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Liu AQ, McNeely BD, Prisman E, Hu A. Patient-Reported Decisional Regret After Operative Otolaryngology Procedures: A Scoping Review. Laryngoscope 2024; 134:2562-2567. [PMID: 37947296 DOI: 10.1002/lary.31176] [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: 05/13/2023] [Revised: 10/10/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE To review the published literature on decisional regret in adult patients undergoing operative otolaryngology procedures. The primary outcome was decisional regret scale (DRS) scores. DRS scores of 0 indicate no regret, 1-25 mild regret, and >25 moderate to strong/severe regret. DATA SOURCES A comprehensive librarian-designed strategy was used to search MEDLINE, Embase, and CINAHL from inception to September 2023. REVIEW METHODS Inclusion criteria consisted of English-language studies of adult patients who underwent operative otolaryngology treatments and reported DRS scores. Data was extracted by two independent reviewers. Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. Oxford Centre's Levels of Evidence were used for quality assessment. RESULTS In total, 6306 studies were screened by two independent reviewers; 13 studies were included after full-text analysis. Subspecialties comprised: Head and neck (10), endocrine (1), general (1), and rhinology (1). The DRS results of the included studies spanned a mean range of 10.1-23.9 or a median range of 0-20.0. There was a trend toward more decisional regret after large head and neck procedures or when patients underwent multiple treatment modalities. Depression, anxiety, and patient-reported quality of life measures were all correlated with decisional regret. Oxford Centre's Levels of Evidence ranged from 2 to 4. CONCLUSION This is the first comprehensive review of decisional regret in otolaryngology. The majority of patients had no or mild (DRS <25) decisional regret after otolaryngology treatments. Future research on pre-operative counseling and shared decision-making to further minimize patient decisional regret is warranted. LEVEL OF EVIDENCE N/A Laryngoscope, 134:2562-2567, 2024.
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Affiliation(s)
- Alice Q Liu
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brendan D McNeely
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eitan Prisman
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amanda Hu
- Division of Otolaryngology Head & Neck Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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Al-Aroomi MA, Al-Worafi NA, Ma Y, Alkebsi K, Mohamed AAS, Jiang C. Patient-reported outcomes after oral cancer reconstructions with radial and ulnar forearm-free flaps. Oral Dis 2024. [PMID: 38696366 DOI: 10.1111/odi.14968] [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: 01/09/2024] [Revised: 04/05/2024] [Accepted: 04/09/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES This study aimed to evaluate patient-reported quality of life and incidence of decision regret in patients undergoing radial (RFFF) and ulnar forearm-free flaps (UFFF) reconstruction. MATERIALS AND METHODS Patients undergoing either RFFF or UFFF were assessed with the University of Washington Quality of Life (UW-QOL) and Oral Health Impact Profile (OHIP-14) questionnaires, and the Decision Regret Scale (DRS), both before and at least 12 months post-reconstruction. RESULTS In total, 40 RFFF and 40 UFFF were included. Harvesting time was longer in RFFF (p = 0.043), and the donor-site defect was significantly larger in RFFF than in UFFF (p = 0.044). Patients with UFFF scored better UW-QOL in the appearance, pain, activity, mood, and social functioning domains (p < 0.05). However, the RFFF group excelled in swallowing and chewing domains. The DRS score revealed a significant difference between RFFF and UFFF, with scores of 36.26 versus 27.36, respectively. Moreover, the mean DRS score reduced at 12 months compared with 6 months, significantly superior for UFFF. CONCLUSION Oral cancer patients reconstructed with UFFF exhibited a better appearance, social domain, and mild decision regret compared with RFFF, indicating that the UFFF may contribute to improving postoperative quality of life in oral cancer patients.
