1
|
Shaw NM, Hills N, Holler J, Fernandez A, Davis D, Palmer NR, Sliwka D, Breyer BN. The Impact of Patient-Physician Racial and Gender Concordance on Patient Satisfaction with Outpatient Clinic Visits. J Racial Ethn Health Disparities 2024; 11:2083-2092. [PMID: 37341950 DOI: 10.1007/s40615-023-01676-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Patient and provider race and gender concordance (patient and physician identify as the same race/ethnicity or gender) may impact patient experience and satisfaction. OBJECTIVE We sought to examine how patient and physician racial and gender concordance effect patient satisfaction with outpatient clinical encounters. Furthermore, we examined factors that changed satisfaction among concordant and discordant dyads. DESIGN Consumer Assessment of Healthcare Provider and Systems (CAHPS) Patient Satisfaction Survey Scores were collected from outpatient clinical encounters between January 2017 and January 2019 at the University of California, San Francisco. PARTICIPANTS Patients who were seen in the eligible time period, who voluntarily provided physician satisfaction scores. Providers with fewer than 30 reviews and encounters with missing data were excluded. MAIN MEASURES Primary outcome was rate of top satisfaction score. The provider score (1-10 scale) was dichotomized as "top score (9-10)" and "low scores (<9)." KEY RESULTS A total of 77,543 evaluations met inclusion criteria. Most patients identified as White (73.5%) and female (55.4%) with a median age of 60 (IQR 45, 70). Compared to White patients, Asian patients were less likely to give a top score even when controlling for racial concordance (OR: 0.67; CI 0.63-0.714). Telehealth was associated with increased odds of a top score relative to in-person visits (OR 1.25; CI 1.07-1.48). The odds of a top score decreased by 11% in racially discordant dyads. CONCLUSIONS Racial concordance, particularly among older, White, male patients, is a nonmodifiable predictor of patient satisfaction. Physicians of color are at a disadvantage, as they receive lower patient satisfaction scores, even in race concordant pairs, with Asian physicians seeing Asian patients receiving the lowest scores. Patient satisfaction data is likely an inappropriate means of determining physician incentives as such may perpetuate racial and gender disadvantages.
Collapse
Affiliation(s)
- Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Nancy Hills
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jordan Holler
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alicia Fernandez
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Denise Davis
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nynikka R Palmer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Diane Sliwka
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA.
| |
Collapse
|
2
|
Witt EE, Jogerst K, Wojcik BM, Mansur A, Mullen JT, Petrusa ER, Phitayakorn R, McKinley SK. Patient satisfaction with women vs men surgical interns and senior residents. Am J Surg 2024; 235:115813. [PMID: 38991253 DOI: 10.1016/j.amjsurg.2024.115813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 06/24/2024] [Accepted: 06/28/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND Patient satisfaction is critical for referrals and reimbursement of surgical faculty but remains poorly characterized for residents. We investigated whether patient evaluations of surgical trainees vary by resident gender. METHODS Surgical inpatients evaluated surgical resident care postoperatively after positively identifying trainees. Evaluations (Consumer Assessment of Healthcare Providers and Systems Surgical Care Surveys (S-CAHPS)) were scored by the "top-box" method, stratified by training level, and compared between women and men residents. RESULTS Ninety-one percent of patients participated (n = 324/357). Patients recognized women interns less than men (75.0 % vs 87.2 %, p = 0.01). S-CAHPS scores for women vs men interns were equivalent except for spending sufficient time with patients (75.6 % vs 88.0 %, p = 0.02). For senior residents, there was no difference in patient recognition of women vs men (83.9 % vs 85.2 %, p = 0.91) or in any S-CAHPS scores (p > 0.05). CONCLUSIONS Gendered differences in patient evaluations of surgical trainees exist for interns but resolve by senior years. Future work should explore how patient evaluations can support trainee development while ensuring patients recognize the role of surgical residents regardless of gender.
Collapse
Affiliation(s)
- Emily E Witt
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA.
| | - Kristen Jogerst
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA
| | - Brandon M Wojcik
- Division of Cardiothoracic Surgery, Department of Surgery, Munson Medical Center, 1105 Sixth St, Traverse City, MI, 49684, USA
| | - Arian Mansur
- Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - John T Mullen
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - Emil R Petrusa
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - Roy Phitayakorn
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| | - Sophia K McKinley
- Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 77 Avenue Louis Pasteur, Boston, MA, 02115, USA
| |
Collapse
|
3
|
Gotschall JW, Fitzsimmons R, Shin DB, Takeshita J. Race, Ethnicity, and Other Patient and Clinical Encounter Characteristics Associated with Patient Experiences of Access to Care. J Patient Exp 2024; 11:23743735241241178. [PMID: 38529206 PMCID: PMC10962025 DOI: 10.1177/23743735241241178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
The Press Ganey (PG) Outpatient Medical Practice Survey measures patients' experiences of healthcare access in the U.S. We aimed to identify differences in experiences of access to care by patient race, ethnicity, and other sociodemographic characteristics, an important first step in informing health policy and ensuring equitable healthcare delivery. We performed a cross-sectional analysis of PG surveys for adult outpatient visits within the University of Pennsylvania Health System from 2014-2017, including 119,373 unique patients. Compared with White patients, Black (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.80-0.87), Asian (OR 0.62; 95% CI 0.58-0.66), and other/unknown race patients (OR 0.83; 95% CI 0.72-0.94) were each less likely to report the maximum score for timely access to care. Patients of all minoritized groups, as well as those whose primary language was not English, reported lower scores in secondary access measures related to communication and respect, compared to White and primarily English-speaking patients, respectively. Efforts to improve the experience of access to care among racial and ethnic minoritized patients are imperative to achieve equity in healthcare delivery.
Collapse
Affiliation(s)
- Jeromy W. Gotschall
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Robert Fitzsimmons
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Daniel B. Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
4
|
Wollney EN, Vasquez TS, Fisher CL, Armstrong MJ, Paige SR, Alpert J, Bylund CL. A systematic scoping review of patient and caregiver self-report measures of satisfaction with clinicians' communication. PATIENT EDUCATION AND COUNSELING 2023; 117:107976. [PMID: 37738791 DOI: 10.1016/j.pec.2023.107976] [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: 04/13/2023] [Revised: 09/05/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVE We conducted a systematic scoping review of self-report tools used to measure patient and/or caregiver satisfaction with clinician communication. Aims included identifying: 1) instruments that have been used to measure communication satisfaction, and 2) content of the communication items on measures. METHODS Two databases (PubMed and CINAHL) were searched for relevant studies. Eligibility included patient or caregiver self-report tools assessing satisfaction with clinicians' communication in a biomedical healthcare setting; and the stated purpose for using the measurement involved evaluating communication satisfaction and measures included more than one question about this. All data were charted in a form created by the authors. RESULTS Our search yielded a total of 4531 results screened as title and abstracts; 228 studies were screened in full text and 85 studies were included in the review. We found 53 different tools used to measure communication satisfaction among those 85 studies, including 29 previously used measures (e.g., FS-ICU-24, CAHPS), and 24 original measures developed by authors. Content of communication satisfaction items included satisfaction with content-specific communication, interpersonal communication skills of clinicians, communicating to set the right environment, and global communication satisfaction items. CONCLUSION There was high variability in the number of items and types of content on measures. Communication satisfaction should be better conceptualized to improve measurement, and more robust measures should be created to capture complex factors of communication satisfaction. PRACTICE IMPLICATIONS Creating a rigorous evaluation of satisfaction with clinician communication may help strengthen communication research and the assessment of communication interventions.
Collapse
Affiliation(s)
- Easton N Wollney
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Taylor S Vasquez
- College of Journalism & Communications, University of Florida, Gainesville, FL, USA
| | - Carla L Fisher
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Control and Population Sciences Program (CCPS), UF Health Cancer Center, Gainesville, FL, USA
| | - Melissa J Armstrong
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Department of Neurology, College of Medicine, University of Florida, Gainesville, FL, USA; Norman Fixel Institute for Neurological Diseases, UF Health, Gainesville, FL, USA
| | - Samantha R Paige
- Health & Wellness Solutions, Johnson & Johnson, Inc., New Brunswick, NJ, USA
| | - Jordan Alpert
- Internal Medicine and Geriatrics, Cleveland Clinic, Cleveland, OH, USA
| | - Carma L Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA; Cancer Control and Population Sciences Program (CCPS), UF Health Cancer Center, Gainesville, FL, USA
| |
Collapse
|
5
|
Rogo-Gupta LJ, Altamirano J, Homewood LN, Donnellan NM, Miles S, Stuparich M, Salinaro J, Lum D, Fassiotto M. Women physicians receive lower Press Ganey patient satisfaction scores in a multicenter study of outpatient gynecology care. Am J Obstet Gynecol 2023; 229:304.e1-304.e9. [PMID: 37330126 DOI: 10.1016/j.ajog.2023.06.023] [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] [Received: 01/02/2023] [Revised: 05/17/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Emerging data suggest that patient satisfaction data are subject to inherent biases that negatively affect women physicians. OBJECTIVE This study aimed to describe the association between the Press Ganey patient satisfaction survey and physician gender in a multi-institutional study of outpatient gynecologic care. STUDY DESIGN This was a multisite, observational, population-based survey study using the results of Press Ganey patient satisfaction surveys from 5 unrelated community-based and academic medical institutions with outpatient gynecology visits between January 2020 and April 2022. The primary outcome variable was the likelihood to recommend a physician, and individual survey responses served as the unit of analysis. Patient demographic data were collected through the survey, including self-reported age, gender, and race and ethnicity (categorized as White, Asian, or Underrepresented in Medicine, which groups together Black, Hispanic or LatinX, American Indian or Alaskan Native, and Hawaiian or Pacific Islander). Bivariate comparisons between demographics (physician gender, patient and physician age quartile, patient and physician race) and likelihood to recommend were assessed using generalized estimating equation models clustered by physician. Odds ratios, 95% confidence intervals, and P values for these analyses are reported, and results were considered statistically significant at P<.05. Analysis was performed using SAS, version 9.4 (SAS Institute Inc., Cary, NC). RESULTS Data were obtained from 15,184 surveys for 130 physicians. Most physicians were women (n=95 [73%]) and White (n=98 [75%]), and patients were also predominantly White (n=10,495 [69%]). A little over half of all visits were race-concordant, meaning that both patient and physician reported the same race (57%). Women physicians were less likely to receive a topbox survey score (74% vs 77%) and in the multivariate model had 19% lower odds of receiving a topbox score (95% confidence interval, 0.69-0.95). Patient age had a statistically significant relationship with score, with patients aged ≥63 years having >3-fold increase in odds of providing a topbox score (odds ratio, 3.10; 95% confidence interval, 2.12-4.52) compared with the youngest patients. After adjustment, patient and physician race and ethnicity showed similar effects on the odds of a topbox likelihood-to-recommend score, with Asian physicians and Asian patients having lower odds of a topbox likelihood-to-recommend score when compared with White physicians and patients (odds ratio: 0.89 [95% confidence interval, 0.81-0.98] and 0.62 [95% confidence interval, 0.48-0.79], respectively). Underrepresented in medicine physicians and patients showed significantly increased odds of a topbox likelihood-to-recommend score (odds ratio: 1.27 [95% confidence interval, 1.21-1.33] and 1.03 [95% confidence interval, 1.01-1.06], respectively). The physician age quartile was not significantly associated with odds of a topbox likelihood-to-recommend score. CONCLUSION Women gynecologists were 18% less likely to receive top patient satisfaction scores compared with men in this multisite, population-based survey study using the results of Press Ganey patient satisfaction surveys. The results of these questionnaires should be adjusted for bias given that they provide data currently being used to understand patient-centered care.
