Factors Associated with Patient Press Ganey Satisfaction Scores for Ophthalmology Patients

Evaluating Pediatric Ophthalmic Care Using Sentiment Analysis of Physician Review Sites

PURPOSE

To assess patient satisfaction within pediatric ophthalmology and identify trends in patient sentiment.

METHODS

Pediatric ophthalmologists in the United States were identified using the American Association for Pediatric Ophthalmology and Strabismus member directory. Demographic data were recorded using publicly available websites. Online written reviews and Stars ratings were obtained from Healthgrades.com. A sentiment analysis package, Valence Aware Dictionary for Sentimental Reasoning (VADER), was used to generate a compound score of reviews, and word frequency analyses were applied.

RESULTS

A total of 377 pediatric ophthalmologists (2,640 online reviews) were evaluated. Physicians received an average of 4.22/5 Stars and a compound sentiment score of 0.56, indicating positive sentiment. No differences in scores were observed by gender or location, although physicians with fewer years in practice had higher Stars ratings compared to peers (P < .001). The three most common words in the word frequency analysis of all reviews were "surgery," "staff," and "time," with heavy emphasis on bedside manner and addressing patient concerns.

CONCLUSIONS

This study demonstrates overall high patient satisfaction in pediatric ophthalmology care, with differences in sentiment based on physician demographic features. The study highlights that patient perspective is influenced by non-clinical features of care. These data may be used by pediatric ophthalmologists seeking to improve health care delivery. [J Pediatr Ophthalmol Strabismus. 2024;61(3):211-218.].

Application of Patient Sentiment Analysis to Evaluate Glaucoma Care

PURPOSE

Patients utilize online physician reviews to decide between and rate ophthalmologists. Sentiment analysis allows for better understanding of patient experiences. In this study, Valence Aware Dictionary sEntiment Reasoner (VADER) and word frequency analysis of glaucoma specialist Healthgrades reviews were used to determine factors prioritized by patients.

DESIGN

Retrospective cross-sectional analysis.

PARTICIPANTS

N/A.

METHODS

Written reviews and Star ratings of glaucoma specialists listed under the Physicians Payments Sunshine Acts were obtained, and demographic information was collected. Valence Aware Dictionary sEntiment Reasoner produced Negative, Neutral, Positive, and Compound scores of reviews, and these were stratified by demographic variables. Word frequency review was applied to determine popular words and phrases.

MAIN OUTCOME MEASURES

Star ratings, VADER Compound score of written reviews, and highest word frequencies.

RESULTS

A total of 203 glaucoma specialists and 3531 written reviews were assessed. Glaucoma specialists had an average of 4.26/5 stars, with a mean of 30 ratings per physician on Healthgrades. Most physicians (86%) had overall Positive written reviews (VADER = 0.74), indicating high patient satisfaction. Specialists who were women or had fewer years of practice had higher Compound and Star scores than their respective male and senior counterparts, with statistical significance observed between junior and senior physician Stars (P < 0.001). Repeated words pertaining to the surgery, staff, wait times, and questions were common overall and among the most positive and most negative reviews.

CONCLUSIONS

Glaucoma specialist patients value nonclinical factors, such as appointment setting and nonphysician health-care staff members, in their written reviews. Thus, factors beyond clinical outcomes are influential in the overall patient experience and should be considered to improve health-care delivery. These results can also advise ophthalmologists on factors that patients prioritize when evaluating physicians, which influences the decisions of other patients seeking glaucoma care.

FINANCIAL DISCLOSURE(S)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Exploring the dynamics of physician-patient relationships: Factors affecting patient satisfaction and complaints

This review identifes the factors influencing the relationship between physicians and patients that can lead to patients' dissatisfaction and medical complaints. Utilizing a systemic approach 92 studies were retrieved which included quantitative, qualitative, and mixed method studies. Through a thematic analysis of the literature, we identified three interrelated main themes that can influence the relationship between physicians and patients, patients' satisfaction, and the decision to file a medico-legal complaint. The main themes include patient and physician characteristics; the interpersonal relationship between physicians and patients; and the health care system and policies, with relevant subthemes. These themes are demonstrated in a descriptive model. The review suggests areas of focus for physicians who may wish to increase their awareness around the potential sources of relational problems with their patients. Identifying these issues may assist in improvements in the therapeutic relationship with patients, can reduce their medico-legal risk, and enhance the quality of their clinical practice. The findings can also be utilized to support andragogical principles for medical learners. The article can serve as a structured framework to identify potential problems and gaps to design and test effective interventions to mitigate these potential relational problems between physician-patient.

Patient Satisfaction in Dental Healthcare Settings at Saudi Ministry of Health: A Descriptive Study

Background

Patient satisfaction is crucial for assessing healthcare quality and identifying strengths and weaknesses in healthcare organizations. In Saudi Arabia, the Ministry of Health (MOH) implemented the Patient Experience Measurement Program to enhance patient experience and healthcare quality. This study aimed to identify specific aspects of patient satisfaction with dental visits in Saudi Arabia to improve dental care quality and inform dental services development.

Methods

The study used a standardized self-administered questionnaire (Health Links/Press Ganey) and analyzed surveys from patients who visited MOH-specialized dental clinics in Saudi Arabia during the first half of 2022. The dental section comprised 20 questions across five domains, with patients rating their experience on a 5-point Likert scale. Statistical analysis was performed using IBM SPSS Statistics 25.

Results

A total of 964 patients were surveyed. The overall patient satisfaction with dental settings was 3.61 out of 5.0 (72.2%). The highest satisfaction score was for personal issues with the dental clinic domain (3.93/5; 78.6%), while the least satisfaction score was for access to the dental clinic domain (3.29/5; 65.8%). Among all items, the cleanliness of the facility showed the highest satisfaction score (4.11/5; 82.2%). The least satisfaction was for the ease of contacting the dental clinic (2.71/5; 54.2%).

Conclusion

The study found high levels of satisfaction among Saudi patients with dental services provided through MOH facilities across various component domains. This highlights the crucial role of dentists in ensuring high-quality dental care and serves as an indication of the overall healthcare quality in MOH facilities.

Effective health communication for age-related macular degeneration: An exploratory qualitative study

PURPOSE

Age-related macular degeneration (AMD) is a major cause of vision loss globally. Patients with AMD may not always understand or retain the information about AMD communicated by their eyecare practitioner. This study aims to explore the characteristics of effective health communication for AMD, from both patients' and eyecare practitioners' perspectives. The purpose is to provide a foundation for understanding how health communication for AMD could potentially be improved in the future.