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Affiliation(s)
- Maged Ali Al-Aroomi
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China
- Faculty of Dentistry, Ibb University, Ibb, Yemen
| | | | - Yujie Ma
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China
| | | | | | - Canhua Jiang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, China
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Rogers MJ, Ou Z, Clawson JW, Presson AP, Stockburger CL, Kazmers NH. The Relationship Between Patient-Reported Outcomes and Patient Satisfaction With Ligament Reconstruction Tendon Interposition. J Hand Surg Am 2023; 48:1218-1228. [PMID: 37737802 PMCID: PMC10841050 DOI: 10.1016/j.jhsa.2023.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 08/10/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE Achieving the minimal clinically important difference (MCID) on an outcomes instrument and reporting satisfaction with surgical outcomes are not equivalent. We hypothesized that improvement exceeding the QuickDASH and PROMIS UE CAT MCID is associated with a greater likelihood of reporting satisfaction with ligament reconstruction tendon interposition (LRTI) treatment. Our secondary hypothesis was that a subset of patients failing to meet MCID would still be satisfied. METHODS Patients ≥1 year after LRTI at one academic tertiary institution were included. QuickDASH and UE CAT v1.2 scores were obtained before and after surgery. Postoperative satisfaction and levels of improvement in pain and function were also obtained. RESULTS A total of 93 patients completed the QuickDASH, and of those, 90 also completed the UE CAT. At a mean of 2.6 ± 1.0 years after surgery, QuickDASH and UE CAT score improvement exceeded the previously published MCID estimates of 8.8 and 4.8. Although 90% (84/93) of the patients reported satisfaction, only 85% (72/93) and 72% (59/90) achieved MCID on the QuickDASH and UE CAT, respectively. Using the MCID estimate of 8.8, 96% (72/75) of the patients meeting the MCID were satisfied with their treatment. Those failing to achieve MCID reported significantly less physical function and pain improvement; however, most were satisfied nonetheless (68% [13/19] for QuickDASH, 77% [23/30] for UE CAT). CONCLUSIONS Achieving published MCID thresholds on the QuickDASH and PROMIS UE CAT v1.2 was predictive of patients reporting general satisfaction with their LRTI outcome ≥1 year after surgery. Most patients failing to achieve MCID still reported satisfaction with their LRTI. Achieving MCID thresholds alone should not be used as a surrogate for patient satisfaction with their treatment. Patient satisfaction is a complicated construct that is potentially very different from that of high-quality care. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic IV.
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Affiliation(s)
- Miranda J Rogers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Zhining Ou
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | - Jordan W Clawson
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT
| | - Angela P Presson
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT
| | | | - Nikolas H Kazmers
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT.
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Patient Satisfaction with Healthcare Services and the Techniques Used for its Assessment: A Systematic Literature Review and a Bibliometric Analysis. Healthcare (Basel) 2023; 11:healthcare11050639. [PMID: 36900644 PMCID: PMC10001171 DOI: 10.3390/healthcare11050639] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
Patient satisfaction with healthcare provision services and the factors influencing it are be-coming the main focus of many scientific studies. Assuring the quality of the provided services is essential for the fulfillment of patients' expectations and needs. Thus, this systematic review seeks to find the determinants of patient satisfaction in a global setting. We perform an analysis to evaluate the collected literature and to fulfill the literature gap of bibliometric analysis within this theme. This review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) approach. We conducted our database search in Scopus, Web of Science, and PubMed in June 2022. Studies from 2000-2021 that followed the inclusion and exclusion criteria and that were written in English were included in the sample. We ended up with 157 articles to review. A co-citation and bibliographic coupling analysis were employed to find the most relevant sources, authors, and documents. We divided the factors influencing patient satisfaction into criteria and explanatory variables. Medical care, communication with the patient, and patient's age are among the most critical factors for researchers. The bibliometric analysis revealed the countries, institutions, documents, authors, and sources most productive and significant in patient satisfaction.
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Otto B, Borzikowsky C, Flörke C, Purz N, Hertrampf K. The influence of diagnoses on patient satisfaction during inpatient stays: A prospective study. J Craniomaxillofac Surg 2023; 51:16-23. [PMID: 36737378 DOI: 10.1016/j.jcms.2023.01.013] [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: 12/21/2021] [Revised: 01/15/2023] [Accepted: 01/25/2023] [Indexed: 01/30/2023] Open
Abstract
The aim of this study was to assess patient satisfaction relating to inpatient stays. In this prospective observational study, adult patients with oncological (oral cancer, medication-related osteonecrosis of the jaw) and non-oncological (mandibular fracture) diagnoses, and who had undergone surgery, were contacted 4 weeks after discharge. Two validated questionnaires were used: EORTC QLQ-C30 for quality of life and IN-PATSAT32 for patient satisfaction. For quality of life, the mandibular fracture group had a lower impairment of physical functioning (M = 83.59, SD = 24.44; p = 0.029) in comparison with both other groups (M = 68.84, SD = 26.24; M = 59.33, SD = 24.43, for oral cancer and osteonecrosis, respectively). Regarding patient satisfaction, patients with oral cancer were slightly more satisfied with doctors' availability (M = 48.91, SD = 24.11; p = 0.583) compared with the other groups (M = 36.54, SD = 19.11; M = 46.67, SD = 20.86, for mandibular fracture and ostenecrosis, respectively). Patients with an unplanned inpatient stay following an acute event tended to be less satisfied than patients with a planned inpatient stay. Within the limitations of the study it seems that knowledge of these influencing external factors and their effects can support physicians and nursing staff in providing improved patient care.
