, Ye B, Sun Y, Zhu X, Zhang N, Liang Y. Effects of organisational and patient factors on doctors' burnout: a national survey in China. BMJ Open 2019; 9:e024531. [PMID: 31266834 PMCID: PMC6609055 DOI: 10.1136/bmjopen-2018-024531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To measure the burnout of doctors affiliated with western medicine (WM) and traditional Chinese medicine (TCM) hospitals and to evaluate its relationships with organisational and patient factors. DESIGN A national cross-sectional study in China. SETTING By convenience sampling, this study was conducted in 64 general hospitals from six provinces and Beijing between July 2014 and April 2015. There were a total of 2576 eligible participants, including 1766 WM doctors and 810 TCM doctors in this study. PRIMARY OUTCOME MEASURES Burnout symptoms of emotional exhaustion, job involvement and personal accomplishment were measured. RESULTS In total, 73.6% of doctors reported emotional exhaustion, the core component of burnout. In multivariable models, emotional exhaustion was significantly associated with organisational factors, including salary fairness [WM: odds ratio (OR)=2.36, 95% confidence interval (CI): 1.80 to 3.09; TCM: OR=1.59, 95% CI: 1.08 to 2.33], participation in organisational decision-making (WM: OR=1.58, 95% CI: 1.21 to 2.08; TCM: OR=1.84, 95% CI: 1.23 to 2.74), professional value (WM: OR=1.74, 95% CI: 1.35 to 2.25), frequency of participation in full-time training (TCM: OR=1.48, 95% CI: 1.01 to 2.16) and frequency of participation in clinical meetings (WM: OR=1.53, 95% CI: 1.11 to 2.10; TCM: OR=2.48, 95% CI: 1.57 to 3.92). Patient factors are also associated with burnout among both WM and TCM doctors, including respect (WM: OR=1.73, 95% CI: 1.31 to 2.28; TCM: OR=1.65, 95% CI: 1.10 to 2.45) and unreasonable demands (WM: OR=2.31, 95% CI: 1.68 to 3.20; TCM: OR=3.44, 95% CI: 2.15 to 5.49). Moreover, job involvement and personal accomplishment among both WM and TCM doctors were significantly associated with organisational and patient factors. CONCLUSIONS Our results suggest that improving organisational management and patient behaviours may be beneficial to reduce doctors' burnout. Our findings require further validation in different organisational settings.
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Affiliation(s)
- Yao Cheng
- Department of Epidemiology and Biostatistics, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fang Wang
- Department of Social Medicine and Health Management, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liuyi Zhang
- Department of Social Medicine and Health Management, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Zhang
- Department of Social Medicine and Health Management, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Beizhu Ye
- Department of Social Medicine and Health Management, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Sun
- Department of Social Medicine and Health Management, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xi Zhu
- Health Management and Policy, College of Public Health, The University of Lowa, Lowa City, Lowa, USA
| | - Naixing Zhang
- Department of Medical Administration, Health and Family Planning Commission of Shenzhen, Shenzhen, China
| | - Yuan Liang
- Department of Social Medicine and Health Management, Public Health School, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Bastemeijer CM, Boosman H, van Ewijk H, Verweij LM, Voogt L, Hazelzet JA. Patient experiences: a systematic review of quality improvement interventions in a hospital setting. Patient Relat Outcome Meas 2019; 10:157-169. [PMID: 31191062 PMCID: PMC6535098 DOI: 10.2147/prom.s201737] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/09/2019] [Indexed: 01/17/2023] Open
Abstract
Purpose: In the era of value-based healthcare, one strives for the most optimal outcomes and experiences from the perspective of the patient. So, patient experiences have become a key quality indicator for healthcare. While these are supposed to drive quality improvement (QI), their use and effectiveness for this purpose has been questioned. The aim of this systematic review was to provide insight into QI interventions used in a hospital setting and their effects on improving patient experiences, and possible barriers and promoters for QI work. Methods: Prisma guidelines were used to design this review. International academic literature was searched in Embase, Medline OvidSP, Web of Science, Cochrane Central, PubMed Publisher, Scopus, PsycInfo, and Google Scholar. In total, 3,289 studies were retrieved and independently screened by the first two authors for eligibility and methodological quality. Data was extracted on the study purpose, setting, design, targeted patient experience domains, QI strategies, results of QI, barriers, and promotors for QI. Results: Twenty-one pre-post intervention studies were included for review. The methodological quality of the included studies was assessed using a Critical Appraisal Skills Program (CASP) Tool. QI strategies used were staff education, patient education, audit and feedback, clinician reminders, organizational change, and policy change. Twenty studies reported improvement in patient experience, 14 studies of the 21 included studies reported statistical significance. Most studies (n=17) reported data-related barriers (eg, questionnaire quality), professional, and/or organizational barriers (eg, skepticism among staff), and 14 studies mentioned specific promoters (eg, engaging staff and patients) for QI. Conclusions: Several patient experience domains are targeted for QI using diverse strategies and methodological approaches. Most studies reported at least one improvement and also barriers and promoters that may influence QI work. Future research should address these barriers and promoters in order to enhance methodological quality and improve patient experiences.