METHODS

A total of 10 focus groups involving 17 patients with AMD and 17 optometrists were conducted via web conferencing. Each session was audio-recorded, transcribed and analysed using the Grounded Theory Methodology.

RESULTS

The five themes identified are as follows: (1) materials' quality, (2) materials' relevance, (3) contextualising for the individual, (4) contextualising for the disease and (5) support network. Participants expressed concern about the unrealistic yet common depiction of vision loss in AMD as a black patch overlying common visual scenes. They also preferred education materials tailored to a specific disease stage and the regular opportunity to ask or answer questions. Longer appointment durations and peer support (from family, friends or others with AMD) were also valued.

CONCLUSION

Optometrists are encouraged to focus on three over-arching dimensions when counselling patients with AMD in routine clinical practice: (1) curating and using disease and stage-specific, impactful education materials, (2) their chairside verbal communication techniques and (3) AMD-specific opportunities for care coordination among patient family and friends, peers and other multidisciplinary members of the care support team.

Physician Review Websites: Understanding Patient Satisfaction with Ophthalmologists Using Natural Language Processing

Introduction

The presence and influence of physician review websites (PRW) have increased significantly in the field of medicine. This study aims to better understand determinants of patient satisfaction and the sentiment of ophthalmologists using natural language processing of Healthgrades reviews.

Methods

Healthgrades is a PRW where patients submit verified reviews, containing a star rating and a narrative review, of US-based ophthalmologists. This was a quantitative observational study conducted on May 23, 2022. We identified associations between physician demographics and both the sentiment analysis scores of narrative reviews and star ratings using the Student's t-tests and one-way ANOVA tests. After natural language processing the reviews, a logistic regression explored the impacts of the most frequent words on the positivity of a given review.

Results

This study examined a total of 16700 reviews of 1125 ophthalmologists. Ophthalmologists of younger age and male gender received statistically significantly higher star ratings and sentiment analysis scores; analysis of location of practice did not affect scores. Textual analysis revealed that words describing the physician's personality, such as "friendly" and "caring," increased the likelihood of reviews being positive more than descriptors of the visit's effectiveness, such as "results" and "efficient."

Conclusion

Younger and male ophthalmologists received higher star ratings and sentiment analysis scores. Additionally, results indicated that words describing the ophthalmologist's pleasant personality and the visit's effectiveness most positively impacted a review, whereas descriptors of a wait or an unpleasant personality most negatively impacted a review.

Using infodemiology metrics to assess patient demand for oculoplastic surgeons in the United States: insights from Google Search Trends

PURPOSE

The aim of this study was to compare state-by-state concentrations of oculoplastic surgeons against patient demand using Google Search Trends data, in order to identify potential areas of unmet need.

METHODS

Google Trends data from 2004 to 2019 was collected to determine relative search volumes for the keyword "blepharoplasty" in each US state and the District of Columbia. Oculoplastic surgeon density was calculated by dividing the number of active American Society of Plastic and Reconstructive Surgeons members in 2019 by the State Census Bureau population estimates. Relative search volume values were divided by the local concentration of surgeons, and results were normalized between 0 and 100 to obtain a relative demand index for each state.

RESULTS

Oculoplastic surgeon density varied widely across the country. The greatest concentrations of surgeons per 100,000 people were in D.C. (0.708) and Rhode Island (0.378), while the lowest were in Montana, New Mexico, North Dakota, South Dakota, and Wyoming (all 0). Relative search volumes were tightly distributed, ranging between 100 (Hawaii) and 45 (Vermont). The highest relative demand was found in low surgeon density states, such as Hawaii, Montana, New Mexico, North Dakota, South Dakota, and Wyoming. The lowest relative demand was found in DC (5), Rhode Island (12), and Utah (12).

CONCLUSIONS

Our results revealed vast disparities in surgical concentrations across the US and highlighted a number of areas with a relative undersupply of oculoplastic surgeons. Further investigation is necessary to examine the underlying factors impacting the supply and distribution of oculoplastic surgeons.

Understanding the Patient Experience: Analysis of 2-Word Assessment and Its Relationship to Likelihood to Recommend in Outpatient Hand Surgery

BACKGROUND

Actionable feedback from patients after a clinic visit can help inform ways to better deliver patient-centered care. A 2-word assessment may serve as a proxy for lengthy post-visit questionnaires. We tested the use of a 2-word assessment in an outpatient hand clinic.

METHODS

New patients were asked to provide a 2-word assessment of the following: (1) their physician; (2) their overall experience; and (3) recommendations for improvement and their likelihood to recommend (LTR) after their clinic visit. Sentiment analysis was used to categorize results into positive, neutral, or negative sentiment. Recommendations for improvement were classified into physician issue, system issue, or neither. We evaluated the relationship between LTR status, sentiment, actionable improvement opportunities, and classification (physician issue, system issue, or neither). Recommendations for improvement were classified into themes based on prior literature.

RESULTS

Sixty-seven (97.1%) patients noted positive sentiment toward their physician; 67 (97.1%) noted positive sentiment toward their overall experience. About 31% of improvement recommendations were system-based, 5.9% were physician-based, and 62.7% were neither. Patients not LTR were more likely to leave actionable opportunities for improvement than those LTR (P = .01). Recommendations for improvement were classified into predetermined themes relating to: (1) physician interaction; (2) check-in process; (3) facilities; (4) unnecessary visit; and (5) appointment delays.

CONCLUSION

Patients not likely to recommend provided actionable opportunities for improvement using a simple 2-word assessment. Implementation of a 2-word assessment in a hand clinic can be used to obtain actionable, real-time patient feedback that can inform operational change and improve the patient experience.

Assessment of scheduling for patients referred for an abnormal red reflex

Scheduling lag time is the time between the date of an appointment and the date an appointment was created in the scheduling system. We sought to determine the scheduling lag time in a pediatric ophthalmology clinic for children <8 years of age, referred by a primary care provider for an abnormal red reflex (ARR), cataract, leukocoria, or retinoblastoma. The median scheduling lag time was 1.8 days (IQR, 0.8-5.0). Of the 106 total appointments, 89 (84%) were completed as scheduled, 12 (11%) were canceled, and 5 (5%) were no-shows. Ten patients (12%) were never seen. There was a shorter scheduling lag time for completed visits (median, 1.1 days; IQR, 0.2-4.0) than canceled visits (median, 12.0 days; IQR, 3.1-48.5; P < 0.001). Monitoring of the scheduling lag time for urgent referrals may be a metric for quality improvement in pediatric ophthalmology.