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Affiliation(s)
- Bente Otto
- Department of Prosthodontics, Propedeutics and Dental Materials, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Building B, D-24105, Kiel, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University, University Hospital of Schleswig-Holstein, Campus Kiel, Brunswiker Str. 10, 24105, Kiel, Germany
| | - Christian Flörke
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Building B, D-24105, Kiel, Germany
| | - Nicolai Purz
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Building B, D-24105, Kiel, Germany
| | - Katrin Hertrampf
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Arnold-Heller-Str. 3, Building B, D-24105, Kiel, Germany.
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Almutairi M, McKenna G, O'Neill C. Satisfaction with dental care services in Great Britain 1998-2019. BMC Oral Health 2022; 22:308. [PMID: 35883074 PMCID: PMC9315088 DOI: 10.1186/s12903-022-02343-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background Satisfaction with dental services can provide valuable insights into aspects of quality including access as well as changes in this over time. In the UK publicly funded dental services are ostensibly delivered by private sector general dental practitioners for whom private patients represent an opportunity cost to the provision of care to public patients. This study examined changes in satisfaction as economic circumstances and policy changed in Britain between 1998 and 2019. Methods Data were taken from successive waves of the British Social Attitudes Survey a representative cross-sectional survey of the population between 1998 and 2019. Descriptive statistics and a series of logistic regression analyses were used to examine the relationships between satisfaction and a range of socio-demographic characteristics over time. Results 37,328 usable responses were extracted from the survey spanning 21 years of data. Over the course of the survey approximately 71% of the sample was very satisfied, satisfied or neither satisfied nor dissatisfied with publicly funded dental services. Satisfaction fell at the outset of the study period but rose following the economic downturn from 2008 which coincided with increased use of publicly funded services. Differences were evident in satisfaction between older versus younger respondents, more affluent versus less affluent respondents and better educated versus less well-educated respondents. Satisfaction did not appear to change in response to policy changes. Conclusion Satisfaction is an important outcome of service provision. Policies aiming to improve satisfaction with publicly funded dental care in the UK must take account of the competing demands on dentists’ time from private patients. At times of economic expansion or when supply has been disrupted, these may be particularly acute and require specific interventions to improve access for those who depend on public services. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02343-7.
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Affiliation(s)
- Majed Almutairi
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK. .,Public Health Department, School of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia.
| | - Gerry McKenna
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Ciaran O'Neill
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
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González-Martín S, Becerro-de-Bengoa-Vallejo R, Rodríguez-García M, Losa-Iglesias ME, Mazoteras-Pardo V, Palomo-López P, Rodríguez-Sanz D, Calvo-Lobo C, López-López D. Influence on Depression, Anxiety, and Satisfaction of the Relatives' Visit to Intensive Care Units prior to Hospital Admission for Elective Cardiac Surgery: A Randomized Clinical Trial. Int J Clin Pract 2022; 2022:1746782. [PMID: 35685601 PMCID: PMC9159139 DOI: 10.1155/2022/1746782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/16/2022] [Accepted: 04/20/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intensive care units (ICUs) may produce stress on the relatives of patients that have long-term physiological and psychological implications. OBJECTIVES This study aimed to evaluate the effects of the relatives´ visit prior to hospital admission(s) on the patient's scheduled cardiac surgery regarding depression, anxiety, and satisfaction of the patient's family in an ICU. METHODS A randomized clinical trial [NCT03605420] was carried out according to the CONSORT criteria. Thirty-eight relatives of ICU patients were recruited at an ICU and randomized into study groups. Experimental group participants (n = 19) consisted of relatives who received 1 ICU visit prior to the patient's admission. Control group participants (n = 19) consisted of patients' relatives who received standard care alone. A self-report test battery, including the Impact of Event Scale-Revised (IES-R) and the Hospital Anxiety and Depression Scale (HADS), was completed by the patient's relative prior to the patient's ICU admission and again three and 90 days after ICU discharge. Furthermore, the Family Satisfaction with Care in the Intensive Care Unit (FS-ICU) and Critical Care Family Needs Inventory (CCFNI) were administered to help determine the respondents' satisfaction three days after the patient's ICU discharge. RESULTS Statistically significant differences in FS-ICU results were found between control and experimental groups; no statistically significant differences were found in IES-R, HADS, and CCFNI results. Thus, members in the control group were more satisfied with the time elapsed to raise their concerns (p=0.005), emotional support provided (p=0.020), quality of care (p=0.035), opportunities to express concerns and ask questions (p=0.005), and general satisfaction with the ICU's decision-making (p=0.003). CONCLUSIONS Relatives' satisfaction during patients' ICU admission may be impaired after their prior visit to the hospital admission. Relative's anxiety and depression scores did not seem to be significantly affected. Relatives´ visit prior to elective cardiac surgery hospital admission impaired their satisfaction in an ICU and may not be advisable for healthcare practice.