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Affiliation(s)
- Carla M Bastemeijer
- MMT, Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Hileen Boosman
- Department of Quality & Patient Safety, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans van Ewijk
- Department of Normative Professionalization, University of Humanistic Studies, Utrecht, the Netherlands
| | - Lisanne M Verweij
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Lennard Voogt
- Department of Physical Therapy Studies, Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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Abstract
Patient harm continues to be a leading cause of morbidity and mortality in the United States. Among high-risk industries, the health care system has a significantly lower safety profile than that of others. There are many driving forces behind this, including significant resistance within the medical community in the late 1960s to consumer demand of patient-centered and family-centered care. In subsequent decades the voice of the customer has taken center stage. The mounting research linking patient experience and engagement to patient safety and positive clinical outcomes is indisputable.
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Rantala A, Behm L, Rosén H. Quality Is in the Eye of the Beholder-A Focus Group Study from the Perspective of Ambulance Clinicians, Physicians, and Managers. Healthcare (Basel) 2019; 7:E41. [PMID: 30871138 PMCID: PMC6473421 DOI: 10.3390/healthcare7010041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 02/27/2019] [Accepted: 03/08/2019] [Indexed: 11/16/2022] Open
Abstract
Quality within all areas of healthcare should be systemically monitored and ensured. However, the definition of quality is complex and diverse. In the ambulance service (AS), quality has traditionally been defined as response time, but this measurement eliminates the possibility of addressing other characteristics of quality, such as the care provided. This study aimed to explore what constitutes quality in the context of the ambulance service as experienced by ambulance clinicians, physicians, and managers. A focus group study was conducted with 18 participants. The three focus groups were analyzed with the focus group method developed by Kreuger and Casey. The participants highlighted patient involvement, information and care, as well as adherence to policies, regulations, and their own standards as representing quality in the AS. This study demonstrates that quality is in the eye of the beholder. As quality seems to be viewed similarly by patients and ambulance clinicians, physicians, and managers, stakeholders should aim for a paradigm shift where patients' experience of the care is just as important as various time measures.
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Affiliation(s)
- Andreas Rantala
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden.
- Emergency Department, Helsingborg General Hospital, SE-205 01 Helsingborg, Sweden.
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linneaus University, SE-251 95 Växjö, Sweden.
| | - Lina Behm
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden.
- Department of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden.
| | - Helena Rosén
- Department of Health Sciences, Lund University, SE-221 00 Lund, Sweden.
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Altieri MS, Yang J, Yin D, Bevilacqua LA, Spaniolas K, Talamini MA, Pryor AD. Defying public expectations: Publicly reported hospital scores do not always correlate with clinical outcomes. Surgery 2019; 165:985-989. [PMID: 30704630 DOI: 10.1016/j.surg.2018.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 11/17/2018] [Accepted: 12/03/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Publicly reported hospital scores are used by patients to make health care-related decisions; however, their relationship to clinical outcomes is unknown. METHODS Through the use of the New York Statewide Planning and Research Cooperative System database, the association between two commonly used scores (Healthgrades and Centers for Medicare & Medicaid Services Hospital Compare) and four clinical outcomes was evaluated in several surgical fields (general, colorectal, hepatobiliary, foregut, and bariatric). RESULTS After adjusting for patient-level factors, patients from facilities with greater Healthgrades scores were less likely to develop any complication after general surgery operations (P = .0013). Also, greater Healthgrades scores were associated with less 30-day readmissions and emergency department visits for general surgery operations only (P = .0061 and P = .0013, respectively). In addition, greater Healthgrades scores were significantly associated with a lesser hospital length of stay for colorectal, foregut, and general surgery operations. Greater Centers for Medicare & Medicaid Services Hospital Compare scores were significantly associated with less 30-day readmissions and lesser hospital length of stay for specific operative groups. CONCLUSION Although some specialties demonstrated a correlation, there was no consistent relationship between publicly reported hospital scores and surgical outcomes that contributed to clinically meaningful use for patients or operations.