Validity of Wait Time Complaints and Effect of Trainee Presence in an Ophthalmic Emergency Department

Purpose

Press Ganey (PG) surveys can provide a more comprehensive evaluation of specific patient complaints through input of comments. In this paper, we evaluate the validity of wait time complaints submitted via PG surveys in an ophthalmic emergency department (ED) and determine the effect of trainee presence on total time spent in the ED and negative PG comments.

Materials and Methods

This was a retrospective study evaluating PG reports for ED demographic, diagnostic, visit time and trainee involvement trends.

Results

Females made up 48.0% (4465) of overall ED patients yet submitted 62.8% (98) of the negative comments on PG surveys. More than a quarter (27.7%) of the negative comments pertained to wait time. Patient-reported times spent in the ED were significantly longer than actual total ED times (p < 0.001). Both reported and actual total ED times were significantly longer for patients who submitted wait time negative comments than those with other complaints (p < 0.001 vs p = 0.039, respectively). Patients seen by residents spent a significantly longer time in the ED than those seen by non-resident providers (p = 0.015), although self-reported total ED times did not differ significantly in these patients (p = 0.467).

Conclusion

Patients submitting complaints about wait time and those seen by treatment teams including residents spent a significantly longer time in the ED. Although PG survey respondents are not representative of the overall ED patient population, this highlights the need for academic institutions to seek methods to maximize efficiency in patient care without compromising trainee education.

Evaluating Factors That Influence Patient Satisfaction in Otolaryngology Clinics

OBJECTIVES

To identify factors that influence patient satisfaction during outpatient visits in various settings of otolaryngology clinics in an academic medical center.

STUDY DESIGN

Retrospective review.

SETTING

Academic medical center.

METHODS

We reviewed Press Ganey patient satisfaction survey responses for new, outpatient visits between January 1, 2014 and December 31, 2018. Self-reported race was identified using electronic medical records. Multivariate binary logistic regression analyses were used to identify continuous and categorical variables associated with patient satisfaction.

RESULTS

There were 3998 unique new patient visits with completed surveys. Multivariate analysis revealed that responses for patients <18 years old are less likely to be satisfied with their care compared to patients ≥18 years old (OR 0.66; P < .001). For each 10-minute increase in wait time, patients were 43.4% less likely report satisfaction (P < .001). African American patients were also less likely to report satisfaction (OR 0.22; P = .043) while Native Hawaiian and Pacific Islanders were over 3 times more likely to be satisfied (OR 3.6; P = .013). Additionally, Medicare patients and those who were seen at community satellite clinics compared to the main University Hospital had increased odds of achieving satisfactory care (OR 1.3; P = .005 and OR 1.3; P = .002, respectively).

CONCLUSIONS

Wait time, clinic location, patient race, insurance provider, and age were all shown to significantly influence patient-reported satisfaction. Understanding how these variables influence patient satisfaction will hopefully lead to processes that improve patient satisfaction.

LEVEL OF EVIDENCE

Level 3.

Patients' Satisfaction with Ophthalmology Clinic Services in a Public Teaching Hospital

PURPOSE

To evaluate patients' satisfaction with ophthalmology health services in a teaching clinic of a tertiary public hospital.

PATIENTS AND METHODS

This was a cross-sectional study in ophthalmology clinic of Dr. Sardjito teaching hospital, Yogyakarta, Indonesia conducted in 2019. Patients were surveyed using the Patient Satisfaction Questionnaire-18 (PSQ-18). PSQ-18 subscale score was analyzed based on patients' characteristics. The main outcome was the odds of reaching top satisfaction score (TSS) of 4-5 from a Likert scale 1 to 5.

RESULTS

Our study recorded 269 participants who consisted of 138 males (51.3%) and 131 females (48.7%) with median age of 52 (18-87) years old. Variables with higher odds of reaching TSS on "patient overall satisfaction" was public health insurance (OR: 7.959 [95% CI: 1.989-31.852], p=0.003) while examination time (OR: 0.955 [95% CI: 0.923-0.988], p=0.008) had lower odds. Examination waiting time (OR: 0.992 [95% CI: 0.985-0.999], p=0.027) and examination time (OR: 0.941 [95% CI: 0.908-0.976], p=0.001) had lower odds of reaching TSS in "general satisfaction". Family monthly income (OR: 1.829 [95% CI: 1.038-3.223], p=0.037) had higher odds of reaching TSS in "technical quality" while examination time (OR: 0.961 [95% CI: 0.931-0.993], p=0.017) and education (OR: 0.549 [95% CI: 0.322-0.934], p=0.027) had lower odds. Comorbidities (OR: 0.533 [95% CI: 0.301-0.944], p=0.031) had lower odds of reaching TSS in "financial aspects". Retina subspecialty clinic (OR: 3.436 [95% CI: 1.154-10.232], p=0.027) had higher odds of reaching TSS in "time spent with doctor". Registrar as attending physician (OR: 0.427 [95% CI: 0.205-0.89], p=0.0230) and examination time (OR: 0.957 [95% CI: 0.924-0.991], p=0.013) had lower odds of reaching TSS in "accessibility-convenience".

CONCLUSION

Examination time and examination waiting time should be shortened, specialist doctors should always see the patients whenever possible, and registrars' technical and communication skill should be improved. Alternative funding for patients without health insurance also should be provided to increase satisfaction.

