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Beckett MK, Quigley DD, Lehrman WG, Giordano LA, Cohea CW, Goldstein EH, Elliott MN. Interventions and Hospital Characteristics Associated With Patient Experience: An Update of the Evidence. Med Care Res Rev 2024; 81:195-208. [PMID: 38238918 DOI: 10.1177/10775587231223292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Patient experience is a key hospital quality measure. We review and characterize the literature on interventions, care and management processes, and structural characteristics associated with better inpatient experiences as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Prior reviews identified several promising interventions. We update these previous efforts by including more recent peer-reviewed literature and expanding the review's scope to include observational studies of HCAHPS measures with process measures and structural characteristics. We used PubMed to identify U.S. English-language peer-reviewed articles published in 2017 to 2020 and focused on hospital patient experience. The two HCAHPS domains for which we found the fewest potential quality improvement interventions were Communication with Doctors and Quietness. We identified several modifiable processes that could be rigorously evaluated in the future, including electronic health record patient engagement functionality, care management processes, and nurse-to-patient ratios. We describe implications for future policy, practice, and research.
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Sertan A, Çek K, Öniz A, Özgören M. The Influence of Medicine Approaches on Patient Trust, Satisfaction, and Loyalty. Healthcare (Basel) 2023; 11:healthcare11091254. [PMID: 37174796 PMCID: PMC10178378 DOI: 10.3390/healthcare11091254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/13/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The increase in traditional and complementary medicine (TCM) methods has revealed the necessity of determining relevant behavioral tendencies among healthcare users. In our study, the evaluation of TCM approaches of healthcare users living in North Cyprus in terms of treatment effectiveness, patient trust and patient satisfaction, and the effects of these variables on patient loyalty, were investigated. Data were collected utilizing the scale approach as well as the survey technique in order to measure the variables in the study. A total of 452 participants completed the survey. TCM has a positive effect on treatment effectiveness, patient trust and patient satisfaction. Patient trust and patient satisfaction have a positive effect on patient loyalty, whereas treatment effectiveness did not have a significant effect on patient loyalty. There is a significant and positive mediating effect of patient trust and patient satisfaction between TCM and patient loyalty. However, the mediating effect of treatment effectiveness is not significant between TCM and patient loyalty. This study will help researchers and practitioners understand the importance of attitude, trust, effectiveness, satisfaction and loyalty in relation to TCM. It is suggested that studies that measure the behaviors of patients should increase in order to obtain better health outcomes.
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Affiliation(s)
- Ayşe Sertan
- Faculty of Health Sciences, Near East University, via Mersin 10, 99138 Nicosia, Turkey
| | - Kemal Çek
- Faculty of Economics and Administrative Sciences, Accounting and Finance, Cyprus International University, via Mersin 10, 99138 Nicosia, Turkey
| | - Adile Öniz
- Healthcare Organizations Management, Dean of Faculty of Health Sciences, Near East University, via Mersin 10, 99138 Nicosia, Turkey
| | - Murat Özgören
- Faculty of Medicine, Near East University, via Mersin 10, 99138 Nicosia, Turkey
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Shipp MM, Sanghavi KK, Kolm P, Zhang G, Miller KE, Giladi AM. Preoperative Patient-Reported Data Indicate the Risk of Prolonged Opioid Use After Hand and Upper Extremity Surgeries. J Hand Surg Am 2022; 47:1068-1075. [PMID: 36031463 PMCID: PMC9637740 DOI: 10.1016/j.jhsa.2022.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/16/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Opioids play an important role in pain management after surgery but also increase the risk of prolonged opioid use in patients. The identification of patients who are more likely to use opioids after intended short-term treatment is critical for employing alternative management approaches or targeted interventions for the prevention of opioid-related problems. We used patient-reported data (PRD) and electronic health record information to identify factors predictive of prolonged opioid use after surgery. METHODS We used our institutional registry containing data on all patients who underwent elective upper extremity surgeries. We evaluated factors associated with prolonged opioid use in the cohort from the year 2018 to 2019. We then validated our results using the 2020 cohort. The predictive variables included preoperative PRD and electronic health record data. Opioid use was determined based on patient reports and/or filled opioid prescriptions 3 months after surgery. We conducted bivariate regression, followed by multivariable regression analyses, and model validation using area under the receiver operating curve. RESULTS We included 2,114 patients. In our final model on the 2018-2019 electronic health records and PRD data (n = 1,589), including numerous patient-reported outcome questionnaire scores, patients who were underweight and had undergone trauma-related surgery had higher odds of being on opioids at 3 months. Additionally, each 5-unit decrease in the preoperative Patient-Reported Outcomes Measurement Information System Global Physical Health score was associated with a 30% increased odds of being on opioids at 3 months. The area under the receiver operating curve of our model was 70.4%. On validation using data from the 2020 cohort, the area under the receiver operating curve was 60.3%. The Hosmer-Lemeshow test indicated a good fit. CONCLUSIONS We found that preoperative questionnaire scores were associated with prolonged postoperative opioid use, independent of other variables. Furthermore, PRD may provide unique patient-level insights, alongside other factors, to improve our understanding of postsurgical pain management. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Michael M Shipp
