Predicting patient intent to return from satisfaction scores

Safety net patients' satisfaction with oral health services by provider type and intent to return for more care

OBJECTIVES

This study examined patients' satisfaction with services provided by different oral health providers, their intent to return for additional care, and associations with patients' demographics and service characteristics.

METHODS

Descriptive analyses and multivariable ordinal logistic regressions were conducted using survey data from 898 patients who received care at Apple Tree Dental (ATD) in Minnesota during 2021. The questionnaire included 12 statements on patient satisfaction with the clinician's ability to explain the dental diagnosis and treatment options, to be considerate of the patient's needs and dental anxiety, and to provide technically competent services.

RESULTS

In general, patients reported high satisfaction with dental care and a strong intent to return to ATD for future services. No significant differences in patient satisfaction were observed by provider type. Patients' intent to return was higher among non-White respondents (OR = 1.76; 95% CI = 1.06-2.92) and patients who were more satisfied with their providers' technical competence/treatment (OR = 1.47; 95% CI = 1.37-1.57). The association between intent to return and patient satisfaction with providers' information/communication was stronger for patients treated by dental hygienists. The association between intent to return and patient satisfaction with providers' technical competence/treatment was also stronger for patients who were more satisfied with providers' information/communication and understanding/acceptance, and for those treated by their desired or usual provider.

CONCLUSIONS

The study underscores the benefits of introducing dental therapists to the oral healthcare team, showing that this can be achieved without sacrificing either the quality of patient care or patient satisfaction.

Patient experiences after implementing lean primary care redesigns

OBJECTIVE

To examine the effect of Lean primary care redesigns on patient satisfaction with care and timeliness of care received.

DATA/SETTING

We used patient surveys and time-stamped electronic health record (EHR) data in a large ambulatory care system.

DESIGN

Lean-based changes to clinical spaces and care team workflows were implemented in one pilot site and then scaled to all primary care departments across the system. Redesigns included standardizing equipment and patient education materials in examination rooms, streamlining call management functions, co-locating physician and medical assistant dyads in a shared workspace, and creating new care team workflows. We used a non-randomized stepped-wedge study design and segmented regression with interrupted time series analysis to examine Lean impacts on patient outcomes.

DATA COLLECTION

We analyzed patient satisfaction ratings and wait times as documented by the EHR. These longitudinal data were collected for 317 physician-led teams in 46 primary care departments from January 2011 to December 2016.

PRINCIPAL FINDINGS

After implementation of Lean redesigns, patients reported a 44.8 percent increase in satisfaction with the adequacy of time spent with care providers during office visits (P < .05). They also reported 71.6 percent higher satisfaction with their care provider's ability to listen to their concerns, and a 55.4 percent increase in perceived staff helpfulness at the visit (P < .01). Based on monthly EHR data, the amount of time elapsed between a patient request for a routine appointment and the scheduled visit day decreased from baseline by an average 2 percent per month (P < .01). On the day of the visit, patient wait times to be seen also decreased gradually by an average 1.2 percent per month (P < .05).

CONCLUSIONS

Patient experiences of care after Lean implementations have not been widely studied in primary care settings. We found that Lean redesign yielded improvements that may strengthen clinical operations while enhancing value for patients.

Predictors of Patient Satisfaction in Hand and Upper Extremity Clinics

Introduction  Patient satisfaction is an important clinical marker for hand/upper extremity patients. Few studies have investigated the predictors of patient satisfaction in the clinic setting. Our objective was to analyze patient satisfaction surveys to explore factors that influence patient satisfaction. Materials and Methods  We conducted a retrospective analysis assessing patient satisfaction in the hand/upper extremity clinics at our university medical center between 2012 and 2018. Patient satisfaction was assessed via Press Ganey Hospital Consumer Assessment of Healthcare Providers and Systems surveys. Patient demographics, satisfaction scores, and clinic experience questionnaire responses were evaluated. Statistical analysis was conducted to identify significant trends. Results  Between 2012 and 2018, 102 surveys were completed. Scores ranged from 5 to 10 with an average provider rating of 9.56. We found six factors significantly influenced patient satisfaction: adequate time was spent with the provider, provider showed respect, patient was seen by provider within 15 minutes of appointment time, provider listened sufficiently, patient received understandable medical instructions, and understandable medical explanations ( p < 0.05). Conclusion  Achieving patient satisfaction is an important clinical marker in hand/upper extremity clinics. Patient satisfaction has defined predictors wherein various clinical factors can influence patient satisfaction and willingness to refer their provider to other patients.