Collapse
Affiliation(s)
- Lisa J Rogo-Gupta
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Laura N Homewood
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA
| | - Nicole M Donnellan
- Department of Obstetrics and Gynecology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - Shana Miles
- Department of Obstetrics and Gynecology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - Mallory Stuparich
- Department of Obstetrics and Gynecology, University of California, Riverside, Riverside, CA
| | - Julia Salinaro
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Deirdre Lum
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
6
|
Lodin HM, Bersoux S, Pannala R, Mi L, Vegunta S. Primary Care Delivery Perceptions and Their Associations with Physician and Patient Gender. J Community Health 2023; 48:711-717. [PMID: 36976390 DOI: 10.1007/s10900-023-01211-x] [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] [Accepted: 03/09/2023] [Indexed: 03/29/2023]
Abstract
INTRODUCTION We aim to survey patients' opinions on perceived differences in patient care delivered by male and female physicians. METHODS Patients of primary care practices at Mayo Clinic, Arizona completed a survey sent through the electronic health record. The survey evaluated opinion regarding their primary care physician (PCP)'s overall healthcare provision capabilities and any perceived differences based on gender. RESULTS 4983 patients' responses were included in final analysis. Compared to male patients, most female patients preferred to have a female PCP (78.1% vs. 32.7%, p < 0.01). Having a preference for female physicians was correlated with higher overall opinion of female physicians. The majority of male patients did not hold a difference in opinion regarding male versus female physicians (p < 0.01). Male patients were half as likely to have a better opinion and nearly 2.5 times more likely to have a worse opinion of female physicians (p < 0.01) compared to female patients. Patients preferring female physicians were nearly 3 times more likely to have a better opinion of female physicians compared to patients with no preference (p < 0.01). CONCLUSION In a primary care setting, majority of female patients compared to male patients preferred female physicians as their PCP and had higher opinion of the care delivery of female physicians. These findings may influence how practices should assign primary care physicians to new patients and add underlying context to patient satisfaction ratings.
Collapse
Affiliation(s)
- Hannah M Lodin
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 13400 E. Shea Blvd, Scottsdale, AZ, 85259, USA.
| | - Sophie Bersoux
- Division of Community Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
| | - Lanyu Mi
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Scottsdale, AZ, USA
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ, USA
| |
Collapse
|
7
|
Noto S, Murata T, Saito S, Watanabe T, Kobayashi M. Preferences for Rehabilitation in Persons with a History of Stroke: A Discrete Choice Experiment. Patient Prefer Adherence 2023; 17:1611-1620. [PMID: 37465057 PMCID: PMC10350424 DOI: 10.2147/ppa.s416699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/08/2023] [Indexed: 07/20/2023] Open
Abstract
Objective To investigate the preferences of persons with a history of stroke for various attributes of rehabilitation using a discrete choice experiment (DCE). Design Cross-sectional study. Setting A web-based survey. Participants A total of 600 adults with a history of stroke who were not asked whether or not they had participated in previous rehabilitation. Intervention None. Main Outcome Measures Preference weights by attribute ie, treatment time (30 minutes, one hour, one and a half hours), treatment content (walking exercises, activities of daily living; ADL exercises), priority treatment of paralyzed limbs (upper extremity, lower upper extremity), treatment location (hospital visit, home visit), therapist gender, and out-of-pocket costs for stroke rehabilitation using discrete choice experiment. Results The most common self-reported diagnosis was cerebral infarction (408 patients, 68%). The mean age was 62.0 ± 9.8 years, and 515 (85.8%) were male. Of the five attributes, excluding out-of-pocket costs, the highest relative importance score was treatment location (0.331), followed by treatment time (0.304). Among the rehabilitation programs, the statistically significant coefficients calculated were one hour of therapy (0.173, 95% CI = 0.088-0.258), hospital visits (0.241, 95% CI = 0.180-0.303), and female therapists (0.186, 95% CI = 0.125-0. 247). No significant differences were obtained regarding the treatment contents or the paralyzed limb to be treated. Conclusion A discrete choice experiment revealed that persons with a history of stroke prefer a one-hour hospital rehabilitation program with a female therapist, with cost being a major consideration for rehabilitation. The results of this study may provide useful information for rehabilitation professionals.
Collapse
Affiliation(s)
- Shinichi Noto
- Department of Rehabilitation, Niigata University of Health and Welfare, Niigata, Japan
| | | | | | - Takahiro Watanabe
- Rehabilitation Center, Niigata University Medical and Dental General Hospital, Niigata, Japan
| | | |
Collapse
|
8
|
Vilendrer S, Levoy E, Miller-Kuhlmann R, Amano A, Brown-Johnson C, De Borba L, Luu JH, Sakamuri S, Gold CA. Physician Perceptions of Performance Feedback and Impact on Personal Well-Being: A Qualitative Exploration of Patient Satisfaction Feedback in Neurology. Jt Comm J Qual Patient Saf 2023; 49:138-148. [PMID: 36732115 DOI: 10.1016/j.jcjq.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND To understand neurologists' experiences and perspectives on patient satisfaction feedback and its impact on personal well-being and behavior. METHODS From May to June 2021, the researchers conducted 19 semistructured interviews with neurologists from a large academic medical center. Clinical Performance Feedback Intervention Theory informed a combined inductive and deductive thematic analysis of the qualitative data, which focused on perceptions of current feedback practices, its impact on physician behavior, and recommendations for improvement. RESULTS Participants tended to be female (n = 12/19, 63.2%), aged 30-39 (n = 8/19, 42.1%), white (n = 9/19, 47.4%), and were 10+ years into clinical practice (n = 18/19, 94.7%). Physicians were receptive to feedback overall, but perceptions varied by feedback type. Physicians preferred informal feedback (delivered unprompted directly by patients), given its tendency toward actionability. They disliked formal feedback (derived from anonymous surveys) due to low actionability, bias and validity issues, lack of contextual considerations, delivery through public reports, and links to financial incentives. Nearly all physicians reported formal feedback programs had the potential to negatively affect well-being and were not beneficial to their practice; a few reported adjusting their clinical practice to improve patient satisfaction performance. Five recommendations to improve patient satisfaction feedback programs emerged: Align on feedback intent, acknowledge survey limitations during program administration, increase actionability of feedback through specificity and control, support direct patient-physician feedback and problem resolution, and support empathetic integration of feedback. CONCLUSION Understanding physician perceptions of current approaches to patient satisfaction feedback offers the opportunity to shape subsequent collection and distribution methods to improve physician performance and optimize professional fulfillment.
Collapse
|
9
|
Abstract
Implicit bias and microaggressions are well-known phenomenon and have recently been acknowledged as contributing to health care disparities. Within Hand Surgery, implicit bias and microaggressions occur in patient-surgeon, surgeon-peer, surgeon-staff, and training environment interactions. Although racial and gender biases are well studied, biases can also be based on age, sexual orientation, socioeconomic background, and/or hierarchal rank. Academia has well-documented evidence of implicit bias and microaggressions, contributing to current disparate demographics of trainees, physicians, and leaders within Hand Surgery. Awareness is fundamental to combating bias and microaggressions; however, actions must be taken to minimize negative effects and change culture.
Collapse
Affiliation(s)
- Kashyap Komarraju Tadisina
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Kelly Bettina Currie
- Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA.
| |
Collapse
|
10
|
Andraska EA, Phillips AR, Asaadi S, Painter L, Bump G, Chaer R, Myers S. Gender Bias in Risk Management Reports Involving Physicians in Training - A Retrospective Qualitative Study. JOURNAL OF SURGICAL EDUCATION 2023; 80:102-109. [PMID: 36207255 PMCID: PMC9890406 DOI: 10.1016/j.jsurg.2022.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/24/2022] [Accepted: 08/27/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Gender bias, which contributes to burnout and attrition of female medical trainees, may manifest as disparate workplace evaluations. Here, we explore gender-based differences in perceived competence and professionalism as described in an institutional electronic risk management reporting system. DESIGN In this retrospective qualitative study, recurring themes were identified from anonymous entries reported to an electronic institutional risk management database from July 2014 to July 2015, and from July 2019 to July 2020 using inductive methods. This electronic system is often used by hospital staff to document complaints against physicians under the pretext of poor patient care, regardless of whether an adverse event occurred. Two individuals independently coded entries. Themes were determined from event indicator codes (EIC) using Delphi methodology and compared between gender and specialty using bivariate statistics. SETTING A multi-center integrated healthcare delivery system. PARTICIPANTS Risk management entries pertaining to physician trainees by hospital staff as written submissions to the institution's electronic risk management reporting system. Main outcomes included themes defined as: (1) lack of professionalism (i.e., delay in response, attitude, lack of communication), (2) perceived medical error, (3) breach of institutional protocol. RESULTS Of the 207 entries included for analysis, 52 entries identified men (25%) and 31 entries identified women (15%). The gender was not available in 124 entries and, therefore, categorized as ambiguous. The most common complaint about men involved a physician-related EIC (n = 12, 23%, EIC TX39) and the most common complaint about women involved a communication-related EIC (n = 7, 23%, EIC TX55). Eighty-eight (43%) entries involved medical trainees; 82 (40%) involved surgical trainees. Women were more often identified by their name only (n = 8, 26% vs. n = 3, 6%; p < 0.001). This finding was consistent in both medical (n = 0, 0% vs. n = 5, 31%; p < 0.001) and surgical (n = 2, 7% vs. n = 3, 25%; p = 0.006) specialties. In entries involving women, a lack of professionalism was most frequently cited (n = 29, 94%). Entries identifying medical errors more frequently involved men (n = 25, 48% vs. n = 7, 23%; p = 0.02). CONCLUSIONS Gender-based differences exist in how hospital staff interpret trainees' actions and attitudes. These differences have consequences for training paradigms, perceptions of clinical competence, physician burnout, and ultimately, patient outcomes.
Collapse
Affiliation(s)
- Elizabeth A Andraska
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Amanda R Phillips
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sina Asaadi
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lisa Painter
- UPMC Corporate Risk Management, Pittsburgh, Pennsylvania
| | - Gregory Bump
- UPMC Medical Education, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rabih Chaer
- Division of Vascular Surgery, Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Sara Myers
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
11
|
Shapiro LM, Thomas KA, Eppler SL, Behal R, Yao J, Kamal RN. Understanding the Patient Experience: Analysis of 2-Word Assessment and Its Relationship to Likelihood to Recommend in Outpatient Hand Surgery. Hand (N Y) 2022; 17:1201-1206. [PMID: 33478269 PMCID: PMC9608275 DOI: 10.1177/1558944720988078] [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: 11/16/2022]
Abstract
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.
Collapse
|
12
|
Wang CN, Kurtzman JT, Melendez E, McKiernan JM, Finkelstein JB, Carpenter CP. Press Ganey® Ratings in Urology: Who is at Risk of Bias? Urology 2022; 170:240-245. [PMID: 36179860 DOI: 10.1016/j.urology.2022.08.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/19/2022] [Accepted: 08/04/2022] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To evaluate effect of patient and physician demographics on Press Ganey® (PG) survey ratings for urologists. METHODS PG surveys (02/2020 - 08/2021) for urologists at a single tertiary care center were analyzed. Univariate and multivariate logistic regression models were used to assess the relationship between patient and physician-level covariates and the primary outcome of a "topbox" Overall Doctor Rating (topbox-ODR) score of 9 or 10 out of 10. RESULTS 4,155 surveys of 20 attending urologists (8 female (F)) across 7 subspecialties, were assessed. Mean ODR score for F physicians was 9.2 (SD 1.7) compared to 9.5 (SD 1.3) for males (M), p < 0.001. Univariate regression demonstrated that F patients are less likely (OR 0.27, p < 0.001) to give topbox-ODRs than M patients, and F physicians are 58% less likely (OR 0.42, p = 0.01) to receive topbox-ODRs than M physicians. Oncologists are more likely to receive topbox-ODRs (OR 3.3, p = 0.009) than all other subspecialists. Multivariate regression demonstrated that M patients are more likely to give M physicians top-box-ODRs (OR 0.32, p = 0.02), while F patients are less likely to give topbox-ODRs to physicians of both genders (M: OR 0.24, p < 0.001; F: 0.21, p < 0.001). Physicians in practice for >10 years are 66% less likely to receive topbox-ODRs (OR 0.33, p = 0.002). CONCLUSIONS Urologists who care for F patients are at risk of being affected by bias in PG physician ratings. M physicians who care for M patients appear to be at the least risk; while F physicians who care for F patients appear to be at the highest risk.