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Affiliation(s)
- Maria S Altieri
- Division of Minimally Invasive Surgery, Washington University School of Medicine, St. Louis, MO.
| | - Jie Yang
- Department of Family, Population and Preventive Medicine, Stony Brook University, Medical Center, NY
| | - Donglei Yin
- Department of Applied Mathematics and Statistics, Stony Brook University, NY
| | | | - Konstantinos Spaniolas
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery Department of Surgery, Stony Brook University Medical Center, NY
| | - Mark A Talamini
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery Department of Surgery, Stony Brook University Medical Center, NY
| | - Aurora D Pryor
- Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery Department of Surgery, Stony Brook University Medical Center, NY
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Trimmer C, Målqvist M. Clinical communication and caregivers' satisfaction with child healthcare in Nepal; results from Nepal Health Facility Survey 2015. BMC Health Serv Res 2019; 19:17. [PMID: 30621685 PMCID: PMC6325866 DOI: 10.1186/s12913-018-3857-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 12/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Patient satisfaction is an important measure of quality of care and a determinant of health service utilisation and the choice of health facility. Measuring patients’ experiences is important for understanding and improving the quality of care at health facilities. The aim of this study was to assess levels and identify associated factors of caregivers’ satisfaction and provider-caregiver communication within child healthcare in Nepal. Methods Secondary analysis of Sick Child Exit Interviews (n = 2092) sourced from 2015 Nepal Health Facility Survey data. Satisfaction was measured through caregivers’ satisfaction with services received and their willingness to recommend the health facility visited. Communication indicators were chosen based on the 2014 WHO IMCI guidelines and aggregate communication scores were calculated based on the number of indicators acknowledged during assessments. Logistic regression was used for analysis. Results Although most respondents (82.1%) reportedly were satisfied with the care provided, only 35.9% experienced good communication with their providers. Caregivers who had ever attended school were more likely to be satisfied with services (1.44, CI 95% 1.04–1.99). Type of provider, sex of child or who the caregiver was had no association with caregivers’ satisfaction. Having been given a diagnosis doubled the chances of satisfaction (AOR 2.04, 95% CI 1.38–3.00), as did discussion of the child’s growth (OR 1.71, 95% CI 1.06–2.76) and having discussed any of the included topics (AOR 1.98, CI 95% 1.14–3.45). Conclusions Interventions to improve healthcare staff’s communication skills are needed in Nepal to further enhance satisfaction with services and increase quality of care. However, this is an area that need further investigation given the high levels of satisfaction displayed despite poor communication. Other factors in the health care exchange between provider and clients are influencing the level of satisfaction and need to be identified and promoted further. High-quality care is no longer a goal for the future or only for high income settings; it is essential for reaching global health goals.
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Affiliation(s)
- Charlotte Trimmer
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden
| | - Mats Målqvist
- International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden.