Ophthalmology Provider Ratings and Patient, Disease, and Appointment Factors

The purpose of the current study is to examine how nonmodifiable sociodemographic, disease, appointment, management, and survey factors correlate with provider rating. This was a retrospective cross-sectional study conducted on 29 857 patient Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys collected from January 2017 to January 2019 at a tertiary eye center. We included surveys of patients aged 18 years or older, who answered at least 4 of 6 subfield questions, and completed the survey within 90 days of the appointment. The main outcome was the odds of receiving top box score (TBS) of 10/10 on the survey question regarding overall provider rating. The results showed that the variables with higher odds of TBS included higher overall appointment attendance (odds ratio [OR]: 2.66 [95% CI: 1.23-5.75], P = .013); older patient age (OR 2.44 [95% CI: 2.08-2.87], P < .001]; higher percentage of survey questions completed (OR: 2.02 [95% CI: 1.79-2.27], P < .001); better best corrected visual acuity (OR: 1.85 [95% CI: 1.3-2.64], P = .001); optometry clinic visit (OR: 1.25 [95% CI: 1.15-1.36], P < .001); having procedures (OR: 1.19 [95% CI: 1.04-1.36], P = .013), surgery scheduled (OR: 1.18 [95% CI: 1.03-1.36], P = .020], or refraction done (OR: 1.16 [95% CI: 1.08-1.25], P < .001); being seen by male providers (OR: 1.11 [95% CI: 1.04-1.17], P = .001); and having additional eye testing performed (OR: 1.06 [95% CI: 1.00-1.13], P = .048). Variables associated with lower odds of TBS included longer time to complete survey (OR: 0.42 [95% CI: 0.3-0.58], P = .001); new patient encounter (OR: 0.62 [95% CI: 0.58-0.65], P < .001); and glaucoma (OR: 0.66 [95% CI: 0.59-0.75], P < .001), cornea (OR: 0.79 [95% CI: 0.71-0.87], P < .001), or comprehensive clinic visits (OR: 0.86 [95% CI: 0.79-0.94], P < .001). Thus, nonmodifiable factors may affect the provider rating, and these factors should be studied further and accounted for when interpreting the results of patient experience surveys.

Press Ganey: Patient-Centered Communication Drives Provider and Hospital Revenue

BACKGROUND

Spurred on in part by government policies that base a portion of reimbursement around patient satisfaction, in 2016, Texas Children's Hospital instituted a patient-focused communication course entitled Breakthrough Communication. The aim of this study is to examine the effect of this training on provider-specific Press Ganey scores within the Department of Surgery, and to assess whether changes in Press Ganey scores correlate to hospital volume and revenue.

METHODS

The intervention period was defined as calendar year 2017. Full-time faculty between 2016 and 2018 who completed the course in 2017 and had at least 10 returned Press Ganey surveys before and after the course were included in this study. Patient volume and revenue were analyzed. A subgroup analysis was conducted to compare participant against nonparticipant plastic surgeons.

RESULTS

For the 56 surgeons who met the inclusion criteria, mean provider Press Ganey ratings increased from 92.0 to 94.3 following participation (p = 0.003). When compared to before intervention, clinical encounters increased by 26.2 percent, the number of patients increased by 26.0 percent, payments increased by 25.2 percent, and charges increased by 21.2 percent. In our subgroup analysis, there was a relative increase of 11 percent in the number of patients and 10 percent in the number of encounters for participant plastic surgeons. Participants reported 113 percent increases in charges and 71 percent increases in payments, whereas nonparticipants had decreases of 10 percent in charges and 4 percent in payments.

CONCLUSION

The authors' findings indicate that improving surgeons' patient-centered communication skills is associated with an increase in patient satisfaction and an accompanying increase in both volume and reimbursements.

The Effect of Photographic Visual Aids in Preoperative Patient Counseling in Oculoplastic Surgery

PURPOSE

To investigate the effect of visual supplementation and its mode of delivery in preoperative counseling of patients undergoing oculoplastic surgery.

METHODS

A prospective randomized controlled trial of consecutive patients undergoing oculoplastic eyebrow and eyelid surgery was conducted. Patients were randomized to an "oral only" group receiving routine preoperative oral counseling or an "oral and visual" group receiving identical counseling visually supplemented with photographs demonstrating common postoperative physical findings. Patients in the "oral and visual" group were further randomized to receive education from the medical team in person versus prerecorded video. Patient emotions and expectations regarding postoperative healing were assessed preoperatively and at 1 week and 2 months postoperatively.

RESULTS

103 patients were included: 32 received in-person oral education, 33 received in-person oral education with photographs, and 38 received education with photographs via video. There were no significant differences in demographics or preoperative patient fear, anxiety, or preparedness. The "oral and visual" group expected more severe postsurgical discomfort and physical findings at postoperative day 1 and week 1. There were no significant differences between groups in surgery signup, cancellation, or triage call rates; patient expectations of postoperative months 2 and 4; or in anxiety, preparedness, or satisfaction.

CONCLUSIONS

Visual supplementation in preoperative counseling increases patient expectations of postoperative physical findings without escalating fear or anxiety, and has no significant impact on patient emotions, triage call rates, and satisfaction throughout their surgical experience. Preoperative education via video is perceived by patients to be equivalent to counseling in person by the surgeon.

Patient Experience and Satisfaction with Telemedicine During Coronavirus Disease 2019: A Multi-Institution Experience

Introduction: The coronavirus disease 2019 (COVID-19) heralded an unprecedented increase in telemedicine utilization. Our objective was to assess patient satisfaction with telemedicine during the COVID-19 era. Methods: Telemedicine visit data were gathered from Stanford Health Care (Stanford) and the Hospital for Special Surgery (HSS). Patient satisfaction data from HSS were captured from a Press-Ganey questionnaire between April 19, 2020, and December 12, 2020, whereas Stanford data were taken from a novel survey instrument that was distributed to all patients between June 22, 2020, and November 1, 2020. Participants: There were 60,550 telemedicine visits at Stanford, each linked with a postvisit survey. At HSS, there were 66,349 total telemedicine visits with 7,348 randomly linked with a postvisit survey. Main Outcomes and Measures: Two measures of patient satisfaction were used for this study: (1) a patient's "overall visit score" and (2) whether the patient indicated the highest possible "likelihood to recommend" (LTR) score (LTR top box score). Results: The LTR top box percentage at Stanford increased from 69.6% to 74.0% (p = 0.0002), and HSS showed no significant change (p = 0.7067). In the multivariable model, the use of a cell phone (adjusted odds ratio [aOR]: 1.18; 95% confidence interval [CI]: 1.12-1.23) and tablet (aOR: 1.15; 95% CI: 1.07-1.23) was associated with higher overall scores, whereas visits with interrupted connections (aOR: 0.49; 95% CI: 0.42-0.57) or help required to connect (aOR: 0.49; 95% CI: 0.42-0.56) predicted lower patient satisfaction. Conclusions: We present the largest published description of patient satisfaction with telemedicine, and we identify important telemedicine-specific factors that predict increased overall visit score. These include the use of cell phones or tablets, phone reminders, and connecting before the visit was scheduled to begin. Visits with poor connectivity, extended wait times, or difficulty being seen, examined, or understood by the provider were linked with reduced odds of high scores. Our results suggest that attention to connectivity and audio/visual definition will help optimize patient satisfaction with future telemedicine encounters.

Inter-specialty variation of the Press Ganey Outpatient Medical Practice Survey

ABSTRACT

Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties.New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score.Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties.Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement.