Patient satisfaction and perceived quality of care: evidence from a cross-sectional national exit survey of HIV and non-HIV service users in Zambia

OBJECTIVE

To examine the associations between perceived quality of care and patient satisfaction among HIV and non-HIV patients in Zambia.

SETTING

Patient exit survey conducted at 104 primary, secondary and tertiary health clinics across 16 Zambian districts.

PARTICIPANTS

2789 exiting patients.

PRIMARY INDEPENDENT VARIABLES

Five dimensions of perceived quality of care (health personnel practice and conduct, adequacy of resources and services, healthcare delivery, accessibility of care, and cost of care).

SECONDARY INDEPENDENT VARIABLES

Respondent, visit-related, and facility characteristics.

PRIMARY OUTCOME MEASURE

Patient satisfaction measured on a 1-10 scale.

METHODS

Indices of perceived quality of care were modelled using principal component analysis. Statistical associations between perceived quality of care and patient satisfaction were examined using random-effect ordered logistic regression models, adjusting for demographic, socioeconomic, visit and facility characteristics.

RESULTS

Average satisfaction was 6.9 on a 10-point scale for non-HIV services and 7.3 for HIV services. Favourable perceptions of health personnel conduct were associated with higher odds of overall satisfaction for non-HIV (OR=3.53, 95% CI 2.34 to 5.33) and HIV (OR=11.00, 95% CI 3.97 to 30.51) visits. Better perceptions of resources and services were also associated with higher odds of satisfaction for both non-HIV (OR=1.66, 95% CI 1.08 to 2.55) and HIV (OR=4.68, 95% CI 1.81 to 12.10) visits. Two additional dimensions of perceived quality of care--healthcare delivery and accessibility of care--were positively associated with higher satisfaction for non-HIV patients. The odds of overall satisfaction were lower in rural facilities for non-HIV patients (OR 0.69; 95% CI 0.48 to 0.99) and HIV patients (OR=0.26, 95% CI 0.16 to 0.41). For non-HIV patients, the odds of satisfaction were greater in hospitals compared with health centres/posts (OR 1.78; 95% CI 1.27 to 2.48) and lower at publicly-managed facilities (OR=0.41, 95% CI=0.27 to 0.64).

CONCLUSIONS

Perceived quality of care is an important driver of patient satisfaction with health service delivery in Zambia.

Optimizing appointment template and number of staff of an OB/GYN clinic--micro and macro simulation analyses

Background

The Department of Obstetrics and Gynecology (OB/GYN) at the University of Arkansas for Medical Sciences (UAMS) tested various, new system-restructuring ideas such as varying number of different types of nurses to reduce patient wait times for its outpatient clinic, often with little or no effect on waiting time. Witnessing little progress despite these time-intensive interventions, we sought an alternative way to intervene the clinic without affecting the normal clinic operations.

Aim

The aim is to identify the optimal (1) time duration between appointments and (2) number of nurses to reduce wait time of patients in the clinic.

Methods

We developed a discrete-event computer simulation model for the OB/GYN clinic. By using the patient tracker (PT) data, appropriate probability distributions of service times of staff were fitted to model different variability in staff service times. These distributions were used to fine-tune the simulation model. We then validated the model by comparing the simulated wait times with the actual wait times calculated from the PT data. The validated model was then used to carry out “what-if” analyses.

Results

The best scenario yielded 16 min between morning appointments, 19 min between afternoon appointments, and addition of one medical assistant. Besides removing all peak wait times and bottlenecks around noon and late in the afternoon, the best scenario yielded 39.84 % (p<.001), 30.31 % (p<.001), and 15.12 % (p<.001) improvement in patients’ average wait times for providers in the exam rooms, average total wait time at various locations and average total spent time in the clinic, respectively. This is achieved without any compromise in the utilization of the staff and in serving all patients by 5pm.

Conclusions

A discrete-event simulation model is developed, validated, and used to carry out “what-if” scenarios to identify the optimal time between appointments and number of nurses. Using the model, we achieved a significant improvement in wait time of patients in the clinic, which the clinic management initially had difficulty achieving through manual interventions. The model provides a tool for the clinic management to test new ideas to improve the performance of other UAMS OB/GYN clinics.