Collapse
Affiliation(s)
- Connie N Wang
- Columbia University Irving Medical Center Department of Urology, New York, NY.
| | - Jane T Kurtzman
- Columbia University Irving Medical Center Department of Urology, New York, NY.
| | - Edwin Melendez
- Columbia University Irving Medical Center Department of Urology, New York, NY.
| | - James M McKiernan
- Columbia University Irving Medical Center Department of Urology, New York, NY.
| | - Julia B Finkelstein
- Columbia University Irving Medical Center Department of Urology, New York, NY; Post-Research Completion Affiliation: Department of Urology, Boston Children's Hospital, Boston, MA.
| | | |
Collapse
|
13
|
Martinez KA, Rothberg MB. Physician Gender and Its Association With Patient Satisfaction and Visit Length: An Observational Study in Telemedicine. Cureus 2022; 14:e29158. [PMID: 36258932 PMCID: PMC9572933 DOI: 10.7759/cureus.29158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Female physicians conduct longer visits than male physicians, with negative implications for their compensation. Yet patients often report higher satisfaction with female physicians. It is unknown whether satisfaction scores for female physicians are associated with their visit lengths. Our objective was to characterize the role of the physician and patient gender with respect to visit length and patient satisfaction. Methods We conducted an observational cohort study with patients and physicians of a nationwide telemedicine service between 2016 and 2018. Visit length was measured by the telemedicine system. Patients rated physicians on scales of one to five stars, with five considered “top box” satisfaction. We used logistic regression to estimate differences in patient satisfaction and linear regression to estimate differences in visit length by the physician and patient gender. We tested interactions between physician and patient gender and accounted for clustering by the physician. Results Among 102,664 visits with 405 physicians, the mean visit length was 5.8 minutes. Visits with male physicians were 1.11 minutes shorter than those with female physicians (95% CI:-1.58, -0.65). Controlling for visit length, male physicians were less likely than female physicians to receive top-box satisfaction scores (OR: 0.72; 95% CI: 0.61, 0.85). Visits between female physicians and male patients were the longest and visits between male physicians and female patients were the shortest. Female physicians had longer visits than male physicians but this did not explain their higher satisfaction scores. Conclusions To reduce inequity in compensation resulting from differences in visit length, female physicians could shorten their visits without negative consequences for their satisfaction ratings.
Collapse
|
14
|
Grimm LJ, Knight JR, Maxfield CM. Patient and radiologist demographics influence perceptions of screening mammogram reports. J Am Coll Radiol 2022; 19:1088-1097. [PMID: 35973651 DOI: 10.1016/j.jacr.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 06/25/2022] [Accepted: 07/01/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To test whether patient and radiologist demographics influence perceptions of screening mammogram reports and the interpreting radiologist. METHODS Patients presenting for breast imaging were surveyed. Demographics were collected and each participant was shown five mock screening mammogram reports with BI-RADS 2 findings, each with a recommendation for one year screening. Each report included a picture of the interpreting radiologist who was Black or white and male or female. Participants were asked seven Likert questions about understanding, satisfaction, and trust in the report and radiologist. Generalized estimating equation ordinal logistic regression compared responses based on participant and radiologist demographics. RESULTS There were 178 women who participated with a mean age of 55.1 ± 10.2 years. Most participants self-identified as white (71%) or Black (20%) and non-Hispanic (98%) with broad educational representation (28% Bachelor's and 28% Master's degree). After controlling for demographics, Black participants reported greater agreement regarding trust in the report's finding (p=0.037) if the radiologist was also Black. Black participants were less likely to be satisfied in the report quality (p=0.043). Additionally, participants without any college education reported lower agreement that they were satisfied with the report quality (p=0.020) and felt the radiologist cares about his/her patients (p=0.037). There were no significant associations for radiologist gender or participant age. DISCUSSION Participant perceptions of screening mammograms and the interpreting radiologist can be influenced by participant and provider race as well as participant education. These findings could have implications for mammography adherence, breast radiologist recruitment, and developing patient centric reports.
Collapse
|
15
|
Galhotra S, Smith RB, Norton T, Mahnert ND. The surgical gender gap: the impact of surgeon gender in medicine and gynecologic surgery. Curr Opin Obstet Gynecol 2022; 34:256-261. [PMID: 35895969 DOI: 10.1097/gco.0000000000000788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the current literature evaluating the effect of surgeon gender on patient outcomes and satisfaction, and the impact of gender bias on female surgeons. RECENT FINDINGS The proportion of female physicians has increased in recent years, especially in Obstetrics and Gynecology. Recent literature assessing this impact supports equivalent or superior medical and surgical outcomes for women surgeons and physicians. It also reveals superior counseling and communication styles as perceived by patients. However, women in medicine receive lower patient ratings in competence, medical knowledge, and technical skills despite the existing evidence. Additionally, female physicians experience pay inequality, limited advancement opportunities, higher prevalence of microaggressions, and higher rates of burnout. SUMMARY Recognition of gender bias is essential to correcting this issue and improving the negative impact it has on female physicians, our patients, and the field of women's health.
Collapse
Affiliation(s)
- Sheena Galhotra
- Banner University Medical Center Phoenix, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA
| | | | | | | |
Collapse
|
16
|
Altamirano J, Kline M, Schwartz R, Fassiotto M, Maldonado Y, Weimer-Elder B. The effect of a relationship-centered communication program on patient experience and provider wellness. PATIENT EDUCATION AND COUNSELING 2022; 105:1988-1995. [PMID: 34772532 DOI: 10.1016/j.pec.2021.10.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/16/2021] [Accepted: 10/20/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Despite evidence of the central importance of communication to patient experience, health outcomes, and provider wellness, communication training for clinicians is not a standard part of clinical education. The study explores the impact of an 8-hour relationship-centered communication (RCC) training program on patient experience and provider wellness. METHODS 636 healthcare providers participated in 48 workshops conducted January-August 2018. 481 (76%) agreed to participate in research. Participants completed a pre/post assessment that included a wellness survey, the Professional Fulfillment Index (PFI). We conducted chi-squared analyses comparing wellness data immediately prior to the course to 3 months following course participation. Patient experience, assessed using Press Ganey likelihood to recommend care provider (PG-LTR CP) scores, were examined prior to an individual's course participation and following participation up to September 2019. RESULTS 104 participants completed the three-month PFI (22% response rate). Participants demonstrated marked improvements in professional wellness after 3 months. In bivariate analyses, PG-LTR CP significantly increased and persisted more than 7 months following program completion. CONCLUSIONS The RCC training program, a low-cost communication intervention, led to significant, beneficial changes in provider wellness and patient experience. PRACTICE IMPLICATIONS Implementing a RCC course for providers may improve patient experience and provider wellness.
Collapse
Affiliation(s)
- Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA, USA.
| | - Merisa Kline
- Patient Experience, Stanford Health Care, Stanford, CA, USA.
| | - Rachel Schwartz
- Patient Experience, Stanford Health Care, Stanford, CA, USA.
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA, USA.
| | - Yvonne Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA, USA.
| | | |
Collapse
|
17
|
Valdez P, Kendrick-Allwood S, Williams TS, Spinks-Franklin A, Nyp SS. Let Me Spell It Out: The Impact of Microaggression on the Health Care Professional. J Dev Behav Pediatr 2022; 43:303-306. [PMID: 35442924 DOI: 10.1097/dbp.0000000000001082] [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: 02/18/2022] [Accepted: 02/25/2022] [Indexed: 11/25/2022]
Abstract
CASE Rachel is a 10-year-old White girl with attention-deficit/hyperactivity disorder and a history of trauma who presented for evaluation by Dr. Narayanaswamy, a developmental-behavioral pediatrician. A pediatric resident observed the visit with permission from Rachel's parents.During the visit, Dr. Narayanaswamy spoke to Rachel's case manager over the phone to advocate for a trauma-based day treatment program at her school. At the end of the call, the case manager asked the physician for her full name. Dr. Narayanaswamy responded with her name and asked the case manager, "Would you like me to spell it?" At that time, Rachel's father began to laugh, shook his head, and incredulously remarked, "Ugh, yeah you need to spell it." Dr. Narayanaswamy ignored the comment and completed the phone call.After the visit, Dr. Narayanaswamy explained to the resident that the father's derisive laughter was a microaggression. The resident appreciated the observation and, after a pause, asked why she chose not to defend herself when the microaggression occurred. Dr. Narayanaswamy reflected that she had refrained from responding to Rachel's father over concern that he would retaliate by providing low ratings on the postvisit patient satisfaction survey sent to all patients who received care at the institution. The granular survey results, comprising ratings in each survey subheading category for each clinician, are made public to members of her division each quarter, and low ratings are scrutinized by the leadership. Dr. Narayanaswamy thought it unfortunate that she felt inhibited in her response because this deprived the resident of observing ways to address microaggressions during an encounter, deprived herself the opportunity to respond directly to Rachel's father, and deprived Rachel from an instructive moment about racial empathy.Dr. Narayanaswamy wrote a letter about the incident to the chief of clinical affairs to inquire what recourse clinicians had in these situations and whether certain patient encounters could be flagged to prevent the postvisit patient survey from being automatically sent. The chief responded that the incident was unfortunate and praised Dr. Narayanaswamy's restraint and professionalism but denied her request to have postvisit surveys blocked for certain encounters. He shared that if a clinician were to be dissatisfied with a visit satisfaction rating, the clinician could petition for a review, and a committee would subsequently determine whether the review could be removed.How can health care professionals respond to microaggressions while maintaining a therapeutic alliance with the patient/family members and how can institutions support health care professionals in this endeavor?
Collapse
Affiliation(s)
- Purnima Valdez
- Division of Pediatric Neurology, Duke University Medical Center, Duke University School of Medicine, Durham, NC
| | - Salathiel Kendrick-Allwood
- Developmental Progress Clinic, Divisions of General Pediatrics & Neonatology, Emory University School of Medicine, Department of Pediatrics & Children's Pediatric Institute, Atlanta, GA
| | | | - Adiaha Spinks-Franklin
- Division of Developmental Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Sarah S Nyp
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, UMKC School of Medicine, Kansas City, MO
| |
Collapse
|
18
|
Affiliation(s)
- Bonnie L Bermas
- Division of Rheumatic Diseases, University of Texas Southwestern Medical Center, Dallas, Texas (B.L.B.)
| |
Collapse
|
19
|
Cha E, Mathis NJ, Joshi H, Sharma S, Zinovoy M, Ru M, Cahlon O, Gillespie EF, Marshall DC. Bias in Patient Experience Scores in Radiation Oncology: A Multicenter Retrospective Analysis. J Am Coll Radiol 2022; 19:542-551. [PMID: 35247326 PMCID: PMC9017791 DOI: 10.1016/j.jacr.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/05/2022] [Accepted: 01/09/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Patient experience scores are increasingly important in measuring quality of care and determining reimbursement from payers, including the Hospital Value-Based Purchasing Program and the Radiation Oncology Model. However, the role of bias in patient experience scores in oncology is unknown, raising the possibility that such payment structures may inadvertently perpetuate bias in reimbursement. Therefore, the authors characterized patient-, physician-, and practice-level predictors of patient experience scores in patients undergoing radiation therapy. METHODS The authors retrospectively reviewed patient experience surveys for radiation oncology patients treated at two large multisite academic cancer centers. The outcome was responses on four survey questions. Covariates included self-reported patient demographics, physician characteristics, practice setting characteristics, and wait-time rating linked to each survey. Multivariable ordinal regression models were fitted to identify predictors of receiving a higher score on each of the survey questions. RESULTS In total, 2,868 patients completed surveys and were included in the analysis. Patient experience scores were generally high, with >90% of respondents answering 5 of 5 on the four survey items. Physician gender was not associated with any measured patient experience outcomes (P > 0.40 for all). Independent predictors of higher score included a wait-time experience classified as "good" as compared with "not good" (q < .001 for all). CONCLUSIONS Oncology practices aiming to improve patient experience scores may wish to focus their attention on improving wait times for patients. Although a difference in patient experience scores on the basis of physician gender was not observed, such bias is likely to be complex, and further research is needed to characterize its effects.