Patient Satisfaction with Medical Tourism: A Review of 460 International Plastic Surgery Patients in Colombia

Cosmetic surgery is at the forefront of an exploding medical tourism industry. Patients are able to research options globally through the internet, and increasing numbers are seeking improved service, quality, and value through surgery overseas. Little work has been done to measure the patient experience when traveling for surgery and, to our knowledge, this is the largest study of its kind to examine patient satisfaction with medical tourism.

METHODS

We retrospectively reviewed patient satisfaction surveys completed by 460 consecutive international patients receiving cosmetic surgery at a private plastic surgery practice in Cartagena, Colombia, between February 2016 and April 2018.

RESULTS

Overall patient satisfaction was excellent, with 98.2% responding that they would refer us to friends and family. Patient satisfaction ratings across all other items was also very high (range: 97.1%-100%) for information provided, the surgeon, the staff, facilities, and payment.

CONCLUSIONS

Excellent patient satisfaction is possible with medical tourism if the patient perceives and receives value through effective results, a pleasant experience, and favorable costs. These successes in plastic surgery medical tourism highlight the potential for significant continued growth in this sector as a whole.

Malpractice Litigation in Ophthalmic Trauma

Objective

To report and analyze the causes and outcomes of malpractice litigation in ophthalmic trauma.

Methods

The Westlaw^® database was reviewed for ophthalmology litigation in the United States between 1930 and 2014. All ophthalmic trauma cases were included and compared to non-traumatic ophthalmology malpractice cases.

Results

Forty-four ophthalmic trauma cases were included. Of these cases, 90.9% of ophthalmic trauma plaintiffs were male compared to 54.8% of plaintiffs in ophthalmology as a whole (P=<0.001); 34.1% of cases involved minor plaintiffs compared to 6.4% in ophthalmology as a whole (P=<0.001). Cases involving minors were more likely to be resolved in favor of the plaintiff than cases involving adult plaintiffs (53.3% vs 37.9%); however, this was not found to statistically significant (P=0.35). Overall, 54.5% of cases were resolved in favor of defendants; 40.9% of cases were resolved via jury trial with 50.0% resulting in payments to plaintiffs compared to the 29.6% rate of plaintiff verdicts in ophthalmology as a whole. Open globe injuries represented 61.4% of cases; 55.6% of these cases had intraocular foreign bodies and 37.0% developed endophthalmitis. Most cases (63.6%) alleged insufficient intervention. Of these cases, 31.8% of cases involved surgical or procedural claims, and 4.5% involved medical claims only.

Conclusion

Males and minors were overrepresented among plaintiffs in ocular trauma litigation. Most cases involved open globe injuries, often complicated by retained intraocular foreign bodies and endophthalmitis. Analysis of malpractice litigation in ophthalmic trauma calls attention to commonly litigated scenarios to improve clinical practice and to inform risk management.

Narcotic Consumption in Opioid Naïve Patients Undergoing Unicompartmental and Total Knee Arthroplasty

BACKGROUND

Total knee arthroplasty (TKA) is associated with increased risk of prolonged narcotic requirement compared to unicompartmental knee arthroplasty (UKA). The purpose of the current study is to compare acute postoperative narcotic consumption between the 2 procedures and quantify narcotic consumption.

METHODS

From October 2017 to August 2019 patients were surveyed for four weeks to determine the amount and duration of opioids consumed and requirement for continued narcotics. Among 976 opioid naïve patients, 314 (32%) underwent UKA and 662 (68%) underwent TKA. Patients were analyzed according to specific narcotic prescribed. Total morphine equivalent dose (MED), number of pills, duration, refill percentage, and usage percentage for 4 weeks were calculated for each procedure.

RESULTS

MED used in the postoperative period was lower in patients undergoing UKA than TKA (200 ± 195 vs 259 ± 250 MED, P = .002). Total number of pills consumed and duration of use was less in UKA compared to TKA regardless of which opioid was prescribed. A smaller proportion of patients required narcotics for 4 weeks after UKA (32% vs 43%, P < .001), and fewer UKA patients required narcotic refills (14% vs 27%, P < .001). Sixty pills of any 1 type of narcotic was sufficient for 90% of UKA patients and over 75% of TKA patients.

CONCLUSION

UKA is associated with less narcotic consumption, shorter duration of use, less refills, and lower likelihood of narcotic requirement for 4 weeks. We report narcotic consumption patterns for both procedures to aid surgeons in judicious postoperative prescribing.

LEVEL OF EVIDENCE

This is a level III retrospective cohort study reviewing narcotic use in over 900 consecutive opioid naïve patients undergoing UKA or TKA.

Is There an Association Between Physician Review Websites and Press Ganey Survey Results in a Neurosurgical Outpatient Clinic?

OBJECTIVE

Recent studies suggest a poor association between physician review websites and the validated metrics used by the Centers for Medicare and Medicaid Services. The purpose of this study was to evaluate the association between online and outpatient Press Ganey (PG) measures of patient satisfaction in a neurosurgical department.

METHODS

We obtained PG survey results from one large academic institution's outpatient neurosurgery clinic. Popular physician review websites were searched for each of the faculty captured in the PG data. Average physician rating and percent Top Box scores were calculated for each physician. PG data were separated into new and established clinic visits for subset analysis. Spearman's rank correlation coefficients were calculated to determine associations.

RESULTS

Twelve neurosurgeons were included. Established patients demonstrated greater PG scores as compared with new patients, with an average physician rating increase of 0.55 and an average Top Box increase of 12.5%. Online physician ratings were found to demonstrate strong agreement with PG scores for the entire PG population, new patient subset, and established patient subset (ρ = 0.77-0.79, P < 0.05). Online Top Box scores demonstrated moderate agreement with overall PG Top Box scores (ρ = 0.59, P = 0.042), moderate agreement with the new patient population Top Box scores (ρ = 0.56, P = 0.059), and weak agreement with established patient population Top Box scores (ρ = 0.38, P = 0.217).

CONCLUSIONS

Our findings demonstrated a strong agreement between PG ratings and online physician ratings and a poorer correlation when comparing PG Top Box scores with online physician Top Box scores, particularly in the established patient population.