Time Seeing a Hand Surgeon Is Not Associated With Patient Satisfaction

BACKGROUND

Previous studies, predominantly in the primary care setting, identified time spent with the physician as an important predictor of satisfaction. It is unknown if the same holds true in hand surgery.

QUESTIONS/PURPOSES

Is patient satisfaction measured immediately after an office visit associated with the duration of time spent with the hand surgeon? What other factors are associated with satisfaction directly after the visits and 2 weeks after the appointment?

METHODS

We prospectively enrolled 81 patients visiting our hand and upper extremity surgery outpatient clinic. We recorded their demographics and measured physical function, pain behavior, symptoms of depression, time spent in the waiting room, time spent with the physician, and patient satisfaction. Office times were measured using our patient ambulatory tracking system and by a research assistant outside the clinic room. To assess satisfaction we used items from the Consumer Assessment of Healthcare Providers and Systems survey (a federally developed standardized survey instrument) relevant to our study. Two weeks later, 51 (64%) patients were available for telephone followup and the same measures were completed. Mean time spent with the hand surgeon was 8 ± 5 minutes and mean in-office wait time to see the hand surgeon was 32 ± 18 minutes. A priori power analyses indicated that 77 patients would provide 80% power to detect an effect size f(2) = 0.18 for a regression with five predictors. This means that we would detect time spent with the physician as a significant factor if it accounted for 7% or more of the variability in satisfaction.

RESULTS

Time spent with the hand surgeon was not associated with patient satisfaction measured directly after the visit (r = -0.023; p = 0.84). Longer time waiting to see the physician correlated with decreased patient satisfaction (r = -0.30; p = 0.0057). The final multivariable model for increased satisfaction directly after the office visit included shorter waiting time (regression coefficient [β] -0.0014; partial R(2) 0.094; 95% confidence interval [CI], -0.0024 to -0.00042; p = 0.006) and being married/living with a partner (β 0.057; partial R(2) 0.11; 95% CI, 0.021-0.093; p = 0.002 [adjusted R(2) 0.18; p < 0.001]). Similarly, multivariable analysis found higher patient satisfaction 2 weeks after the visit to be independently associated with shorter waiting time (β -0.0037; partial R(2) 0.10; 95% CI, -0.0070 to -0.00054; p = 0.023) and being married/living with a partner (β 0.15; partial R(2) 0.12; 95% CI, 0.033-0.26; p = 0.012 [adjusted R(2) 0.16; p = 0.0052]).

CONCLUSIONS

Patient satisfaction among patients undergoing hand surgery may relate more to shorter time in the waiting room and to the quality more than the quantity of time spent with the patient.

LEVEL OF EVIDENCE

Level II, prognostic study.

Toward Continuous Primary Care in the United States: Differences in Patient Satisfaction Between First and Return Visits to Primary Care Physicians/Analysis of DrScore--The National e-Survey Data

BACKGROUND

As stated by Donabedian, the father of quality assurance, satisfaction is an integral component of quality in medical care. Patient satisfaction is an important predictor of health-related behaviors, use of medical services, and health outcomes. Impressive literature exists in examining various aspects of patient satisfaction, however, no study thus far has examined differences in patient satisfaction between first and return visits to primary care physicians.

OBJECTIVE

Our interest is to determine whether there are differences in patient satisfaction between first and return visits to primary care physicians, with the hypothesis that patients returning for their visits have a higher satisfaction level compared to their first initial visit.

METHODS

The authors conducted a cross-sectional analysis of the national Web-based survey DrScore. Via DrScore, patients anonymously rated their physician on the basis of treatment satisfaction received from their most recent outpatient visit. The association between physician satisfaction and total care patient ratings of first and return visits was assessed via regression analysis.

RESULTS

In total, 15,341 patients were included in this study. Our findings indicate that for a 1-unit change from first visit to return visits, the coefficient of patient satisfaction for the return visits is approximately 10 times higher compared to that of the first visit. Furthermore, the mean satisfaction score for the return visit group is higher than that for the first visit group, 80.28 versus 64.48, respectively (P < .05).

CONCLUSION

Return visits to primary care physicians are associated with higher patient satisfaction compared to the first initial visit.

Patient satisfaction with nurse practitioner-delivered primary healthcare services

PURPOSE

To identify levels of satisfaction with nurse practitioner (NP)-delivered primary healthcare services and to determine demographic differences in degrees of general satisfaction reported by patients.