Collapse
Affiliation(s)
- Elaine Cha
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Noah J Mathis
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Himanshu Joshi
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York; Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sonam Sharma
- Assistant Program Director, Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa Zinovoy
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Meng Ru
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Oren Cahlon
- Deputy Physician-in-Chief for Strategic Partnerships and Vice Chair, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Deborah C Marshall
- Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York.
| |
Collapse
|
20
|
Badreldin N, DiTosto JD, Grobman WA, Yee LM. Association Between Patient-Prescriber Racial and Ethnic Concordance and Postpartum Pain and Opioid Prescribing. Health Equity 2022; 6:198-205. [PMID: 35402767 PMCID: PMC8985536 DOI: 10.1089/heq.2021.0130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/12/2022] Open
Abstract
Objective: To evaluate whether patient-prescriber racial and ethnic concordance is associated with postpartum opioid prescribing patterns and patient-reported pain scores. Methods This is a retrospective cohort study of patients who delivered at a tertiary care center between December 1, 2015 and November 30, 2016. Self-identified non-Hispanic white (NHW), non-Hispanic black (NHB), Hispanic, or Asian patients were included. Patient-prescriber pairs were categorized as racially and ethnically concordant if they shared the same racial and ethnic identity; the prescriber was defined as the obstetrical provider who was responsible for the postpartum discharge of the patient. Multivariable regression models controlling for demographic and clinical confounders were used to assess the relationship of patient-prescriber racial and ethnic concordance with receipt of an opioid prescription and patient-reported pain score at discharge. Results Of 10,242 patients included in this analysis, 62.3% identified as NHW, 19.1% Hispanic, 9.7% NHB, and 8.9% Asian. About half (52.8%) of patients were discharged by a racially and ethnically concordant prescriber. Patient-prescriber racial and ethnic concordance was not associated with receipt of an opioid prescription (adjusted odds ratio [aOR] 0.82, confidence interval [95% CI] 0.67–1.00) or reporting a pain score ≥5 (aOR 0.90, 95% CI 0.69–1.16). However, NHB and Hispanic patients were less likely to receive an opioid prescription (aOR 0.73, 95% CI 0.56–0.95; aOR 0.73, 95% CI 0.57–0.92, respectively) and significantly more likely to report a pain score ≥5 (aOR 2.13, 95% CI 1.51–3.00; aOR 1.48 95% CI 1.08–2.01, respectively) than NHW patients, even when accounting for concordance. Conclusion Disparities in postpartum opioid prescribing and pain perception are not ameliorated by patient-prescriber racial and ethnic concordance.
Collapse
Affiliation(s)
- Nevert Badreldin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Julia D. DiTosto
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - William A. Grobman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois, USA
| | - Lynn M. Yee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Northwestern University School of Medicine, Chicago, Illinois, USA
| |
Collapse
|
21
|
Redding TS, Keefe KR, Stephens AR, Gurgel RK. Evaluating Factors That Influence Patient Satisfaction in Otolaryngology Clinics. Ann Otol Rhinol Laryngol 2022; 132:19-26. [PMID: 35094607 DOI: 10.1177/00034894211055531] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
Collapse
Affiliation(s)
- Taylor S Redding
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Katherine R Keefe
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Andrew R Stephens
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Richard K Gurgel
- Department of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
22
|
Ho AF, Zhou Y, Kirby JJ, Rahman MM, Tessitore K, Abdel-Raziq Y, d'Etienne JP, Schrader CD, Wang H. Causal Effect Analysis of Demographic Concordance of Physician Trust and Respect in an Emergency Care Setting. Open Access Emerg Med 2021; 13:503-509. [PMID: 34824553 PMCID: PMC8610774 DOI: 10.2147/oaem.s334495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
Objective Patient perceptions of physician trust and respect are important factors for patient satisfaction evaluations. However, perceptions are subjective by nature and can be affected by patient and physician demographic characteristics. We aim to determine the causal effect on patient-physician demographic concordance and patient perceptions of physician trust and respect in an emergency care setting. Methods We performed a causal effect analysis in an observational study setting. A near-real-time patient satisfaction survey was sent via telephone to patients within 72 h of discharge from an emergency department (ED). Patient-trust-physician (PTP) and physician-show-respect (PSR) scores were measured. Patient and physician demographics (age, gender, race, and ethnicity) were matched. Causal effect was analyzed to determine the direct effect of patient-physician demographic concordance on PTP/PSR scores. Results We enrolled 1815 patients. The treatment effect of patient-physician age concordance on PTP scores was -0.119 (p = 0.036). Other treatment effect of patient-physician demographic concordance on patient perception of physician trust and respect ranged from -0.02 to -0.2 (p > 0.05). Conclusion Patient-physician age concordance may cause a negative effect on patient perception of physician trust. Otherwise, patient-physician demographic concordance has no effect on patient perceptions of physician trust and respect.
Collapse
Affiliation(s)
- Amy F Ho
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - Yuan Zhou
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, Arlington, TX, 76019, USA
| | - Jessica J Kirby
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - Md Mamunur Rahman
- Department of Industrial, Manufacturing, and Systems Engineering, The University of Texas at Arlington, Arlington, TX, 76019, USA
| | - Kathryn Tessitore
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - Yousef Abdel-Raziq
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - James P d'Etienne
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - Chet D Schrader
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| | - Hao Wang
- Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX, 76104, USA
| |
Collapse
|
23
|
Ahmad SR, Ahmad TR, Balasubramanian V, Facente S, Kin C, Girod S. Are You Really the Doctor? Physician Experiences with Gendered Microaggressions from Patients. J Womens Health (Larchmt) 2021; 31:521-532. [PMID: 34747651 DOI: 10.1089/jwh.2021.0169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: In contrast to physician implicit bias toward patients, bias and microaggressions from patients toward physicians have received comparatively less attention. Materials and Methods: We captured physician experiences of gendered microaggressions from patients by conducting a mixed-methods survey-based study of physicians at a single academic health care institution in May 2019. A quantitative portion assessed the frequency of gendered microaggressions (microaggression experiences [ME] score) and the association with measures of perceived impacts (job satisfaction, burnout, perceived career impacts, behavioral modifications). A one-tailed Wilcoxon rank sum test compared distributional frequencies of microaggressions by gender, and by gender and race. Chi-square tests measured the associations between gendered microaggressions and perceived impacts. Welch two-sample t-tests assessed differences in ME scores by rank and specialty. Linear regression assessed the association of ME scores and job satisfaction/burnout. A qualitative portion solicited anecdotal experiences, analyzed by inductive thematic analysis. Results: There were 297 completed surveys (response rate 27%). Female physicians experienced a significantly higher frequency of gendered microaggressions (p < 0.001) compared with male physicians. Microaggressions were significantly associated with job satisfaction (chi-square 6.83, p = 0.009), burnout (chi-square 8.76, p = 0.003), perceived career impacts (chi-square 18.67, p < 0.001), and behavioral modifications (chi-square 19.96, p < 0.001). Trainees experienced more microaggressions (p = 0.009) and burnout (p = 0.009) than faculty. Higher ME scores predicted statistically significant increases in burnout (p < 0.0001) and reduced job satisfaction (p = 0.02). Twelve microaggressions themes emerged from the qualitative responses, including role questioning and assumption of inexperience. The frequency of microaggressions did not vary significantly by race; however, qualitative responses described race as a factor. Conclusions: Physicians experience gendered microaggressions from patients, which may influence job satisfaction, burnout, career perceptions, and behavior. Future research may explore the multidirectionality of microaggressions and tools for responding at the individual and institutional level.
Collapse
Affiliation(s)
- Sarah R Ahmad
- Division of Headache Medicine, Department of Neurology, University of California, San Francisco, San Francisco, California, USA
| | - Tessnim R Ahmad
- Department of Ophthalmology, University of California, San Francisco, San Francisco, California, USA
| | - Vidhya Balasubramanian
- Quantitative Sciences Unit, Biomedical Informatics Research Division in the Department of Medicine, Stanford Medicine, Stanford, California, USA
| | | | - Cindy Kin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Medicine, Stanford, California, USA
| | - Sabine Girod
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford Medicine, Stanford, California, USA
| |
Collapse
|
24
|
Tran TB, Raoof M, Melstrom L, Kyulo N, Shaikh Z, Jones VC, Erhunmwunsee L, Fong Y, Warner SG. Racial and Ethnic Bias Impact Perceptions of Surgeon Communication. Ann Surg 2021; 274:597-604. [PMID: 34506314 DOI: 10.1097/sla.0000000000005060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate patient satisfaction scores as a function of physician and patient race and sex. BACKGROUND Patient satisfaction is increasingly used as a surrogate for physician performance. How patient and surgeon race and ethnicity affect perceptions of surgeon communication and care is not widely explored. METHODS Press Ganey patient satisfaction surveys collected from January 2019 to September 2020 were studied. Multivariate logistic regressions were used to identify factors associated with favorable surgeon performance as a function of patient and surgeon demographics. RESULTS A total of 4732 unique outpatient satisfaction survey responses were analyzed. The majority of patients were White (60.5%), followed by Asian (8.6%), Black (4.2%), and Hispanic (4.3%). URM accounted for 8.9% of the 79 surgeons evaluated, and 34% were female. Black, Hispanic, and Asian patients were more likely to report unfavorable experiences than their White counterparts (P < 0.01). Spanish-speaking patients were most likely to perceive that surgeon show less respect for patient concerns (13.9% vs 9.3%, P = 0.004) and inadequate time spent explaining health concerns (12.6% vs 9.2%, P < 0.001). Female surgeons were more likely to achieve the highest overall ratings for effective communication, whereas Asian surgeons received lower scores. Asian surgeons were more likely than non-Asian surgeons to receive lower scores in explanation (37.3% vs 44.1%, P = 0.003). After adjusting for confounding factors, Asian surgeons had 26% lower odds of receiving favorable scores for overall communication (odds ratio: 0.736, 95% confidence interval: 0.619-0.877, P = 0.001). CONCLUSIONS Both patient and surgeon race and sex drive negative perceptions of patient-physician communication. As URM report more negative experiences, further studies should focus on effects of surgeon cultural awareness on underrepresented patient satisfaction.