Association Between Nonmodifiable Demographic Factors and Patient Satisfaction Scores in Spine Surgery Clinics

The Press Ganey survey is the most widely used instrument for measuring patient satisfaction. Understanding the factors that influence these surveys may permit better use of survey results and may direct interventions to increase patient satisfaction. Press Ganey Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys administered to ambulatory spine surgery clinic patients within a large tertiary care network from May 2016 to September 2017 were retrospectively reviewed. Mean comparison testing was performed to measure associations between patient demographics and responses to "overall provider rating" and "recommend this provider's office" survey questions. Mean difference to achieve significance was set at α<0.05. A multivariate analysis was performed to determine independent factors. A total of 1400 survey responses from the offices of 11 orthopedic spine surgeons were included. Patients 18 to 34 years old had significantly lower responses to the overall provider rating question than older patients (P<.001), and increasing patient age was correlated with improved ratings. Highest education level was inversely correlated with satisfaction scores, with patients who had attained graduate level education having the lowest satisfaction scores (P=.001). Those with commercial insurance had significantly lower ratings for recommend this provider's office (P=.042) and overall provider rating (P=.022) questions than those with other insurance types. Patients administered the survey on paper had significantly lower ratings than those administered the survey online (P=.006). Provider ratings were significantly higher when the sex and ethnicity of the patient were concordant with the provider (P=.021). This study showed that independent, nonmodifiable factors such as age, education level, and survey mode were significantly associated with the satisfaction of ambulatory spine surgery clinic patients. [Orthopedics. 2019; 42(3):143-148.].

Characteristics of cataract surgery patients influencing patient satisfaction scores

PURPOSE

To determine factors that influence patient satisfaction scores in individuals who have recently had cataract surgery.

SETTING

Byers Eye Institute, Palo Alto, California, USA.

DESIGN

Prospective case series.

METHODS

Selected questions from the Press Ganey survey and the National Eye Institute Visual Function Questionnaire-25 were administered to each patient immediately after completion of a clinic visit. The correlation between patient-specific variables and the answer to the survey question "likelihood of recommending our practice to others," a surrogate for overall patient satisfaction, was assessed using the Student t test. A logistical regression model was used to adjust for potentially confounding variables.

RESULTS

One hundred forty-three patients were recruited from 4 providers; 57 (39.8%) were men, and the mean age was 70.0 years ± 11.6 (SD). The main outcome was the proportion of scores less than 5, or "very good," for the likelihood of recommending the practice to others. There was a statistically significant association between a non-5 patient satisfaction score and self-reported ethnicity of Asian or Pacific Islander compared with other ethnicities (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.0-5.1; P = .049); other possible correlates were not statistically significant. The relationship persisted after adjustment for potential confounding variables (OR, 2.6; 95% CI, 1.1-6.3; P = .027).

CONCLUSION

In postoperative cataract patients, Asian or Pacific Islander ethnicity, a factor out of the control of the provider and clinic staff, was associated with a lower overall Press Ganey patient satisfaction score compared with patients of all other ethnicities.

Patient Preferences for Physician Attire in Ophthalmology Practices

IMPORTANCE

Interest is growing in targeting physician attire to improve the patient experience. Few studies in ophthalmology have examined patient preferences for physician attire.

OBJECTIVE

To understand patient preferences for physician attire in ophthalmology practices in the United States.

DESIGN

Survey-based, cohort study.

SETTING

Two private and two academic ophthalmology practices.

PARTICIPANTS

A convenience sample of patients receiving ophthalmic care between June 1, 2015 and October 31, 2016.

METHODS

A questionnaire containing 22 questions and photographs of a male and female physician in seven forms of attire were presented to patients; 14 unique questionnaires were randomly distributed. Patient preference for physician attire was the primary outcome determined by summing ratings of how knowledgeable, trustworthy, caring, approachable, and comfortable the pictured physician made the respondent feel. One-way ANOVA assessed differences in mean composite scores. Comparisons between respondent demographics, practice type, and attire preferences were assessed by chi-square tests. Patient satisfaction was assessed by agreement with questions about importance of physician attire and whether this influences happiness with care.

RESULTS

In total, 1,297 of 1,826 (71.0%) questionnaires were completed. Physician attire was rated as "important" by 62.9% of participants. A total of 43.6% of participants indicated that physician attire influenced how happy they were with their care. Overall, formal attire with white coat was preferred to casual, formal, and business attire (all comparisons, p < 0.05). No differences in composite scores between formal attire with white coat, scrubs alone, scrubs with white coat, or casual attire with white coat were observed. However, compared with formal attire with white coat, physicians wearing scrubs without white coat appeared less knowledgeable (mean [standard deviation]: 8.2 [1.8] vs. 7.4 [2.1]; p < 0.05) and trustworthy (8.3 [1.8] vs. 7.6 [2.1]; p < 0.05). Additionally, casual attire with white coat was rated as less knowledgeable compared with formal attire with white coat (7.4 [2.0] vs. 8.2 [1.8]; p < 0.05). Preferences for attire varied by clinical setting: patients preferred surgeons (45.2%) and physicians in emergency rooms (41.7%) in scrubs rather than formal attire with white coat.

CONCLUSIONS

Physician attire is important to patients receiving ophthalmic care. Policies aimed at physician attire in ophthalmology practices should be considered.

Physician Gender Is Associated with Press Ganey Patient Satisfaction Scores in Outpatient Gynecology

BACKGROUND

Patient satisfaction is gaining increasing attention as a quality measure in health care, but the methods used to assess it may negatively impact women physicians.

OBJECTIVE

Our objective was to examine the relationship between physician gender and patient satisfaction with outpatient gynecology care as measured by the Press Ganey patient satisfaction survey.

STUDY DESIGN

This cross-sectional study analyzed 909 Press Ganey patient satisfaction surveys linked to outpatient gynecology visits at a single academic institution (March 2013-August 2014), including self-reported demographics and satisfaction. Surveys are delivered in a standardized fashion electronically and by mail. Surveys were completed by 821 unique patients and 13,780 gynecology visits occurred during the study period. The primary outcome variable was likelihood to recommend (LTR) a physician. We used χ² tests of independence to assess the effect of demographic concordance on LTR and two generalized estimating equations models were run clustered by physician, with topbox physician LTR as the outcome variable. Analysis was performed in SAS Enterprise Guide 7.1 (SAS, Inc., Cary, NC).

RESULTS

Nine hundred nine surveys with complete demographic data were completed by women during the study period (mean age, 49.3 years). Age- and race-concordant patient-physician pairs received significantly higher proportions of top LTR score than discordant pairs (p = .014 and p < .0001, respectively). In contrast, gender-concordant pairs received a significantly lower proportion of top scores than discordant pairs (p = .027). In the generalized estimating equations model adjusting for health care environment, only gender remained statistically significant. Women physicians had significantly lower odds (47%) of receiving a top score (odds ratio, 0.53; 95% CI, 0.37-0.78; p = .001).