DATA SOURCES

The Nurse Practitioner Satisfaction Survey (NPSS), a 28-item, 5-point, Likert-type survey instrument was developed; data from 300 female and male clients over 18 years of age presenting for primary healthcare visits at the employee health department of a not-for-profit hospital in the Southern United States were analyzed.

CONCLUSIONS

Although many studies using a variety of healthcare-related patient satisfaction instruments have demonstrated acceptable patient satisfaction with NPs, few have investigated patient satisfaction with NPs in the outpatient primary care occupational health arena. Overall the population seeking health care was satisfied with NP services. In particular, married or cohabitating subjects reported general satisfaction scores that were statistically significantly higher than those who were single and never married. No other differences were found.

IMPLICATIONS FOR PRACTICE

The provision of on-site, employer-sponsored NP primary healthcare services that are perceived as acceptable and satisfactory to employees and families affords significant opportunity and advantage to both employee and employer. Such benefits include enhanced employee and family wellness, facilitated health promotion, enhanced access to care, reduced illness related to time away from work, improved employee productivity, and reduced overall organizational healthcare costs. Knowledge regarding those characteristics contributing to general satisfaction with NP-delivered care serves to facilitate practice pattern changes within the profession that further enhances the visibility, utilization, and acceptability of NPs as primary care providers.

Development and preliminary validation of the MedRisk instrument to measure patient satisfaction with chiropractic care

OBJECTIVE

The purpose of this study is to provide preliminary information regarding the factor-structure, group- and individual-level reliability, and criterion-referenced validity of measures obtained from the MedRisk Instrument for Measuring Patient Satisfaction with Chiropractic Care.

METHOD

Three hundred twenty-three subjects who had completed a course of chiropractic care responded to questionnaire in which they rated their degree of satisfaction from 1 to 5 (1 = very unsatisfied to 5 = very satisfied) for each of 20 items. Factor structure was assessed using item-correlation and exploratory factor analysis. Group-level reliability for single test administration was assessed by calculating Cronbach α, and individual-level reliability was determined using the standard error of measure. Criterion-referenced validity was investigated by comparing the item scores and mean scores of individual factors to global measures of satisfaction.

RESULTS

Individual item scores ranged from 3.98 for "Office location was convenient" to 4.77 for "My chiropractor treats me respectfully." The items that were most highly correlated with overall patient satisfaction were "My chiropractor thoroughly explained the treatment I received" (r = 0.77) and "My chiropractor answered all of my questions" (r = 0.71). Exploratory factor analysis suggested a 2-factor solution: a 5-item "internal" factor and a 6-item "external" factor. The mean scores from these factors were correlated with the 2 global measures ranging from r = 0.68 to r = 0.80. The standard error of measure was 0.20 for the internal factor and 0.17 for the external factor.

CONCLUSIONS

Preliminary assessment suggests that a 13-item version of the MedRisk instrument provides psychometrically sound measures to assess patient satisfaction with chiropractic care; however, additional confirmatory validation should be performed.

The relationship between patient satisfaction with physical therapy care and global rating of change reported by patients receiving worker's compensation

This study examined relationships between patient satisfaction with physical therapy care and global rating of change; 1,944 respondents completed the Medrisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MR-12) and a nine-point Global Rating of Change Scale (GROC) following a course of physical therapy for a work-related musculoskeletal problem. Ninety percent of all respondents reported being satisfied or very satisfied with their overall care, whereas 70.1% of all respondents indicated they improved following treatment. Respondents who reported improvement had significantly higher scores for all measures of satisfaction (p<0.01) than did those who reported failure to improve; however, both of these groups had mean scores of greater than 4.0 on the MR-12, indicating that respondents were likely to be satisfied or very satisfied with care regardless of perceived change following treatment. Scores>4.0 from the MR-12 had high sensitivity to detect those respondents classified as "improved" (0.87-0.95), but low specificity to differentiate between those who were classified as "improved" and those who were classified as "did not improve" (0.22-0.30). Our findings support the hypothesis that patient satisfaction with care is primarily independent of perceived clinical change.

Spanish-language version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS): preliminary validation

BACKGROUND AND PURPOSE

An instrument that provides valid measurements of satisfaction with physical therapy care for Spanish-speaking patients will enhance communication and ensure their representation in quality assurance analyses and research on health care disparities. The purpose of this investigation was to provide preliminary information on the factor structure, group- and individual-level reliability, and criterion-referenced validity of measurements obtained from a Spanish-language version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS).