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Kaneko M, Aoki T, Mori H, Ohta R, Matsuzawa H, Shimabukuro A, Motomura K, Inoue M. Associations of Patient Experience in Primary Care With Hospitalizations and Emergency Department Visits on Isolated Islands: A Prospective Cohort Study. J Rural Health 2018; 35:498-505. [PMID: 30550635 PMCID: PMC7380050 DOI: 10.1111/jrh.12342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE In rural areas, the management of hospitalizations and emergency department (ED) visits is an important issue, and it is compounded by factors such as the long distance to secondary care facilities, funding difficulties in many rural medical institutions, and shortage of medical staff. While better patient experience (PX) has been shown to reduce hospitalizations and ED visits, previous studies have not considered the differences between urban and rural areas. In addressing this gap, this study examines the association between PX and hospitalizations/ED visits on isolated islands. METHODS This prospective cohort study was conducted on 5 isolated islands in Okinawa, Japan. We assessed the PX of primary care using the Japanese version of the Primary Care Assessment Tool (JPCAT), which comprises 6 domains: first contact, longitudinality, coordination, comprehensiveness (services available), comprehensiveness (services provided), and community orientation. The primary outcome was hospitalizations and ED visits in a year. We used a mixed effect model to adjust clustering within islands and individual covariates. FINDINGS Of 1,258 residents, 740 responded to a questionnaire for PX measurement. There were 73 hospitalizations and 62 ED visits. Adjusting for confounding and geographical clustering, hospitalizations had significant positive association with the PX score of each patient. ED visits were not associated with the total score of the JPCAT. CONCLUSION On the isolated islands, PX in primary care had positive correlation with hospitalizations. The contrast of our findings to those of previous studies may be due to the close patient-doctor relationship on isolated islands.
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Affiliation(s)
- Makoto Kaneko
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka, Japan.,Shizuoka Family Medicine Program, Kikugawa, Shizuoka, Japan
| | - Takuya Aoki
- Department of Healthcare Epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hideki Mori
- National Hospital Organization, Nagasaki Medical Center, Omura-shi, Nagasaki, Japan
| | | | | | | | | | - Machiko Inoue
- Department of Family and Community Medicine, Hamamatsu University School of Medicine, Higashi-ku, Hamamatsu, Shizuoka, Japan.,Shizuoka Family Medicine Program, Kikugawa, Shizuoka, Japan
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Golda N, Beeson S, Kohli N, Merrill B. Analysis of the patient experience measure. J Am Acad Dermatol 2018; 78:645-651. [PMID: 29548417 DOI: 10.1016/j.jaad.2017.03.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2016] [Revised: 02/22/2017] [Accepted: 03/20/2017] [Indexed: 11/25/2022]
Abstract
Assessing the patient experience has been a component of national health care policy for years in various forms, and it is now incorporated into many areas affecting physician practice. This review will focus on the origin and importance of this measure and address its critiques. The evolution of the measure as it progressed from patient satisfaction to patient experience and the rationale behind this shift will be detailed, the thought process behind the measure as an indicator of a culture of patient-centeredness and quality rather than as strictly a score will be reviewed, and the various motivators for physicians to improve patient experience will be divided into extrinsic and intrinsic and discussed.
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Affiliation(s)
- Nicholas Golda
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri.
| | - Stephen Beeson
- American Academy of Physician Leadership, Tampa, Florida
| | - Nita Kohli
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri; Orlando Veterans Administration Medical Center, Orlando, Florida
| | - Brandon Merrill
- Department of Dermatology, University of Missouri School of Medicine, Columbia, Missouri
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Cedillo-Couvert EA, Hsu JY, Ricardo AC, Fischer MJ, Gerber BS, Horwitz EJ, Kusek JW, Lustigova E, Renteria A, Rosas SE, Saunders M, Sha D, Slaven A, Lash JP. Patient Experience with Primary Care Physician and Risk for Hospitalization in Hispanics with CKD. Clin J Am Soc Nephrol 2018; 13:1659-1667. [PMID: 30337326 PMCID: PMC6237062 DOI: 10.2215/cjn.03170318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 08/14/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES In the general population, the quality of the patient experience with their primary care physician may influence health outcomes but this has not been evaluated in CKD. This is relevant for the growing Hispanic CKD population, which potentially faces challenges to the quality of the patient experience related to language or cultural factors. We evaluated the association between the patient experience with their primary care physician and outcomes in Hispanics with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This prospective observational study included 252 English- and Spanish-speaking Hispanics with entry eGFR of 20-70 ml/min per 1.73 m2, enrolled in the Hispanic Chronic Renal Insufficiency Cohort study between 2005 and 2008. Patient experience with their primary care physician was assessed by the Ambulatory Care Experiences Survey subscales: communication quality, whole-person orientation, health promotion, interpersonal treatment, and trust. Poisson and proportional hazards models were used to assess the association between the patient experience and outcomes, which included hospitalization, ESKD, and all-cause death. RESULTS Participants had a mean age of 56 years, 38% were women, 80% were primary Spanish speakers, and had a mean eGFR of 38 ml/min per 1.73 m2. Over 4.8 years (median) follow-up, there were 619 hospitalizations, 103 ESKD events, and 56 deaths. As compared with higher subscale scores, lower scores on four of the five subscales were associated with a higher adjusted rate ratio (RR) for all-cause hospitalization (communication quality: RR, 1.54; 95% confidence interval [95% CI], 1.25 to 1.90; health promotion: RR, 1.31; 95% CI, 1.05 to 1.62; interpersonal treatment: RR, 1.50; 95% CI, 1.22 to 1.85; and trust: RR, 1.57; 95% CI, 1.27 to 1.93). There was no significant association of subscales with incident ESKD or all-cause death. CONCLUSIONS Lower perceived quality of the patient experience with their primary care physician was associated with a higher risk of hospitalization.