CONCLUSIONS

Women gynecologists are 47% less likely to receive top patient satisfaction scores compared with their male counterparts owing to their gender alone, suggesting that gender bias may impact the results of patient satisfaction questionnaires. Therefore, the results of this and similar questionnaires should be interpreted with great caution until the impact on women physicians is better understood.

Factors Associated with Patient Satisfaction in an Outpatient Glaucoma Population

PURPOSE

To determine what metrics might impact satisfaction survey responses.

METHODS

A 37-question survey was administered to 249 participants. Responses were correlated to demographics, clinical factors, weather conditions, and examination timing.

RESULTS

Sample consists of 55.4% female and 73.9% white, and mean age was 65.1 years. Participants were assigned to: completely satisfied (77.9%) or not completely satisfied (22.1%) groups based on their rating of glaucoma specialist on a scale of 1-10, while 10 considered "completely satisfied" and less than 10 "not completely satisfied." Complete satisfaction was associated with ability to schedule appointments early, phone calls answered/returned same day, shorter perceived wait time, and better communication skills of ophthalmologist (p < 0.05). Completely satisfied participants reported their ophthalmologist spent enough time with them, listened carefully, and communicated in an understandable way (p < 0.05).

CONCLUSIONS

The majority of factors found to be associated with patient satisfaction were related to characteristics of the ophthalmologists and their office.

The Impact of Physician EHR Usage on Patient Satisfaction

Background and Significance

The increased emphasis on patient satisfaction has coincided with the growing adoption of electronic health records (EHRs) throughout the U.S. The 2001 Institute of Medicine Report, “Crossing the Quality Chasm,” identified patient-centered care as a key element of quality health care.[1] In response to this call, the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was developed to assess patients' health care experiences in the inpatient setting. Simultaneously, financial incentives have facilitated the rapid adoption of EHR applications, with 84% of hospitals maintaining at least a basic EHR in 2015 (a ninefold increase since 2008).[2]

Despite the concurrent deployment of patient satisfaction surveys and EHRs, there is a poor understanding of the relationship that may exist between physician usage of the EHR and patient satisfaction. Most prior research into the impact of the EHR on physician–patient communication has been observational, describing the behaviors of physicians and patients when the clinician accesses an EHR in the exam room. Past research has shown that encounters where physicians access the EHR are often filled with long pauses,[3] and that few clinicians attempt to engage patients by sharing what they are looking at on the screen.[4] A recent meta-analysis reviewing 53 papers found that only 7 studies attempted to correlate objective observations of physician communication behaviors with patient perceptions by eliciting feedback from the patients.[5] No study used a standardized assessment tool of patient satisfaction. The authors conclude that additional work is necessary to better understand the patient perspective of the presence of an EHR during a clinical encounter.

Additionally, increasing EHR adoption and emphasis on patient satisfaction have also corresponded with rising physician burnout rates.[6] [7] Prior work suggests that EHR adoption may be contributing to this trend.[8] Burnout from the EHR may be due in part to the significant amount of time physicians spend logged into systems, documenting long after clinic has ended in effort to avoid disrupting the patient–physician relationship.[9]

We used existing data sources to describe the relationship between the amount of time physicians spend logged in to the EHR—both during daytime hours as well after clinic hours—and performance on a validated patient satisfaction survey. Our null hypothesis is that there is no relationship between increased time logged in to the EHR and patient satisfaction.

Time Requirements for Electronic Health Record Use in an Academic Ophthalmology Center

Importance

Electronic health record (EHR) systems have transformed the practice of medicine. However, physicians have raised concerns that EHR time requirements have negatively affected their productivity. Meanwhile, evolving approaches toward physician reimbursement will require additional documentation to measure quality and cost of care. To date, little quantitative analysis has rigorously studied these topics.

Objective

To examine ophthalmologist time requirements for EHR use.

Design, Setting, and Participants

A single-center cohort study was conducted between September 1, 2013, and December 31, 2016, among 27 stable departmental ophthalmologists (defined as attending ophthalmologists who worked at the study institution for ≥6 months before and after the study period). Ophthalmologists who did not have a standard clinical practice or who did not use the EHR were excluded.

Exposures

Time stamps from the medical record and EHR audit log were analyzed to measure the length of time required by ophthalmologists for EHR use. Ophthalmologists underwent manual time-motion observation to measure the length of time spent directly with patients on the following 3 activities: EHR use, conversation, and examination.

Main Outcomes and Measures

The study outcomes were time spent by ophthalmologists directly with patients on EHR use, conversation, and examination as well as total time required by ophthalmologists for EHR use.

Results

Among the 27 ophthalmologists in this study (10 women and 17 men; mean [SD] age, 47.3 [10.7] years [median, 44; range, 34-73 years]) the mean (SD) total ophthalmologist examination time was 11.2 (6.3) minutes per patient, of which 3.0 (1.8) minutes (27% of the examination time) were spent on EHR use, 4.7 (4.2) minutes (42%) on conversation, and 3.5 (2.3) minutes (31%) on examination. Mean (SD) total ophthalmologist time spent using the EHR was 10.8 (5.0) minutes per encounter (range, 5.8-28.6 minutes). The typical ophthalmologist spent 3.7 hours using the EHR for a full day of clinic: 2.1 hours during examinations and 1.6 hours outside the clinic session. Linear mixed effects models showed a positive association between EHR use and billing level and a negative association between EHR use per encounter and clinic volume. Each additional encounter per clinic was associated with a decrease of 1.7 minutes (95% CI, -4.3 to 1.0) of EHR use time per encounter for ophthalmologists with high mean billing levels (adjusted R2 = 0.42; P = .01).

Conclusions and Relevance

Ophthalmologists have limited time with patients during office visits, and EHR use requires a substantial portion of that time. There is variability in EHR use patterns among ophthalmologists.