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Affiliation(s)
- Sara González-Martín
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Moisés Rodríguez-García
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Victoria Mazoteras-Pardo
- Department of Nursing, Physiotherapy and Occupational Therapy, School of Physiotherapy and Nursing, University of Castilla-La Mancha, Toledo, Spain
| | | | - David Rodríguez-Sanz
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol, Universidade da Coruña, A Coruña, Spain
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Nallani R, Smith JB, Penn JP, Bur AM, Kakarala K, Shnayder Y, Villwock MR, Sykes KJ. Decision regret 3 and 6 months after treatment for head and neck cancer: An observational study of associations with clinicodemographics, anxiety, and quality of life. Head Neck 2021; 44:59-70. [PMID: 34704319 DOI: 10.1002/hed.26911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/26/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND While quality of life (QOL), psychosocial health, and adverse treatment outcomes have been studied in head and neck cancer (HNC) patients, decision regret is an important and understudied complication that can negatively impact future health care decision making. METHODS Data collected using a HNC patient registry with questionnaires administered at initial consultation visits plus 3 and 6 months after treatment completion was retrospectively analyzed. A visual analog anxiety scale and the University of Washington Quality of Life were given at clinic visits. Decision regret was determined using a validated scale. Demographic and clinical variables were collected retrospectively and at baseline. RESULTS Patients with higher anxiety and lower self-reported QOL had higher concurrent regret at 3-month (n = 140) and at 6-month (n = 82) post-treatment. Later disease stage at presentation, nonprimary surgical treatment, and lower health literacy were associated with greater regret. CONCLUSIONS Decision regret was highest in HNC patients with high anxiety, low QOL, and more advanced disease.
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Affiliation(s)
- Rohit Nallani
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Joshua B Smith
- Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, St. Louis, Missouri, USA
| | - Joseph P Penn
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Andres M Bur
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kiran Kakarala
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Yelizaveta Shnayder
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Mark R Villwock
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kevin J Sykes
- Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
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Does Emotional Intelligence of Dental Undergraduates Influence Their Patient Satisfaction? Int J Dent 2021; 2021:4573459. [PMID: 34608391 PMCID: PMC8487387 DOI: 10.1155/2021/4573459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/25/2021] [Accepted: 09/18/2021] [Indexed: 12/30/2022] Open
Abstract
Objectives The research aimed to investigate if emotional intelligence (EI) scores of dental undergraduates influenced their patients' satisfaction with the treatment received. Methods A 33-item EI questionnaire was completed by 46 dental undergraduates in a cross-sectional study. Responses, measured on a five-point Likert scale, were summed to yield EI scores. Patients treated by the same undergraduates were invited to complete a patient satisfaction (PS) questionnaire. EI and PS scores were calculated and compared by undergraduates' gender and the patients' age and education status. The four EI factors (optimism/mood regulation, appraisal of emotions, utilization of emotions, and social skills of students) were correlated with PS using Spearman's correlation test with a significance level set at p < 0.05. Results EI scores did not differ significantly between male (N = 23) and female (N = 23) undergraduates (p=0.218). PS was not associated with patients' gender, but those educated to the secondary school level were more likely to be satisfied compared to those educated to the college/university level (p=0.022). Of the four EI factors, optimism/mood regulation was positively correlated with PS (p=0.049). Conclusion The results of the study suggest that the EI of the students can influence PS. Practical Implications. Interventions to enhance EI can be developed to improve the patient experience.