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Affiliation(s)
| | - Jesse Y. Hsu
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ana C. Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Michael J. Fischer
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
| | - Ben S. Gerber
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | | | - John W. Kusek
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Eva Lustigova
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
| | - Amada Renteria
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Sylvia E. Rosas
- Joslin Diabetes Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Milda Saunders
- Department of Medicine, University of Chicago, Chicago, Illinois
| | - Daohang Sha
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Anne Slaven
- Department of Medicine, MetroHealth, Cleveland, Ohio
| | - James P. Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - on behalf of the CRIC Study Investigators
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania
- Center of Innovation for Complex Chronic Healthcare, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois
- Department of Medicine, MetroHealth, Cleveland, Ohio
- Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
- Department of Epidemiology, Tulane University, New Orleans, Louisiana
- Joslin Diabetes Center and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
- Department of Medicine, University of Chicago, Chicago, Illinois
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Slater AM, Estrada F, Suarez-Lopez L, de la Vara-Salazar E, Campero L. Overall user satisfaction with family planning services and associated quality care factors: a cross-sectional analysis. Reprod Health 2018; 15:172. [PMID: 30314514 PMCID: PMC6186057 DOI: 10.1186/s12978-018-0615-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 09/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies of user satisfaction with family planning services (FPSs) have been conducted in different countries, and have been employed to identify ways of improving health, reducing costs and implementing reforms. The present work is the first-ever study undertaken in Mexico on the subject. Our objective was to identify how overall user satisfaction with FPSs in Mexico was related to: healthcare logistics, the functional value of services and the quality of interpersonal relations. METHODS Users of 18 public clinics were surveyed in 2015. Data collected referred to their past and present use of FPSs, as well as to their perceptions of the services provided. We built a logistic regression model with potentially influential variables in order to assess their association with overall satisfaction. RESULTS According to the self-reports of the 722 users interviewed, the following factors were decisive in their overall satisfaction with services: receiving sufficient information during visits (OR = 3.38; 95% CI:1.88-6.06), feeling that their opinions were taken into consideration by clinic staff (OR = 2.58; 95% CI:1.14-5.85), feeling that the motives for their visits were addressed (OR = 2.71; 95% CI:1.29-5.71), being assigned enough time for consultation (OR = 2.35; 95% CI:1.26-4.37), having the opportunity to ask questions and clarify doubts (OR = 2.31; 95% CI:1.21-4.43), experiencing no or few interruptions during their medical consultations (OR = 1.97;95% CI:1.10-3.51), and feeling satisfied with the contraceptive method provided (OR = 1.79; 95% CI:1.03-3.11). CONCLUSIONS Service providers must be kept well informed on the perspective of users concerning user expectations. Taking into account the cultural context and perceived needs of users while providing service would improve the quality of care and, hence, the overall satisfaction of users.
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Affiliation(s)
| | - Fatima Estrada
- Cátedras CONACYT- Instituto Nacional de Salud Pública, 7a. Cerrada de Fray Pedro de Gante #50, Col. Sección XVI, Tlalpan, C.P. 14080, Ciudad de México, Mexico.