Collapse
Affiliation(s)
- Thuy B Tran
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Mustafa Raoof
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Laleh Melstrom
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Namgyal Kyulo
- Department of Patient Experience, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Zameer Shaikh
- Department of Patient Experience, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Veronica C Jones
- Department of Surgery, Division of Breast Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Loretta Erhunmwunsee
- Department of Surgery, Division of Thoracic Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Yuman Fong
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Susanne G Warner
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| |
Collapse
|
25
|
Prasad T, Buta E, Cleary PD. Is Patient-Physician Gender Concordance Related to the Quality of Patient Care Experiences? J Gen Intern Med 2021; 36:3058-3063. [PMID: 33469761 PMCID: PMC8481522 DOI: 10.1007/s11606-020-06411-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/07/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is great interest in identifying factors that are related to positive patient experiences such as physician communication style. Documented gender-specific physician communication and patient behavior differences raise the question of whether gender concordant relationships (i.e., both the provider and patient share the same gender) might affect patient experiences. OBJECTIVE Assess whether patient experiences are more positive in gender concordant primary care relationships. DESIGN Statewide telephone surveys. Linear mixed regression models to estimate the association of CAHPS scores with patient gender and gender concordance. SUBJECTS Two probability samples of primary care Medicaid patients in Connecticut in 2017 (5/17-7/17) and 2019 (7/19-10/19). MAIN MEASURES Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey augmented with questions about aspects of care most salient to PCMH-designated organizations and two questions to assess access to mental health services. KEY RESULTS There were no significant effects of gender concordance and differences in experiences by patient gender were modest. CONCLUSIONS This study did not support the suggestion that patient and physician gender and gender concordance have an important effect on patient experiences.
Collapse
Affiliation(s)
| | - Eugenia Buta
- Yale Center for Analytical Studies, Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA
| | - Paul D Cleary
- Anna M.R. Lauder Professor of Public Health, Department of Health Policy and Management, Yale School of Public Health, PO Box 208034, New Haven, CT, 06520-8034, USA.
| |
Collapse
|
26
|
Haynes D, Pampari A, Topham C, Schwarzenberger K, Heath M, Zou J, Greiling TM. Patient Experience Surveys Reveal Gender-Biased Descriptions of Their Care Providers. J Med Syst 2021; 45:90. [PMID: 34468879 DOI: 10.1007/s10916-021-01766-z] [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] [Received: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Patient experience surveys (PES) are collected by healthcare systems as a surrogate marker of quality and published unedited online for the purpose of transparency, but these surveys may reflect gender biases directed toward healthcare providers. This retrospective study evaluated PES at a single university hospital between July 2016 and June 2018. Surveys were stratified by overall provider rating and self-identified provider gender. Adjectives from free-text survey comments were extracted using natural language processing techniques and applied to a statistical machine learning model to identify descriptors predictive of provider gender. 109,994 surveys were collected, 17,395 contained free-text comments describing 687 unique providers. The mean overall rating between male (8.84, n = 8558) and female (8.80, n = 8837) providers did not differ (p = 0.149). However, highly-rated male providers were more often described for their agentic qualities using adjectives such as "informative," "forthright," "superior," and "utmost" (OR 1.48, p < 0.01)-whereas highly-rated female providers were more often described by their communal qualities through adjectives such as "empathetic," "sweet," "warm," "attentive," and "approachable" (OR 2.11, p < 0.0001). PES may contain gender stereotypes, raising questions about their impact on physicians and their validity as a quality metric which must be balanced with the need for unedited transparency. Future prospective studies are needed to further characterize this trend across geographically and racially diverse healthcare providers.
Collapse
Affiliation(s)
- Dylan Haynes
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - Anusri Pampari
- Department of Biomedical Data Science, Stanford University, 350 Serra Mall, Room 258, Stanford, CA, 94305, USA
| | - Christina Topham
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - Kathryn Schwarzenberger
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - Michael Heath
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA
| | - James Zou
- Department of Biomedical Data Science, Stanford University, 350 Serra Mall, Room 258, Stanford, CA, 94305, USA.
| | - Teri M Greiling
- Department of Dermatology, Center for Health and Healing, Oregon Health & Science University, Building 1 Suite #16, 3303 SW Bond Ave, Portland, OR, 97239, USA.
| |
Collapse
|
27
|
Han MM, Hsueh J, Chen AX, Greenlee TE, Conti TF, Rose SL, Singh RP, Rachitskaya AV. Ophthalmology Provider Ratings and Patient, Disease, and Appointment Factors. J Patient Exp 2021; 8:23743735211033750. [PMID: 34395846 PMCID: PMC8358496 DOI: 10.1177/23743735211033750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The purpose of the current study is to examine how nonmodifiable sociodemographic, disease, appointment, management, and survey factors correlate with provider rating. This was a retrospective cross-sectional study conducted on 29 857 patient Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys collected from January 2017 to January 2019 at a tertiary eye center. We included surveys of patients aged 18 years or older, who answered at least 4 of 6 subfield questions, and completed the survey within 90 days of the appointment. The main outcome was the odds of receiving top box score (TBS) of 10/10 on the survey question regarding overall provider rating. The results showed that the variables with higher odds of TBS included higher overall appointment attendance (odds ratio [OR]: 2.66 [95% CI: 1.23-5.75], P = .013); older patient age (OR 2.44 [95% CI: 2.08-2.87], P < .001]; higher percentage of survey questions completed (OR: 2.02 [95% CI: 1.79-2.27], P < .001); better best corrected visual acuity (OR: 1.85 [95% CI: 1.3-2.64], P = .001); optometry clinic visit (OR: 1.25 [95% CI: 1.15-1.36], P < .001); having procedures (OR: 1.19 [95% CI: 1.04-1.36], P = .013), surgery scheduled (OR: 1.18 [95% CI: 1.03-1.36], P = .020], or refraction done (OR: 1.16 [95% CI: 1.08-1.25], P < .001); being seen by male providers (OR: 1.11 [95% CI: 1.04-1.17], P = .001); and having additional eye testing performed (OR: 1.06 [95% CI: 1.00-1.13], P = .048). Variables associated with lower odds of TBS included longer time to complete survey (OR: 0.42 [95% CI: 0.3-0.58], P = .001); new patient encounter (OR: 0.62 [95% CI: 0.58-0.65], P < .001); and glaucoma (OR: 0.66 [95% CI: 0.59-0.75], P < .001), cornea (OR: 0.79 [95% CI: 0.71-0.87], P < .001), or comprehensive clinic visits (OR: 0.86 [95% CI: 0.79-0.94], P < .001). Thus, nonmodifiable factors may affect the provider rating, and these factors should be studied further and accounted for when interpreting the results of patient experience surveys.
Collapse
Affiliation(s)
- Michael M Han
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jessica Hsueh
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Andrew X Chen
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tyler E Greenlee
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thais F Conti
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Susannah L Rose
- Office of Patient Experience, Center for Bioethics, Clinical Transformation, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Rishi P Singh
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Center for Ophthalmic Bioinformatics, Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | | |
Collapse
|
28
|
Pacella CB, Guyette MK. Proceed With Caution: Mitigating the Impact of Implicit Bias in Patient Experience Scores. Ann Emerg Med 2021; 78:397-399. [PMID: 34334232 DOI: 10.1016/j.annemergmed.2021.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Charissa B Pacella
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
| | - Maria K Guyette
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| |
Collapse
|
29
|
Karalius VP, Kaskar SB, Levine DA, Darling TA, Loftus TM, McCarthy DM. Emergency Department Patient Experiences During the COVID-19 Pandemic. J Patient Exp 2021; 8:23743735211033752. [PMID: 34368429 PMCID: PMC8317244 DOI: 10.1177/23743735211033752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Emergency department (ED) utilization changed notably during the coronavirus disease 2019 (COVID-19) pandemic in the United States. The purpose of the study was to gain a more thorough understanding of ED patient experience during the early stages of the COVID-19 pandemic. This study used the consensual qualitative approach to analyze open-ended responses from post-ED patient experience surveys from February through July 2020. Comments were included in the analysis if they pertained to care during the pandemic (eg, mentioned “the virus,” “masks,” “PPE”). A total of 242 COVID-specific comments from 192 unique patients were analyzed (median age 49 years; 69% female). Six themes were identified: visually observed changes, experiences of process changes, expressions of understanding or appreciation, sense of security, COVID-19 disease-specific comments, and “classic” satisfaction comments that align with previous literature on patient experience. The COVID-19 pandemic has challenged health care systems across the world in unique and unprecedented ways. This study identified six themes that better elucidate ED patient experience during an unprecedented public health crisis.
Collapse
Affiliation(s)
- Vytas P Karalius
- Department of Emergency Medicine, Northwestern University, Chicago, IL, USA
| | - Saabir B Kaskar
- Department of Emergency Medicine, Northwestern University, Chicago, IL, USA
| | - Daniel A Levine
- Department of Emergency Medicine, Northwestern University, Chicago, IL, USA
| | | | - Timothy M Loftus
- Department of Emergency Medicine, Northwestern University, Chicago, IL, USA
| | - Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University, Chicago, IL, USA.,Center for Health Services & Outcomes Research, Northwestern University, Chicago, IL, USA
| |
Collapse
|
30
|
Kuhn D, Goldberg H, Salker N, Hurst J, Sethuraman K. Anchoring Vignettes as a Method to Address Implicit Gender Bias in Patient Experience Scores. Ann Emerg Med 2021; 78:388-396. [PMID: 34304916 DOI: 10.1016/j.annemergmed.2021.04.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE Patient experience metrics have become increasingly important in evaluations of health care organizations and physician performance. Although such measures have been touted as a way to make objective comparisons of performance, they are subject to many of the same biases as other survey instruments, including gender bias. METHODS A total of 320 surveys were conducted between February and October 2020. Surveys included vignettes describing different scenarios, and respondents were asked to rate the vignette physician in each scenario on 1 of 3 themes: listening, time, or courtesy. Three vignettes per theme were used. Half of the surveys used a male physician and half used a female physician. Using tests of difference, we compared the ratings of male and female vignette physicians. We also used a statistical technique known as anchoring vignettes to show how respondents' ratings of vignette physicians related to their ratings of their own physicians. RESULTS In all 9 vignette scenarios, the male vignette physician was rated more highly than the female vignette physician. These differences were statistically significant in 2 of 9 scenarios. Male vignette physicians were given more top-box ratings than female vignette physicians. Anchoring vignettes showed a statistically nonsignificant association between vignette ratings and ratings of respondents' own physicians. CONCLUSION Our findings revealed a pattern of higher ratings of male vignette physicians when compared to female vignette physicians, which may translate to ratings of patients' own physicians. These findings suggest that current methods to evaluate patients' experiences with their own physicians may disadvantage female physicians.
Collapse
Affiliation(s)
- Diane Kuhn
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
| | - Hannah Goldberg
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Nikita Salker
- University of Maryland School of Medicine, Baltimore, MD
| | - Jonathan Hurst
- University of Maryland School of Medicine, Baltimore, MD
| | - Kinjal Sethuraman
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD
| |
Collapse
|
31
|
Provider Personal and Demographic Characteristics and Patient Satisfaction in Orthopaedic Surgery. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202104000-00004. [PMID: 33835991 DOI: 10.5435/jaaosglobal-d-20-00198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patient satisfaction has increasingly been used to assess physician performance and quality of care. Although there is evidence that patient satisfaction is associated with patient-reported health outcomes and communication-related measures, there is debate over the use of patient satisfaction in reimbursement policy. Patient characteristics that influence satisfaction have been studied, but the effects of personal and demographic characteristics of physicians on patient satisfaction have yet to be explored. METHODS Outpatient satisfaction scores from 11,059 patients who rated 25 orthopaedic surgeons from a single institution were studied. In this study, we sought to explore the relationship between nonmodifiable physician characteristics, such as sex and race, and patient satisfaction with outpatient orthopaedic surgery care, as expressed in the Press Ganey Satisfaction Scores. Univariate logistic regression models were used to test the associations between each provider characteristic and patient satisfaction on the Press Ganey patient satisfaction questionnaire. RESULTS Three nonmodifiable physician personal and demographic characteristics were markedly associated with lower patient satisfaction scores across overall satisfaction, communication, and empathy domains: (1) female gender, (2) Asian ethnicity, and (3) being unmarried. Asian ethnicity reduced the odds of receiving a 5-star rating for likelihood to recommend the provider by nearly 40%, but none of these nonmodifiable physician personal and demographic characteristics affected the likelihood to recommend the practice. DISCUSSION Sex, ethnicity, and marital status are nonmodifiable provider characteristics, each associated with markedly lower odds of receiving a 5-star rating on Press Ganey patient satisfaction survey. These data reveal inherent patient biases that negatively affect physician-patient interactions and may exacerbate the lack of diversity in orthopaedic surgery. More research is necessary before using patient satisfaction ratings to evaluate surgeons or as quality measures that affect reimbursement policies.