SUBJECTS

A total of 203 Spanish-speaking patients in the New York City area participated in this study.

METHODS

Consenting subjects completed a 20-item MRPS after discharge from outpatient physical therapy care. Several translators performed "forward" and "backward" translation of the MRPS, followed by consensus agreement on item structure. Factor structure was investigated using item-correlation and exploratory factor analysis. Group-level reliability for single test administration was assessed using the Cronbach alpha, and individual-level reliability was assessed by calculating the standard error of the measure (SEM). Concurrent validity was tested by comparing the item scores and mean scores of factors to global measures of satisfaction.

RESULTS

The means of individual item scores (1-5) ranged from 3.22 for "I did not wait too long" to 4.80 for "My therapist treated me respectfully." There were no sex-based differences in item scores. Exploratory factor analysis suggested a 2-factor solution: a 7-item "external" factor and a 3-item "internal" factor. The correlations (r) of the mean scores from these factors with the 2 global measures ranged from .59 to .82. The SEM was 0.16 for the internal factor and 0.25 for the external factor.

DISCUSSION AND CONCLUSION

The underlying factor structure of the Spanish-language version of the MRPS was identical to the English-language version. Our findings provide preliminary support for the reliability and validity of measurements obtained from the Spanish-language version of the MRPS. Further study is needed to assess the stability of these findings in other samples. As with English-speaking patients, Spanish-speaking patient's satisfaction with physical therapy care is most strongly linked to the professional behavior of the clinician.

Willing to wait?: the influence of patient wait time on satisfaction with primary care

Background

This study examined the relationship between patient waiting time and willingness to return for care and patient satisfaction ratings with primary care physicians.

Methods

Cross-sectional survey data on a convenience sample of 5,030 patients who rated their physicians on a web-based survey developed to collect detailed information on patient experiences with health care. The survey included self-reported information on wait times, time spent with doctor, and patient satisfaction.

Results

Longer waiting times were associated with lower patient satisfaction (p < 0.05), however, time spent with the physician was the strongest predictor of patient satisfaction. The decrement in satisfaction associated with long waiting times is substantially reduced with increased time spent with the physician (5 minutes or more). Importantly, the combination of long waiting time to see the doctor and having a short doctor visit is associated with very low overall patient satisfaction.

Conclusion

The time spent with the physician is a stronger predictor of patient satisfaction than is the time spent in the waiting room. These results suggest that shortening patient waiting times at the expense of time spent with the patient to improve patient satisfaction scores would be counter-productive.

Optimizing management and financial performance of the teaching ambulatory care clinic

OBJECTIVE

To examine how to optimize teaching ambulatory care clinics performance with regard to access to care, access to teaching, and financial viability.

DESIGN

Optimization analysis using computer simulation.

METHODS

A discrete-event simulation model of the teaching ambulatory clinic setting was developed. This method captures flow time, waiting time, competition for resources, and the interdependency of events, providing insight into system dynamics. Sensitivity analyses were performed on staffing levels, room availability, patient characteristics such as "new" versus "established" status, and clinical complexity and pertinent probabilities.

MAIN RESULTS

In the base-case, 4 trainees:preceptor, patient flow time (registration to check out) was 148 minutes (SD 5), wait time was 20.6 minutes (SD 4.4), the wait for precepting was 6.2 minutes (SD 1.2), and average daily net clinic income was $1,413. Utilization rates were preceptors (59%), trainees (61%), medical assistants (64%), and room (68%). Flow time and the wait times remained relatively constant for strategies with trainee:preceptor ratios <4:1 but increased with number of trainees steadily thereafter. Maximum revenue occurred with 3 preceptors and 5 trainees per preceptor. The model was relatively insensitive to the proportion of patients presenting who were new, and relatively sensitive to average evaluation and management (E/M) level. Flow and wait times rose on average by 0.05 minutes and 0.01 minutes per percent new patient, respectively. For each increase in average E/M level, flow time increased 8.4 minutes, wait time 1.2 minutes, wait for precepting 0.8 minutes, and net income increased by $490.

CONCLUSION

Teaching ambulatory care clinics appear to operate optimally, minimizing flow time and waiting time while maximizing revenue, with trainee-to-preceptor ratios between 3 and 7 to 1.