| | - Leticia Suarez-Lopez
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Elvia de la Vara-Salazar
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Lourdes Campero
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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Improvement of the quality payment program by improving data reporting process: an action research. BMC Health Serv Res 2018; 18:692. [PMID: 30189897 PMCID: PMC6128004 DOI: 10.1186/s12913-018-3472-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 08/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Successful implementation of pay-for-quality (P4Q) programs mostly depends upon a valid, timely, and reliable data about quality measures generated by providers, and interpreted by payers. The aim of this study was to establish a data reporting method for P4Q program through an action research. METHODS Qualitative method was used to align theory with action through a three-cycle action research. The study was conducted in September 15, 2015 to March 15, 2017, in East-Azerbaijan, Iran. The purposeful sampling was used to select participants. The participants included healthcare providers, staff in district health centers (DHC), experts, and managers in the provincial primary health center (PPHC). Data was collected by interviews, focus group discussions, and expert panels. Content analysis was used to synthesize the data. In each step, decisions about data reporting methods were made through a consensus of expert panel members. RESULTS The most important dimensions of data reporting method were data entry and accuracy, data reporting, data analysis and interpretations, the flexibility of method, and training. By establishment of an online data reporting system for the P4Q program, a major improvement was observed in the documentation of performance data, the satisfaction of health care providers and staff (e.g. either in DHCs or PPHC), improvement of the P4Q program and acceptance of the P4Q program by providers. Following the present study, the online system was expanded in Iran's public health system for data collection and estimating the amount of incentive payments in P4Q program. Moreover, more improvements were achieved by linking the system to EMRs and also, providing automated feedback to providers about their own performance. CONCLUSIONS A web-based computerized system with the capability of linking medical record and also its ability to provide feedback to healthcare providers was identified as an appropriate method of data reporting in the P4Q program from the viewpoints of participants in this study.
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Latona JA, Tannouri S, Yeo TP, Cannaday S, Lavu H, Winter JM, Yeo CJ. Surgeon-Led Imaging Review for Patients with Periampullary Disease: An Important Aspect of the Preoperative Consultation. J Pancreat Cancer 2018; 4:52-59. [PMID: 30631859 PMCID: PMC6145539 DOI: 10.1089/pancan.2018.0010] [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: 11/12/2022] Open
Abstract
Background: The perceived benefit of utilizing patients' own imaging studies as a preoperative educational tool has not been studied. Methods: Pancreaticobiliary surgeons reviewed key findings of imaging studies with patients to educate about their diagnosis and inform treatment recommendations. Patient surveys were administered pre- and postvisit by an independent researcher to assess the impact of this practice. Results: Only 55% of patients stated that it was important to see their imaging studies before the consultation. However, after the visit, 90% of patients understood their disease process better, and 86% of patients had a clearer understanding of their planned operation having seen their imaging studies. This represents significant improvement in patients' understanding of their medical condition (p < 0.05). Conclusion: Reviewing imaging findings with patients is an underappreciated aspect of the surgical consultation. It is a powerful educational tool that takes little time, improves patient understanding, and enhances patient experience.
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Affiliation(s)
- Jessica A. Latona
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Sami Tannouri
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Theresa P. Yeo
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Shawnna Cannaday
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Harish Lavu
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Jordan M. Winter
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Charles J. Yeo
- Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Jones AL, Mor MK, Haas GL, Gordon AJ, Cashy JP, Schaefer JH, Hausmann LRM. The Role of Primary Care Experiences in Obtaining Treatment for Depression. J Gen Intern Med 2018; 33:1366-1373. [PMID: 29948804 PMCID: PMC6082202 DOI: 10.1007/s11606-018-4522-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 04/03/2018] [Accepted: 05/24/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Managing depression in primary care settings has increased with the rise of integrated models of care, such as patient-centered medical homes (PCMHs). The relationship between patient experience in PCMH settings and receipt of depression treatment is unknown. OBJECTIVE In a large sample of Veterans diagnosed with depression, we examined whether positive PCMH experiences predicted subsequent initiation or continuation of treatment for depression. DESIGN AND PARTICIPANTS We conducted a lagged cross-sectional study of depression treatment among Veterans with depression diagnoses (n = 27,362) in the years before (Y1) and after (Y2) they completed the Veterans Health Administration's national 2013 PCMH Survey of Healthcare Experiences of Patients. MAIN MEASURES We assessed patient experiences in four domains, each categorized as positive/moderate/negative. Depression treatment, determined from administrative records, was defined annually as 90 days of antidepressant medications or six psychotherapy visits. Multivariable logistic regressions measured associations between PCMH experiences and receipt of depression treatment in Y2, accounting for treatment in Y1. KEY RESULTS Among those who did not receive depression treatment in Y1 (n = 4613), positive experiences in three domains (comprehensiveness, shared decision-making, self-management support) predicted greater initiation of treatment in Y2. Among those who received depression treatment in Y1 (n = 22,749), positive or moderate experiences in four domains (comprehensiveness, care coordination, medication decision-making, self-management support) predicted greater continuation of treatment in Y2. CONCLUSIONS In a national PCMH setting, patient experiences with integrated care, including care coordination, comprehensiveness, involvement in shared decision-making, and self-management support predicted patients' subsequent initiation and continuation of depression treatment over time-a relationship that could affect physical and mental health outcomes.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA.