Collapse
|
32
|
Stephens AR, Presson AP, Chen D, Tyser AR, Kazmers NH. Inter-specialty variation of the Press Ganey Outpatient Medical Practice Survey. Medicine (Baltimore) 2021; 100:e25211. [PMID: 33761706 PMCID: PMC9281982 DOI: 10.1097/md.0000000000025211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 01/22/2021] [Accepted: 02/24/2021] [Indexed: 01/05/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Andrew R. Stephens
- Department of Orthopaedics, University of Utah, 590 Wakara Way
- University of Utah, School of Medicine, 30N 1900E
| | - Angela P. Presson
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT
| | - Danli Chen
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT
| | - Andrew R. Tyser
- Department of Orthopaedics, University of Utah, 590 Wakara Way
| | | |
Collapse
|
33
|
Nuyen B, Altamirano J, Fassiotto M, Alyono J. Effects of surgeon sociodemographics on patient-reported satisfaction. Surgery 2021; 169:1441-1445. [PMID: 33531133 DOI: 10.1016/j.surg.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear. METHODS This cross-sectional study analyzed Press Ganey surveys linked to outpatient surgical visits at a single academic institution from January 2015 to December 2018 as they related to surgeon age, gender, and race. The primary outcome variable was achievement of a top-box score (5/5) on likelihood to recommend surgeon queries. Secondary analysis examined the relationship of likelihood to recommend surgeon to other survey questions, such as those regarding surgeon courtesy, concern, understandability, patient inclusion in medical decision making, and patient confidence in surgeon. χ2 tests and generalized estimating equation regression models were run to assess correlation. RESULTS In bivariate analysis of 36,840 surveys, non-Hispanic white surgeons were more likely to receive likelihood to recommend surgeon top-box ratings than Asian (P < .001) or underrepresented minority surgeons (P < .001). Additionally, male gender (P < .01) and older surgeon age (P < .001) were associated with higher top-box scores. However, in multivariate generalized estimating equation analysis, the effect of age was no longer significant, but female gender continued to be associated with lower odds of top-box likelihood to recommend surgeon ratings (odds ratio 0.83; 95% confidence interval, 0.70%-0.99%), as did Asian compared with white race (odds ratio 0.78; 95% confidence interval, 0.65%-0.95%). Likelihood to recommend surgeon scores correlated most closely with patients' "confidence" in the surgeon rather than measures of courtesy, concern, understandability, or inclusion in medical decision making. CONCLUSION Top-box scores varied by surgeon race and gender in correlation with patients' perceived confidence in the provider. Interpretation of Press Ganey scores should account for potential bias in patient satisfaction surveys based on surgeon demographics.
Collapse
Affiliation(s)
- Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Jennifer Alyono
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
| |
Collapse
|
34
|
Takeshita J, Wang S, Loren AW, Mitra N, Shults J, Shin DB, Sawinski DL. Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Netw Open 2020; 3:e2024583. [PMID: 33165609 PMCID: PMC7653497 DOI: 10.1001/jamanetworkopen.2020.24583] [Citation(s) in RCA: 326] [Impact Index Per Article: 81.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The Press Ganey Outpatient Medical Practice Survey is used to measure the patient experience. An understanding of the patient- and physician-related determinants of the patient experience may help identify opportunities to improve health care delivery and physician ratings. OBJECTIVE To evaluate the associations between the patient experience as measured by scores on the Press Ganey survey and patient-physician racial/ethnic and gender concordance. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of Press Ganey surveys returned for outpatient visits within the University of Pennsylvania Health System between 2014 and 2017 was performed. Participants included adult patient and physician dyads for whom surveys were returned. Data analysis was performed from January to June 2019. EXPOSURES Patient-physician racial/ethnic and gender concordance. MAIN OUTCOMES AND MEASURES The primary outcome was receipt of the maximum score for the "likelihood of your recommending this care provider to others" question in the Care Provider domain of the Press Ganey survey. Secondary outcomes included each of the remaining 9 questions in the Care Provider domain. Generalized estimating equations clustering on physicians with exchangeable intracluster correlations and cluster-robust standard errors were used to investigate associations between the outcomes and patient-physician racial/ethnic and gender concordance. RESULTS In total, 117 589 surveys were evaluated, corresponding to 92 238 unique patients (mean [SD] age, 57.7 [15.6] years; 37 002 men [40.1%]; 75 307 White patients [81.6%]) and 747 unique physicians (mean [SD] age 45.5 [10.6] years; 472 men [63.2%]; 533 White physicians [71.4%]). Compared with racially/ethnically concordant patient-physician dyads, discordance was associated with a lower likelihood of physicians receiving the maximum score (adjusted odds ratio [OR], 0.88; 95% CI, 0.82-0.94; P < .001). Black (adjusted OR, 0.73; 95% CI, 0.68-0.78; P < .001) and Asian (adjusted OR, 0.55; 95% CI, 0.50-0.60; P < .001) patient race were both associated with lower patient experience ratings. Patient-physician gender concordance was not associated with Press Ganey scores (adjusted OR, 1.00; 95% CI, 0.96-1.04; P = .90). CONCLUSIONS AND RELEVANCE In this study, higher Press Ganey survey scores were associated with racial/ethnic concordance between patients and their physicians. Efforts to improve physician workforce diversity are imperative. Delivery of health care in a culturally mindful manner between racially/ethnically discordant patient-physician dyads is also essential. Furthermore, Press Ganey scores may differ by a physician's patient demographic mix; thus, care must be taken when publicly reporting or using Press Ganey scores to evaluate physicians on an individual level.
Collapse
Affiliation(s)
- Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Shiyu Wang
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alison W. Loren
- Hematology/Oncology Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Justine Shults
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Daniel B. Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Deirdre L. Sawinski
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| |
Collapse
|
35
|
Has a critical mass of women resulted in gender equity in gynecologic surgery? Am J Obstet Gynecol 2020; 223:665-673. [PMID: 32585225 DOI: 10.1016/j.ajog.2020.06.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 11/23/2022]
Abstract
Gender equity in medicine and surgery has recently received widespread attention. Unlike surgical specialties that remain predominantly male, the majority of obstetrician-gynecologists have been women for nearly a decade, and women have composed the majority of trainees since the 1990s. Despite a critical mass of women, biases related to gender persist in the field. Professional and behavioral expectations of men and women gynecologists remain different for patients and workplace colleagues. Gender discrimination and sexual harassment are still experienced at high rates by both trainees and obstetrician-gynecologists in practice. In addition, in other surgical fields, women gynecologic surgeons face a gender wage gap that is unexplained by differences in experience, hours worked, or subspecialty training. Academic advancement and the attainment of leadership positions remain a challenge for many women. Policies related to pregnancy and parenting may disproportionately affect the careers of women gynecologists. This article presents peer-reviewed evidence relevant to gender equity in the workplace and suggests proactive interventions to ensure diversity and inclusion for gynecologic surgeons.
Collapse
|
36
|
Chekijian S, Kinsman J, Taylor RA, Ravi S, Parwani V, Ulrich A, Venkatesh A, Agrawal P. Association between patient-physician gender concordance and patient experience scores. Is there gender bias? Am J Emerg Med 2020; 45:476-482. [PMID: 33069544 DOI: 10.1016/j.ajem.2020.09.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patient satisfaction, a commonly measured indicator of quality of care and patient experience, is often used in physician performance reviews and promotion decisions. Patient satisfaction surveys may introduce gender-related bias. OBJECTIVE Examine the effect of patient and physician gender concordance on patient satisfaction with emergency care. METHODS We performed a cross-sectional analysis of electronic health record and Press Ganey patient satisfaction survey data of adult patients discharged from the emergency department (2015-2018). Logistic regression models were used to examine relationships between physician gender, patient gender, and physician-patient gender dyads. Binary outcomes included: perfect care provider score and perfect overall assessment score. RESULTS Female patients returned surveys more often (n=7 612; 61.55%) and accounted for more visits (n=232 024; 55.26%). Female patients had lower odds of perfect scores for provider score and overall assessment score (OR: 0.852, 95% CI: 0.790, 0.918; OR: 0.782, 95% CI: 0.723, 0.846). Female physicians had 1.102 (95% CI: 1.001, 1.213) times the odds of receiving a perfect provider score. Physician gender did not influence male patients' odds of reporting a perfect care provider score (95% CI: 0.916, 1.158) whereas female patients treated by female physicians had 1.146 times the odds (95% CI: 1.019, 1.289) of a perfect provider score. CONCLUSION Female patients prefer female emergency physicians but were less satisfied with their physician and emergency department visit overall. Over-representation of female patients on patient satisfaction surveys introduces bias. Patient satisfaction surveys should be deemphasized from physician compensation and promotion decisions.
Collapse
Affiliation(s)
- Sharon Chekijian
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Jeremiah Kinsman
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shashank Ravi
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Stanford University School of Medicine, USA
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Arjun Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
37
|
Dermatologist demographics and patient satisfaction: A single-center survey study. Int J Womens Dermatol 2020; 6:290-293. [PMID: 33015289 PMCID: PMC7522901 DOI: 10.1016/j.ijwd.2020.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/01/2022] Open
Abstract
Background Patient satisfaction is a proxy for quality clinical care. Understanding the factors that drive patient satisfaction scores is important because they are publicly reported, may be used in determining hospital and physician compensation, and may allow patients to preselect physicians. Objective This single-center survey study of adult patients at the Michigan Medicine outpatient dermatology clinics aimed to investigate how patients respond differently to theoretical dermatologic scenarios with varying dermatologist gender. Methods Each questionnaire contained one of four clinical scenarios illustrating overall positive or negative encounters with a male or female dermatologist, followed by questions derived from the Press Ganey survey to assess patient satisfaction. Results A total of 452 completed questionnaires were collected. There were statistically significant differences in overall patient satisfaction scores between positive versus negative female and positive versus negative male dermatologists, but there were no differences in scores between positive female and positive male dermatologists or between negative female and negative male dermatologists. There were also no differences in overall scores after controlling for patient demographic characteristics or patient–dermatologist gender concordance. Conclusion Previous studies have suggested that male physicians receive better patient satisfaction scores compared to female physicians. However, our study found that, in response to hypothetical scenarios of positive and negative dermatology encounters, dermatologist gender did not affect any domain of patient satisfaction scores. Limitations include the use of hypothetical patient–dermatologist encounters and possible lack of generalizability because the study was conducted at one academic center in southeast Michigan with a predominantly Caucasian patient population.
Collapse
|
38
|
The effect of nonmodifiable physician demographics on Press Ganey patient satisfaction scores in ophthalmology. J AAPOS 2020; 24:299-301. [PMID: 32890735 DOI: 10.1016/j.jaapos.2020.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022]
Abstract
Press Ganey patient satisfaction scores are increasingly being used as a physician quality metric. In this retrospective review of over 25,000 patient surveys for 61 ophthalmologists, pediatric ophthalmologists and neuro-ophthalmologists received significantly lower patient satisfaction scores than their peers, suggesting that the problem for which a patient seeks care may affect whether he or she is satisfied with the care received. These findings should be taken into account when considering the validity of Press Ganey scores as an equitable, modifiable measure of physician performance, especially when considering factoring these scores into physician evaluation and reimbursement.