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kavya K Sanghavi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD
| | - Paul Kolm
- MedStar Health Research Institute, Hyattsville, MD
| | - Gongliang Zhang
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD
| | - Kristen E Miller
- MedStar Health Research Institute, Hyattsville, MD; National Center for Human Factors in Healthcare, MedStar Health Research Institute, Hyattsville, MD
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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Boloori A, Arnetz BB, Viens F, Maiti T, Arnetz JE. Misalignment of Stakeholder Incentives in the Opioid Crisis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7535. [PMID: 33081276 PMCID: PMC7589670 DOI: 10.3390/ijerph17207535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/03/2020] [Accepted: 10/04/2020] [Indexed: 12/14/2022]
Abstract
The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients' non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis.
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Affiliation(s)
- Alireza Boloori
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
| | - Bengt B. Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
| | - Frederi Viens
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
| | - Taps Maiti
- Department of Statistics and Probability, Michigan State University, East Lansing, MI 48824, USA; (F.V.); (T.M.)
| | - Judith E. Arnetz
- Department of Family Medicine, Michigan State University, Grand Rapids, MI 49503, USA; (B.B.A.); (J.E.A.)
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Wong B, Perkins MW, Tressler J, Rodriguez A, Devorak J, Sciuto AM. Effects of inhaled aerosolized carfentanil on real-time physiological responses in mice: a preliminary evaluation of naloxone. Inhal Toxicol 2017; 29:65-74. [DOI: 10.1080/08958378.2017.1282065] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Benjamin Wong
- Biochemistry and Toxicology Branch, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Michael W. Perkins
- Biochemistry and Toxicology Branch, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Justin Tressler
- Biochemistry and Toxicology Branch, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Ashley Rodriguez
- Biochemistry and Toxicology Branch, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Jennifer Devorak
- Biochemistry and Toxicology Branch, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
| | - Alfred M. Sciuto
- Biochemistry and Toxicology Branch, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD, USA
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Sinnenberg LE, Wanner KJ, Perrone J, Barg FK, Rhodes KV, Meisel ZF. What Factors Affect Physicians' Decisions to Prescribe Opioids in Emergency Departments? MDM Policy Pract 2017; 2:2381468316681006. [PMID: 30288413 PMCID: PMC6124837 DOI: 10.1177/2381468316681006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/31/2016] [Indexed: 11/28/2022] Open
Abstract
Objective: With 42% of all emergency department visits in the United
States related to pain, physicians who work in this setting are tasked with
providing adequate pain management to patients with varying primary complaints
and medical histories. Complicating this, the United States is in the midst of
an opioid overdose epidemic. State governments and national organizations have
developed guidelines and legislation to curtail opioid prescriptions in acute
care settings, while also incentivizing providers for patient satisfaction and
completeness of pain control. In order to inform future policies that focus on
provider pain medication prescribing, we sought to characterize the factors
physicians weigh when considering treating pain with opioids in the emergency
department. Methods: We conducted and transcribed open-ended,
semistructured qualitative interviews with 52 physicians at a national emergency
medicine conference. Results: Participants reported a wide range of
factors contributing to their opioid prescribing patterns related to three
domains: 1) provider assessment of pain characteristics, 2) patient-based
considerations, and 3) practice environment. Pain characteristics include the
characteristics of various acute and chronic pain syndromes, including
physicians’ empathy due to their own experiences with pain. Patient
characteristics include “trustworthiness,” race and ethnicity, and the concern
for risk of misuse. Factors related to the practice environment include hospital
policy, legislation/regulation, and guidelines. Conclusion: The
decision to prescribe opioids to patients in the emergency department is complex
and nuanced. Physicians are interested in guidance and are concerned about the
competing pressures placed on their opioid prescribing due to incentives related
to patient satisfaction scores on one hand and inflexible policies that do not
allow for individualized, patient-centered decisions on the other.