Factors Influencing Patients' Hospital Rating After Total Joint Arthroplasty

Patient satisfaction assessments, such as the Press Ganey surveys, have been adopted by the Centers for Medicare & Medicaid Services to help determine reimbursements. It is uncertain what facets most affect survey scores among patients who have received total joint arthroplasty (TJA). This study explored which factors guide scores for TJA patients. Specifically, the authors assessed (1) which Press Ganey survey features affected the patients' overall hospital rating and (2) whether survey scores were disparate between patients who did and patient who did not have complications. The authors' institutional Press Ganey database was queried for lower-extremity TJAs that occurred between November 2009 and January 2015. This yielded 1454 patients with a mean age of 63 years (range, 15-92 years; 60% women and 40% men). The database contains information related to American Society of Anesthesiologists scores, Press Ganey question responses, and demographics. Multiple regression analysis was performed to assess the association (beta weight) between Press Ganey domains and overall hospital rating. The weighted mean for each domain was calculated. The authors' analysis revealed that overall hospital rating was significantly influenced by communication with nurses (beta weight=0.434, P<.001), responsiveness of hospital staff (beta weight=0.181, P=.001), communication with doctors (beta weight=0.115, P=.014), and hospital environment (beta weight=0.100, P=.039). No significant differences were found when comparing the Press Ganey scores of patients with and without complications. By recognizing these elements, physicians can direct measures appropriately, which may help avoid financial penalties and possibly increase patient satisfaction after TJA. [Orthopedics. 2017; 40(6):377-380.].

"Is There An App For That?" Orthopaedic Patient Preferences For A Smartphone Application

BACKGROUND

Patients are seeking out medical information on the Internet and utilizing smartphone health applications ("apps"). Smartphone use has exponentially increased among orthopaedic surgeons and patients. Despite this increase, patients are rarely directed to specific apps by physicians. No study exists querying patient preferences for a patient-centered, orthopaedic smartphone application.

OBJECTIVES

The purpose of this study is to 1) determine Internet use patterns amongst orthopaedic patients; 2) ascertain access to and use of smartphones; and 3) elucidate what features orthopaedic patients find most important in a smartphone application.

METHODS

We surveyed patients in an orthopaedic practice in an urban academic center to assess demographics, access to and patterns of Internet and Smartphone use, and preferences for features in a smartphone app.

RESULTS

A total of 310 surveys were completed. Eighty percent of patients reported Internet access, and 62% used the Internet for health information. Seventy-seven percent owned smartphones, 45% used them for health information, and 28% owned health apps. Only 11% were referred to an app by a physician. The highest ranked features were appointment reminders, ability to view test results, communication with physicians, and discharge instructions. General orthopaedic information and pictures or videos explaining surgery were the 2 lowest ranked features. Seventy-one percent of patients felt an app with some of the described features would improve their healthcare experiences, and 40% would pay for the app.

CONCLUSIONS

The smartphone is an under-utilized tool to enhance patient-physician communication, increase satisfaction, and improve quality of care. Patients were enthusiastic about app features that are often included in patient health portals, but ranked orthopaedic educational features lowest. Further study is required to elucidate how best to use orthopaedic apps as physician-directed educational opportunities to promote patient satisfaction and quality of care.

What Influences How Patients Rate Their Hospital After Total Hip Arthroplasty?

BACKGROUND

Centers for Medicare and Medicaid Services are now using results from patient satisfaction surveys, such as Press Ganey, for reimbursement. It is unknown what factors influence scores on satisfaction surveys in post-total hip arthroplasty (THA) patients. The purpose of this study was to evaluate what influences these scores in THA patients. Specifically, we aimed to evaluate: (1) how pain control affects the patients' perception of their orthopedist, nursing staff, and overall hospital satisfaction; (2) the individual impact of these factors on overall hospital satisfaction after THA; and (3) the impact of lengths of stay, age, body mass index (BMI), and American Society of Anesthesiology (ASA) scores on overall satisfaction.

METHODS

To assess whether pain management influences patients' perception of the orthopedist, a correlation analysis was performed between pain control and perception of their doctor. Similar analyses were performed to determine the relationship between pain management and patients' perception of their treating nurse, as well as overall satisfaction. A multiple regression analysis was performed to determine which of the aforementioned factors have the greatest impact on overall satisfaction. To determine the impact of length of stay on overall hospital satisfaction, a correlation analysis was performed between these 2 variables. Similar analyses were performed for age, BMI, and ASA scores.

RESULTS

Patients' perception of pain control was significantly positively correlated with the perception of their orthopedist, nurse, and overall hospital satisfaction. Multiple regression analysis demonstrated that patients' perception of nurses and orthopedists yielded a significantly positive influence on overall hospital satisfaction. A significant negative correlation existed between lengths of stay and hospital satisfaction. There were no significant correlations between age, BMI, and ASA scores and overall hospital rating.

CONCLUSION

Post-THA patients associate pain management with hospital satisfaction, as well as their perception of their treating nurses and orthopedists. Overall satisfaction was most impacted by patients' perception of their nurse, followed by their orthopedist. In addition, there was an association between shorter length of stay and higher overall satisfaction. These results are of paramount importance because by recognizing factors that affect scores on satisfaction surveys, orthopedic surgeons can direct efforts to improve post-THA satisfaction and optimize reimbursements.

Pain, Functional Scores, and Radiographic Severity of Illness Influence the Perception of Time Spent With the Physician by Patients Presenting for Initial Evaluation of Knee Osteoarthritis

BACKGROUND

Patient satisfaction has become a significant factor in reimbursement schedules for physicians. A matter of debate is whether the patient's perception of time spent with the physician improves patient satisfaction. We sought to determine whether patient-physican time correlates with patient satisfaction and which factors are associated with patient perception of time.

METHODS

A total of 73 patients who presented for an initial evaluation of knee osteoarthritis were evaluated by the same orthopedic surgeon at an outpatient clinic in New Orleans, LA. Each encounter was timed with a stopwatch. After the physician encounter, patients were asked to fill out a questionnaire assessing their perception of time spent with the physician, subjective pain, satisfaction with the visit, and understanding of the diagnosis and treatment plan. Patients were also asked to complete 4 functionality surveys. Radiographs of the patients' knees were taken and quantified using Kellgren-Lawrence and Ahlbäck grading scales.

RESULTS

We noted no relationship between patient satisfaction and patients' perception of time spent with the physician. Patients perceived their time with the physician to be an average of 6.5 minutes more than the actual time. However, patients who reported higher subjective pain scores (>7 on a 10-point scale) misestimated their time with the physician by nearly 96%, while patients with lower subjective pain scores (<7 on a 10-point scale) misestimated their time with the physician by only 54% (P<0.007). We discovered similar findings in patients with worse Kellgren-Lawrence radiographic scores as well as worse Oxford Knee Scores and Knee injury and Osteoarthritis Outcome Scores. The actual time spent was not different among patients.

CONCLUSION

Patients with greater subjective pain and worse functional status and patients with worse radiographic severity of knee osteoarthritis perceived greater time spent with the physician. However, no relationship between these variables and patient satisfaction scores was seen.