Collapse
|
39
|
Plichta JK, Williamson H, Sergesketter AR, Grimm LJ, Thomas SM, DiLalla G, Zwischenberger BA, Hwang ES, Plichta RP. It's not you, It's me: The influence of patient and surgeon gender on patient satisfaction scores. Am J Surg 2020; 220:1179-1188. [PMID: 32847689 DOI: 10.1016/j.amjsurg.2020.07.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 07/09/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Surgeons face the unique challenge of being responsible for both clinical encounters and surgical outcomes. We aim to explore how patient evaluations of surgeons may be influenced by patient and provider factors. METHODS Patient responses from the 2016 CGCAHPS survey at a single institution were identified. A Poisson regression model was used to identify patient/provider factors associated with ratings. RESULTS 11,007 surveys of 134 surgeons were included. After adjustment, higher overall surgeon ratings were associated with older patient age (p < 0.001) and male patient gender (p = 0.001). Lower ratings were associated with higher patient education (p < 0.001) and lower patient self-health ratings (p < 0.001). Although female surgeons tended to have higher communication scores, overall scores did not differ based on any surgeon factors. CONCLUSIONS Patient satisfaction scores of surgeons are more closely correlated with patient variables than surgeon factors. This may have implications for physician performance evaluation in value-based care models.
Collapse
Affiliation(s)
- Jennifer K Plichta
- Duke University Medical Center, Department of Surgery, Durham, NC, USA; Duke Cancer Institute, Women's Cancer Program, Durham, NC, USA.
| | - Hannah Williamson
- Duke Cancer Institute, Biostatistics Shared Resources, Durham, NC, USA
| | | | - Lars J Grimm
- Duke Cancer Institute, Women's Cancer Program, Durham, NC, USA; Duke University Medical Center, Department of Radiology, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Biostatistics Shared Resources, Durham, NC, USA; Duke University, Department of Biostatistics & Bioinformatics, Durham, NC, USA
| | - Gayle DiLalla
- Duke University Medical Center, Department of Surgery, Durham, NC, USA; Duke Cancer Institute, Women's Cancer Program, Durham, NC, USA; Duke Women's Cancer Care Raleigh, Raleigh, NC, USA
| | | | - E Shelley Hwang
- Duke University Medical Center, Department of Surgery, Durham, NC, USA; Duke Cancer Institute, Women's Cancer Program, Durham, NC, USA
| | - Ryan P Plichta
- Duke University Medical Center, Department of Surgery, Durham, NC, USA
| |
Collapse
|
40
|
Chen H, Pierson E, Schmer-Galunder S, Altamirano J, Jurafsky D, Leskovec J, Fassiotto M, Kothary N. Gender Differences in Patient Perceptions of Physicians' Communal Traits and the Impact on Physician Evaluations. J Womens Health (Larchmt) 2020; 30:551-556. [PMID: 32857642 DOI: 10.1089/jwh.2019.8233] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Communal traits, such as empathy, warmth, and consensus-building, are not highly valued in the medical hierarchy. Devaluing communal traits is potentially harmful for two reasons. First, data suggest that patients may prefer when physicians show communal traits. Second, if female physicians are more likely to be perceived as communal, devaluing communal traits may increase the gender inequity already prevalent in medicine. We test for both these effects. Materials and Methods: This study analyzed 22,431 Press Ganey outpatient surveys assessing 480 physicians collected from 2016 to 2017 at a large tertiary hospital. The surveys asked patients to provide qualitative comments and quantitative Likert-scale ratings assessing physician effectiveness. We coded whether patients described physicians with "communal" language using a validated word scale derived from previous work. We used multivariate logistic regressions to assess whether (1) patients were more likely to describe female physicians using communal language and (2) patients gave higher quantitative ratings to physicians they described with communal language, when controlling for physician, patient, and comment characteristics. Results: Female physicians had higher odds of being described with communal language than male physicians (odds ratio 1.29, 95% confidence interval 1.18-1.40, p < 0.001). In addition, patients gave higher quantitative ratings to physicians they described with communal language. These results were robust to inclusion of controls. Conclusions: Female physicians are more likely to be perceived as communal. Being perceived as communal is associated with higher quantitative ratings, including likelihood to recommend. Our study indicates a need to reevaluate what types of behaviors academic hospitals reward in their physicians.
Collapse
Affiliation(s)
- Heidi Chen
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Emma Pierson
- Department of Computer Science, Stanford University, Stanford, California, USA
| | | | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford School of Medicine, Stanford, California, USA
| | - Dan Jurafsky
- Department of Computer Science, Stanford University, Stanford, California, USA.,Department of Linguistics, Stanford University, Stanford, California, USA
| | - Jure Leskovec
- Department of Computer Science, Stanford University, Stanford, California, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford School of Medicine, Stanford, California, USA
| | - Nishita Kothary
- Department of Radiology, Stanford School of Medicine, Stanford, California, USA
| |
Collapse
|
41
|
Physician-patient racial concordance and disparities in birthing mortality for newborns. Proc Natl Acad Sci U S A 2020; 117:21194-21200. [PMID: 32817561 DOI: 10.1073/pnas.1913405117] [Citation(s) in RCA: 361] [Impact Index Per Article: 90.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Recent work has emphasized the benefits of patient-physician concordance on clinical care outcomes for underrepresented minorities, arguing it can ameliorate outgroup biases, boost communication, and increase trust. We explore concordance in a setting where racial disparities are particularly severe: childbirth. In the United States, Black newborns die at three times the rate of White newborns. Results examining 1.8 million hospital births in the state of Florida between 1992 and 2015 suggest that newborn-physician racial concordance is associated with a significant improvement in mortality for Black infants. Results further suggest that these benefits manifest during more challenging births and in hospitals that deliver more Black babies. We find no significant improvement in maternal mortality when birthing mothers share race with their physician.
Collapse
|
42
|
Liao L, Chung S, Altamirano J, Garcia L, Fassiotto M, Maldonado B, Heidenreich P, Palaniappan L. The association between Asian patient race/ethnicity and lower satisfaction scores. BMC Health Serv Res 2020; 20:678. [PMID: 32698825 PMCID: PMC7374891 DOI: 10.1186/s12913-020-05534-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/13/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for patient R/E. The objective of this study is to examine R/E differences in patient satisfaction ratings and how these differences impact provider rankings. METHODS Patient satisfaction survey data linked to electronic health records from two large outpatient centers in northern California - a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B) - was collected and analyzed. Participants consisted of adult patients who received outpatient care at Site A from December 2010 to November 2014 and Site B from March 2013 to August 2014, and completed Press-Ganey Medical Practice Survey questionnaires (N = 216,392 (Site A) and 30,690 (Site B)). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied. For six questions each representing a survey subdomain, favorable ratings were defined as top-box ("very good") compared to all other categories ("very poor," "poor," "fair," and "good"). Using multivariable logistic regression with provider random effects, we assessed whether the likelihood of giving favorable ratings differed by patient R/E, adjusting for patient age and sex. RESULTS Asian, younger and female patients provided less favorable ratings than other R/E, older and male patients. After adjustment, Asian patients were less likely than NHW patients to provide top-box ratings to the overall assessment question "likelihood of recommending this practice to others" (Site A: Asian predicted probability (PP) 0.680, 95% confidence interval (CI): 0.675-0.685 compared to NHW PP 0.820, 95% CI: 0.818-0.822; Site B: Asian PP 0.734, 95% CI: 0.733-0.736 compared to NHW PP 0.859, 95% CI: 0.859-0.859). The effect sizes for Asian R/E were greater than the effect sizes for older age and female sex. An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking. CONCLUSIONS Patient satisfaction scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.
Collapse
Affiliation(s)
- Lillian Liao
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
- Columbia University Vagelos College of Physicians and Surgeons, 50 Haven Avenue Box #B-26, New York, NY10032 USA
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, USA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Luis Garcia
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Bonnie Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Paul Heidenreich
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
| |
Collapse
|
43
|
Nepal S, Keniston A, Indovina KA, Frank MG, Stella SA, Quinzanos-Alonso I, McBeth L, Moore SL, Burden M. What Do Patients Want? A Qualitative Analysis of Patient, Provider, and Administrative Perceptions and Expectations About Patients' Hospital Stays. J Patient Exp 2020; 7:1760-1770. [PMID: 33457641 PMCID: PMC7786759 DOI: 10.1177/2374373520942403] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Patient experience is increasingly recognized as a measure of health care quality and patient-centered care and is currently measured through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The HCAHPS survey may miss key factors important to patients, and in particular, to underserved patient populations. We performed a qualitative study utilizing semi-structured interviews with 45 hospitalized English- and Spanish-speaking patients and 6 focus groups with physicians, nurses, and administrators at a large, urban safety-net hospital. Four main themes were important to patients: (1) the hospital environment including cleanliness and how hospital policies and procedures impact patients’ perceived autonomy, (2) whole-person care, (3) communication with and between care teams and utilizing words that patients can understand, and (4) responsiveness and attentiveness to needs. We found that several key themes that were important to patients are not fully addressed in the HCAHPS survey and there is a disconnect between what patients and care teams believe patients want and what hospital policies drive in the care environment.
Collapse
Affiliation(s)
- Sansrita Nepal
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Both the authors are first co-authors
| | - Angela Keniston
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA.,Both the authors are first co-authors
| | - Kimberly A Indovina
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Maria G Frank
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Sarah A Stella
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Itziar Quinzanos-Alonso
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lauren McBeth
- Division of Hospital Medicine, Denver Health, Denver, CO, USA.,Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Susan L Moore
- Community and Behavioral Health, Colorado School of Public Health, Aurora, CO, USA.,Division of General Internal Medicine, University of Colorado, Aurora, CO, USA
| | - Marisha Burden
- Division of Hospital Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| |
Collapse
|
44
|
Setoodefar M, Tabesh H, Tara F, Eslami S, Heshmati Nabavi F, Valizadeh Zare N, Taheri SH, Rajabzadeh Moghaddam MR, Etminani K. Measurement Model of Women's Preferences in Obstetrician and Gynecologist Selection in the Private Sector: Exploratory and Confirmatory Factor Analysis. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2020; 8:150-163. [PMID: 32309456 PMCID: PMC7153421 DOI: 10.30476/ijcbnm.2020.82278.1049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: The purpose of this study is to construct and validate a measurement model of women’s preferences in Obstetrician
and Gynecologist (OB/GYN) selection in the private sector of non-clinical parameters. Methods: This methodological study included 462 respondents in OB/GYN’s offices to a researcher-made questionnaire.
The patients visited 57 offices of OB/GYNs in the city of Mashhad in Iran and completed women’s preferences in OB/GYN selection
questionnaire over a 2-month period from January to February 2018. Exploratory Factor Analysis (EFA) was conducted to verify the
instrument’s construct validity. Confirmatory Factor Analysis (CFA) was used to test whether the data fit our hypothesized model obtained from EFA model. Results: The first draft of the questionnaire was prepared with 118 items based on literature review. The outcome of content validity
assessment was a 51-item questionnaire. Scale-Content Validity Index (S-CVI) turned out to be 0.80. The results of EFA yielded
an instrument with 33 items in six domains, which explained 52.657% of the total variance of the questionnaire. With performing
CFA, the 6-factor model with 29 items demonstrated a good fit with the data (CFI=0.952, CMIN/DF=1.613, RMSEA=0.036).
Availability and Accessibility, Communicational Skills, Office Environment, Recommendation by Others, Special Services,
and Cost and Insurance were found to define the women’s preferences in OB/GYN selection in private sector, Iran. Conclusion: The developed measurement model considers the patient’s preferences that influence decision-making process on OB/GYN selection.
It can provide useful knowledge for OB/GYNs and policymakers to design appropriate and efficient marketing strategies according to the consumer preferences priority.