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Affiliation(s)
- Lauren E Sinnenberg
- Department of Emergency Medicine (LES, JP, ZFM), Perelman School of Medicine.,Department of Family Medicine and Community Health (FKB), Perelman School of Medicine.,Center for Clinical Epidemiology and Biostatistics (FKB), Perelman School of Medicine.,Center for Emergency Care Policy and Research (LES, KJW, ZFM), University of Pennsylvania, Philadelphia, Pennsylvania.,Office of Population Health Management, Hofstra Northwell School of Medicine, Hempstead, New York (KVR)
| | - Kathryn J Wanner
- Department of Emergency Medicine (LES, JP, ZFM), Perelman School of Medicine.,Department of Family Medicine and Community Health (FKB), Perelman School of Medicine.,Center for Clinical Epidemiology and Biostatistics (FKB), Perelman School of Medicine.,Center for Emergency Care Policy and Research (LES, KJW, ZFM), University of Pennsylvania, Philadelphia, Pennsylvania.,Office of Population Health Management, Hofstra Northwell School of Medicine, Hempstead, New York (KVR)
| | - Jeanmarie Perrone
- Department of Emergency Medicine (LES, JP, ZFM), Perelman School of Medicine.,Department of Family Medicine and Community Health (FKB), Perelman School of Medicine.,Center for Clinical Epidemiology and Biostatistics (FKB), Perelman School of Medicine.,Center for Emergency Care Policy and Research (LES, KJW, ZFM), University of Pennsylvania, Philadelphia, Pennsylvania.,Office of Population Health Management, Hofstra Northwell School of Medicine, Hempstead, New York (KVR)
| | - Frances K Barg
- Department of Emergency Medicine (LES, JP, ZFM), Perelman School of Medicine.,Department of Family Medicine and Community Health (FKB), Perelman School of Medicine.,Center for Clinical Epidemiology and Biostatistics (FKB), Perelman School of Medicine.,Center for Emergency Care Policy and Research (LES, KJW, ZFM), University of Pennsylvania, Philadelphia, Pennsylvania.,Office of Population Health Management, Hofstra Northwell School of Medicine, Hempstead, New York (KVR)
| | - Karin V Rhodes
- Department of Emergency Medicine (LES, JP, ZFM), Perelman School of Medicine.,Department of Family Medicine and Community Health (FKB), Perelman School of Medicine.,Center for Clinical Epidemiology and Biostatistics (FKB), Perelman School of Medicine.,Center for Emergency Care Policy and Research (LES, KJW, ZFM), University of Pennsylvania, Philadelphia, Pennsylvania.,Office of Population Health Management, Hofstra Northwell School of Medicine, Hempstead, New York (KVR)
| | - Zachary F Meisel
- Department of Emergency Medicine (LES, JP, ZFM), Perelman School of Medicine.,Department of Family Medicine and Community Health (FKB), Perelman School of Medicine.,Center for Clinical Epidemiology and Biostatistics (FKB), Perelman School of Medicine.,Center for Emergency Care Policy and Research (LES, KJW, ZFM), University of Pennsylvania, Philadelphia, Pennsylvania.,Office of Population Health Management, Hofstra Northwell School of Medicine, Hempstead, New York (KVR)
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