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Maria K Mor
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Gretchen L Haas
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- VISN4 Mental Illness Research, Education, and Clinical Center, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences Center of Innovation (IDEAS 2.0), Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT, USA
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John P Cashy
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - James H Schaefer
- Department of Veterans Affairs Office of Reporting, Analytics, Performance, Improvement and Deployment, Durham, NC, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Perry SJ, Richter JP, Beauvais B. The Effects of Nursing Satisfaction and Turnover Cognitions on Patient Attitudes and Outcomes: A Three-Level Multisource Study. Health Serv Res 2018; 53:4943-4969. [PMID: 29957888 DOI: 10.1111/1475-6773.12997] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore antecedents and outcomes of nurse self-reported job satisfaction and dissatisfaction-based turnover cognitions, theorizing (using Self-Determination Theory) that leaders can foster work conditions that help fulfill innate needs, thereby fostering satisfaction of nurses and patients, and reducing adverse events. DATA SOURCES/STUDY SETTING Primary and secondary data were collected within a 4-month period in 2015, from 2,596 nurses in 110 Army treatment facilities (hospitals and clinics) across 35 health care systems. DATA COLLECTION/EXTRACTION We collected individual nurse responses to the Practice Environment Scale-Nursing Work Index, in addition to aggregated archival data from the same timeframe, including both facility-level patient satisfaction records (the Army Provider Level Satisfaction Survey) and health care system-level adverse events records (provided by the Army Programming, Analysis, and Evaluation office). PRINCIPAL FINDINGS Five predictors of nurse satisfaction and turnover cognitions emerged-supportive leadership, staffing levels, nurse-physician teamwork, adoption of nursing care practice, and advancement opportunities. Aggregated nurse satisfaction was the most consistent predictor of both patient satisfaction and adverse events. CONCLUSION These findings provide evidence of the importance of nurse attitudes in improving perceived and actual performance across facilities and health care systems; in addition to practical steps, managers can take to improve satisfaction and retention.
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Affiliation(s)
| | - Jason P Richter
- 4th Medical Support Squadron, Seymour Johnson AFB, Goldsboro, NC
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48
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Madan A, Sharp C, Newlin E, Vanwoerden S, Fowler JC. Adolescents Are Less Satisfied with Inpatient Psychiatric Care than Their Parents: Does It Matter? J Healthc Qual 2018; 38:e19-28. [PMID: 25103571 DOI: 10.1111/jhq.12081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Patient satisfaction is a commonly used measure of healthcare quality. Limited research exists among psychiatric inpatients, especially adolescents, who pose unique challenges. This study sought to (1) concurrently assess adolescents' and parents' satisfaction with treatment and (2) compare their perspectives' association with treatment outcomes. METHODS This exploratory study assessed discharged adolescents from a specialty psychiatric hospital. Adolescent patients and parents completed the Perceptions of Care survey (POC), a measure of patient satisfaction. Patients also completed the Youth Self-Report measure, while parents also completed the Child Behavior Checklist-both are used as measures of mental health treatment outcomes. RESULTS Adolescents and parents gave favorable overall ratings of care. Adolescents were more critical than their parents, and there was little agreement between them. Adolescents' ratings on the POC frequently related to outcomes, whereas parents' ratings rarely did. CONCLUSIONS Ratings of satisfaction with adolescent healthcare can vary depending on whether patients or caregivers are assessed. The discrepancy between them contains value: adolescents' perception may be a better gauge of treatment outcomes and may affect treatment adherence. Future research should examine adolescent-specific concerns in the context of satisfaction with care and relate them to longer term treatment outcomes.