Collapse
Affiliation(s)
- Masood Setoodefar
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Tara
- Patient Safety Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Eslami
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Heshmati Nabavi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Najmeh Valizadeh Zare
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyed Hassan Taheri
- Department of Computer Sciences, School of Engineering, Khayyam University, Mashhad, Iran
| | | | - Kobra Etminani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| |
Collapse
|
45
|
Solnick RE, Peyton K, Kraft-Todd G, Safdar B. Effect of Physician Gender and Race on Simulated Patients' Ratings and Confidence in Their Physicians: A Randomized Trial. JAMA Netw Open 2020; 3:e1920511. [PMID: 32083686 PMCID: PMC7043197 DOI: 10.1001/jamanetworkopen.2019.20511] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Women and black physicians encounter workplace challenges because of their gender and race. It is unclear whether these individuals are assessed with lower patient satisfaction or confidence ratings compared with white male physicians. OBJECTIVE To examine whether physician gender and race affect participant ratings in scenarios in which physician competence is challenged. DESIGN, SETTING, AND PARTICIPANTS This randomized trial enrolled a geographically diverse sample of 3592 online respondents in the United States who were recruited from 2 crowdsourcing platforms: Amazon Mechanical Turk (n = 1741) and Lucid (n = 1851). A 2 × 2 factorial design for the gender and race of simulated physicians was conducted between March 9 and July 25, 2018. Participants were excluded before intervention if they were younger than 18 years, were pregnant, or had a history of cancer or abdominal surgical procedures. INTERVENTIONS A clinical vignette was presented to the participant with a picture of the emergency department physician. Participants were randomly assigned to physicians with different gender and race, with 823 assigned to black women, 791 to black men, 828 to white women, and 835 to white men. A contradictory diagnosis from an online symptom checker introduced doubt about the clinical diagnosis. MAIN OUTCOMES AND MEASURES A composite outcome (range, 0-100, with 0 representing low patient confidence and satisfaction and 100 representing the maximum on the composite scale) measured participant (1) confidence in the physician, (2) satisfaction with care, (3) likelihood to recommend the physician, (4) trust in the physician's diagnosis, and (5) likelihood to request additional tests. RESULTS Among 3277 adult participants, complete data were available for 3215 (median age, 49 years [range, 18-89 years]; 1667 [52%] female; 2433 [76%] white). No significant differences were observed in participant satisfaction and physician confidence for the white male physician control physicians (mean composite score, 66.13 [95% CI, 64.76-67.51]) compared with white female (mean composite score, 66.50 [95% CI, 65.19-67.82]), black female (mean composite score, 67.36 [95% CI, 66.03-68.69]), and black male (mean composite score, 66.96 [95% CI, 65.55-68.36]) physicians. Machine learning with bayesian additive regression trees revealed no evidence of treatment effect heterogeneity as a function of participants' race, gender, racial prejudice, or sexism. CONCLUSIONS AND RELEVANCE No significant differences were observed for simulated patients' evaluations of female or black physicians, suggesting that bias in favor of white male physicians is negligible in survey-based measures of patient satisfaction. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04190901.
Collapse
Affiliation(s)
- Rachel E. Solnick
- National Clinical Scholars Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor
| | | | - Gordon Kraft-Todd
- Department of Psychology, Boston College, Chestnut Hill, Massachusetts
| | - Basmah Safdar
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
46
|
Boeckxstaens P, Meskens A, Van der Poorten A, Verpoort AC, Sturgiss EA. Exploring the therapeutic alliance in Belgian family medicine and its association with doctor-patient characteristics: a cross-sectional survey study. BMJ Open 2020; 10:e033710. [PMID: 32029490 PMCID: PMC7045179 DOI: 10.1136/bmjopen-2019-033710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Patient-centred care is related to better health outcomes, greater patient satisfaction and reduced healthcare costs. One of the core components of patient-centred care, defined in the patient-centred clinical method, is enhancing the patient-doctor relationship. In this study, we aim to measure the therapeutic alliance in consultations between patients and family doctors in Belgium, and explore which patient, provider and practice characteristics are associated with the strength of the therapeutic alliance. DESIGN Cross-sectional cohort study using the Working Alliance Inventory for General Practice (WAI-GP). The patients and family doctors completed a survey after the consultation. The survey consisted of the WAI-GP, demographics, consultation characteristics and variables related to the patient-doctor relationship. SETTING Belgian primary care. PARTICIPANTS Every third patient (both practice and house call visits) was invited to participate. 170 patient-doctor dyads from four practices were included. Total of 10 doctors (30% men, age range 24-63 years) and 170 patients (35.9% men, age range 18-92 years). PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was the WAI-GP score and its correlations with characteristics of the doctor (gender, age) and patients (gender, age, chronic disease, number of annual consultations). RESULTS The median WAI-GP score reported after these consultations was 4.5±0.62. Higher WAI-GP scores were reported for consultations with male doctors and by older patients. In the subsample of patients with a chronic illness, higher WAI-GP scores were reported by patients who had more than 10 follow-up consultations per year. CONCLUSIONS Consultation quality is an important aspect of healthcare, but attention is needed to understand how the WAI-GP performs in relation to variables that are beyond control, such as gender of the physician, age of the patient and variables related to building continuity of care. This has implications for the measurement of quality of healthcare.
Collapse
Affiliation(s)
- Pauline Boeckxstaens
- Department of Public Health and Primary Healthcare, Ghent University, Gent, Belgium
| | - Annelou Meskens
- Department of Public Health and Primary Healthcare, Ghent University, Gent, Belgium
| | | | | | - Elizabeth Ann Sturgiss
- Department of General Practice, Monash University, Melbourne, Victoria, Australia
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
47
|
Matsen CB, Ray D, Kaphingst KA, Zhang C, Presson AP, Finlayson SRG. Patient Satisfaction With Decision Making Does Not Correlate With Patient Centeredness of Surgeons. J Surg Res 2020; 246:411-418. [PMID: 31635834 DOI: 10.1016/j.jss.2019.09.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 08/09/2019] [Accepted: 09/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND High-quality decision making is important in patient-centered care. Although patient involvement in decision making varies widely, most patients desire to share in decision making. The Press-Ganey Patient Satisfaction survey includes questions that measure patients' perceptions of their providers' efforts to involve them in decision making (PGDM). We hypothesized that higher PGDM scores would correlate with higher scores on a validated measure of patient centeredness. MATERIALS AND METHODS Surgical providers at a university hospital who routinely receive Press-Ganey scores received a survey that included the Patient-Practitioner Orientation Scale (PPOS), a validated tool that measures the provider's orientation toward patient centeredness on a continuous six-point scale: score ≥5 = high, 4.57-5 = moderate, and <4.57 = low and includes nine-item "caring" or "sharing" subscales. We compared PPOS scores to PGDM scores, averaged from April 2015 to January 2016. RESULTS Eighty-six of 112 (75%) of surgical providers responded to the survey. Fifty-two (46%) had PGDM scores available and 26% achieved a perfect score on the PGDM. The overall PPOS scores were low, with a mean of 4.2 (SD = 0.5). The PPOS was not correlated with the PGDM, correlation coefficient (rs) = -0.07 (CI: -0.34-0.21, P = 0.63). Similarly, the two subscales of the PPOS did not correlate with the PGDM with rs = -0.15 (CI: -0.41-0.13, P = 0.29) for "caring" and rs = -0.04 (CI: -0.31-0.23, P = 0.76) for "sharing". CONCLUSIONS Although surgical providers scored low in patient centeredness using the PPOS, over one-quarter (26%) of them rank in the top 1% on the PGDM. No correlation was found between providers' patient centeredness and their patients' perceptions of efforts to include them in decision making.
Collapse
Affiliation(s)
- Cindy B Matsen
- Department of Surgery, University of Utah, Salt Lake City, Utah.
| | - David Ray
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Kimberly A Kaphingst
- Department of Communication, University of Utah College of Humanities, Salt Lake City, Utah
| | - Chong Zhang
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - Angela P Presson
- Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | | |
Collapse
|
48
|
Stephens AR, Rowberry TJ, Tyser AR, Kazmers NH. Evaluating opportunities for improved orthopedics outpatient satisfaction: an analysis of Press Ganey® Outpatient Medical Practice Survey responses. J Orthop Surg Res 2020; 15:28. [PMID: 31992339 PMCID: PMC6986136 DOI: 10.1186/s13018-020-1567-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 01/21/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION The Press Ganey® Outpatient Medical Practice Survey (PGOMPS) is composed of 10 provider-specific and 15 non-provider-specific questions. Some healthcare systems link PGOMS overall scores to physician reimbursements. The aim of this study was to determine the frequency of patient satisfaction across individual PGOMPS question, the null hypothesis being that there was no variability between the frequency of satisfaction and similar questions. METHODS We reviewed all new patient orthopedic PGOMPS scores between January 2014 and December 2017. Due to the large ceiling effect, satisfaction was defined as a perfect total score. The frequency of perfect scores for each question was calculated. RESULTS Five thousand one hundred sixty-three patients met the inclusion criteria. Two thousand two hundred sixty-six (43.89%) provider-specific questions received perfect satisfaction versus 986 (19.10%) with perfect satisfaction for non-provider-specific questions (p < 0.001). The five questions most likely to receive perfect satisfaction were MD friendliness/courtesy (80.36), MD spoke using clear language (80.35%), likelihood to recommend practice (79.11%), likelihood to recommend MD (78.8%), and MD confidence (78.74%). The five least likely were convenience of office hours (60.44%), ease of getting on phone (59.72%), ability to get desired appointment (59.50%), wait time (54.63%), and information about delays (53.80%). CONCLUSIONS Our results suggest that the majority of orthopedic patients are satisfied with their provider, demonstrating that room for improvement is limited with provider-specific areas. Leaders of health care teams should consider these results when seeking to improve patient satisfaction scores and determining how and if scores should be linked to reimbursements.
Collapse
Affiliation(s)
- Andrew R Stephens
- University of Utah, School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Tyson J Rowberry
- University of Utah, School of Medicine, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| |
Collapse
|
49
|
Steinmetz L, Vasquez-Montes D, Johnson BC, Buckland AJ, Goldstein JA, Bendo JA, Errico TJ, Fischer CR. Modifiable and nonmodifiable factors associated with patient satisfaction in spine surgery and other orthopaedic subspecialties: A retrospective survey analysis. CURRENT ORTHOPAEDIC PRACTICE 2019. [DOI: 10.1097/bco.0000000000000800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Tracy LF, Jabbour N, Rubin BR, Sobin LB, Lawlor CM, Basa KC, Levi JR, Tracy JC. Satisfaction in Academic Otolaryngology: Do Physician Demographics Impact Press Ganey Survey Scores? Laryngoscope 2019; 130:1902-1906. [DOI: 10.1002/lary.28335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/03/2019] [Accepted: 09/10/2019] [Indexed: 11/05/2022]
Affiliation(s)
- Lauren F. Tracy
- Department of Otolaryngology–Head and Neck Surgery Boston University School of Medicine Boston Massachusetts
| | - Nicolette Jabbour
- Boston Medical Center Boston University School of Medicine Boston Massachusetts
| | - Batsheva R. Rubin
- Boston Medical Center Boston University School of Medicine Boston Massachusetts
- Boston University School of Public Health Boston Massachusetts
| | - Lindsay B. Sobin
- Department of Otolaryngology–Head and Neck Surgery University of Massachusetts Amherst Massachusetts
| | - Claire M. Lawlor
- Department of Otolaryngology–Head and Neck Surgery Children's National Health System, George Washington University Washington DC
| | - Krystyne C. Basa
- Department of Otolaryngology–Head and Neck Surgery Boston University School of Medicine Boston Massachusetts
| | - Jessica R. Levi
- Department of Otolaryngology–Head and Neck Surgery Boston University School of Medicine Boston Massachusetts
| | - Jeremiah C. Tracy
- Department of Otolaryngology–Head and Neck Surgery University of Massachusetts Amherst Massachusetts
| |
Collapse
|