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49
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Rummans TA, Burton MC, Dawson NL. How Good Intentions Contributed to Bad Outcomes: The Opioid Crisis. Mayo Clin Proc 2018; 93:344-350. [PMID: 29502564 DOI: 10.1016/j.mayocp.2017.12.020] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/08/2017] [Accepted: 12/22/2017] [Indexed: 02/02/2023]
Abstract
The opioid crisis that exists today developed over the past 30 years. The reasons for this are many. Good intentions to improve pain and suffering led to increased prescribing of opioids, which contributed to misuse of opioids and even death. Following the publication of a short letter to the editor in a major medical journal declaring that those with chronic pain who received opioids rarely became addicted, prescriber attitude toward opioid use changed. Opioids were no longer reserved for treatment of acute pain or terminal pain conditions but now were used to treat any pain condition. Governing agencies began to evaluate doctors and hospitals on their control of patients' pain. Ultimately, reimbursement became tied to patients' perception of pain control. As a result, increasing amounts of opioids were prescribed, which led to dependence. When this occurred, patients sought more in the form of opioid prescriptions from providers or from illegal sources. Illegal, unregulated sources of opioids are now a factor in the increasing death rate from opioid overdoses. Stopping the opioid crisis will require the engagement of all, including health care providers, hospitals, the pharmaceutical industry, and federal and state government agencies.
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Affiliation(s)
- Teresa A Rummans
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN.
| | | | - Nancy L Dawson
- Department of Internal Medicine, Mayo Clinic, Jacksonville, FL
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50
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Zickmund SL, Burkitt KH, Gao S, Stone RA, Jones AL, Hausmann LRM, Switzer GE, Borrero S, Rodriguez KL, Fine MJ. Racial, Ethnic, and Gender Equity in Veteran Satisfaction with Health Care in the Veterans Affairs Health Care System. J Gen Intern Med 2018; 33:305-331. [PMID: 29313226 PMCID: PMC5834960 DOI: 10.1007/s11606-017-4221-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/05/2017] [Accepted: 11/02/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patient satisfaction is an important dimension of health care quality. The Veterans Health Administration (VA) is committed to providing high-quality care to an increasingly diverse patient population. OBJECTIVE To assess Veteran satisfaction with VA health care by race/ethnicity and gender. DESIGN AND PARTICIPANTS We conducted semi-structured telephone interviews with gender-specific stratified samples of black, white, and Hispanic Veterans from 25 predominantly minority-serving VA Medical Centers from June 2013 to January 2015. MAIN MEASURES Satisfaction with health care was assessed in 16 domains using five-point Likert scales. We compared the proportions of Veterans who were very satisfied, somewhat satisfied, and less than satisfied (i.e., neither satisfied nor dissatisfied, somewhat dissatisfied, or very dissatisfied) in each domain, and used random-effects multinomial regression to estimate racial/ethnic differences by gender and gender differences by race/ethnicity. KEY RESULTS Interviews were completed for 1222 of the 1929 Veterans known to be eligible for the interview (63.3%), including 421 white, 389 black, and 396 Hispanic Veterans, 616 of whom were female. Veterans were less likely to be somewhat satisfied or less than satisfied versus very satisfied with care in each of the 16 domains. The highest satisfaction ratings were reported for costs, outpatient facilities, and pharmacy (74-76% very satisfied); the lowest ratings were reported for access, pain management, and mental health care (21-24% less than satisfied). None of the joint tests of racial/ethnic or gender differences in satisfaction (simultaneously comparing all three satisfaction levels) was statistically significant (p > 0.05). Pairwise comparisons of specific levels of satisfaction revealed racial/ethnic differences by gender in three domains and gender differences by race/ethnicity in five domains, with no consistent directionality across demographic subgroups. CONCLUSIONS Our multisite interviews of a diverse sample of Veterans at primarily minority-serving sites showed generally high levels of health care satisfaction across 16 domains, with few quantitative differences by race/ethnicity or gender.
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Affiliation(s)
- Susan L Zickmund
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, UT, USA. .,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.
| | - Kelly H Burkitt
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Shasha Gao
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Roslyn A Stone
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Leslie R M Hausmann
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Galen E Switzer
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sonya Borrero
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Keri L Rodriguez
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael J Fine
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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