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Pompili C, Dalmia S, McLennan Battleday F, Rogers Z, Absolom K, Bekker H, Franks K, Brunelli A, Velikova G. Factors influencing patient satisfaction after treatments for early-stage non-small cell lung cancer. J Cancer Res Clin Oncol 2021; 148:2447-2454. [PMID: 34515847 PMCID: PMC9349300 DOI: 10.1007/s00432-021-03795-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/03/2021] [Indexed: 11/26/2022]
Abstract
Purpose Patient-reported outcome measures, including satisfaction with treatment decisions, provide important information in addition to clinical outcomes, survival and decision-making in lung cancer surgery. We investigated associations between preoperative clinical and socio-demographic factors and patient-reported satisfaction 6 weeks after radical treatment for early-stage non-small cell lung cancer (NSCLC). Methods We conducted a sub-group analysis of the prospective observational longitudinal study of 225 participants in two treatment groups—surgical (VATS) and radiotherapy (SABR). The Patient Satisfaction Questionnaire-18 (PSQ-18) was used to measure patient satisfaction 6 weeks after treatment. Clinical variables, Index of Multiple Deprivation decile and Decision self-efficacy scores were used in regression analysis. Variables with a p level < 0.1 were used as independent predictors in generalised linear logistic regression analyses. Results As expected, the two groups differed in pre-treatment clinical features. The SABR group experienced more grade 1–2 complications than the VATS group. No differences were found between the groups in any subscale of the PSQ-18 questionnaire. Patients experiencing complications or living in more deprived areas were more satisfied with care. Properative factors independently associated with patient satisfaction were the efficacy in decision-making and age. Conclusion We showed that efficacy in treatment decision-making and age was the sole predictor of patient satisfaction with their care after radical treatment for early-stage NSCLC. Patients from more deprived areas and patients who suffered complications reported greater subsequent satisfaction. Involving patients in their care may improve satisfaction after treatment for early-stage NSCLC.
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Affiliation(s)
- Cecilia Pompili
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK.
- Bexley Wing, St. James' Institute of Oncology, Beckett Street, Leeds, LS9 7TF, UK.
| | | | - Finn McLennan Battleday
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Zoe Rogers
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
| | - Kate Absolom
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Hilary Bekker
- Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | | | | | - Galina Velikova
- Section of Patient Centred Outcomes Research, Leeds Institute for Medical Research at St James's, University of Leeds, Leeds, UK
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Chae W, Kim J, Park EC, Jang SI. Comparison of Patient Satisfaction in Inpatient Care Provided by Hospitalists and Nonhospitalists in South Korea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158101. [PMID: 34360394 PMCID: PMC8345769 DOI: 10.3390/ijerph18158101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 12/02/2022]
Abstract
Background: A Korean hospitalist is a medical doctor in charge of inpatient care during hospital stays. The purpose of this study is to examine the patient satisfaction of hospitalist patients compared to non-hospitalist patients. Patient satisfaction is closely related to the outcome, quality, safety, and cost of care. Thus, seeking to achieve high patient satisfaction is essential in the inpatient care setting. Design, setting, and participants: This is a case-control study based on patient satisfaction survey by the Korean Health Insurance Review and Assessment Service. We measured patients’ satisfaction in physician accessibility, consultation and care service skills, and overall satisfaction through logistic regression analyses. A total of 3871 patients from 18 facilities responded to 18 questionnaires and had health insurance claim data. Results: Hospitalist patients presented higher satisfaction during the hospital stay compared to non-hospitalist patients. For example, as per accessibility, hospitalist patients could meet their attending physician more than twice a day (OR: 3.46, 95% CI: 2.82–4.24). Concerning consultation and care service skills, hospitalists’ explanations on the condition and care plans were easy to understand (OR: 2.33, 95% CI: 1.89–2.88). Moreover, overall satisfaction was significantly higher (β: 0.431, p < 0.0001). Subgroup analyses were conducted by medical division and region. Hospitalist patients in the surgical department and the rural area had greater patient satisfaction in all aspects of the survey than non-hospitalist patients. Conclusions: Hospitalists’ patients showed higher satisfaction during the hospital stay. Our study discovered that hospitalists could provide high-quality care as they provide onsite care continuously from admission to discharge.
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Affiliation(s)
- Wonjeong Chae
- BK21 FOUR R&E Center for Precision Public Health, College of Health Science, Korea University, Seoul 02841, Korea;
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (J.K.); (E.-C.P.)
| | - Juyeong Kim
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (J.K.); (E.-C.P.)
- Department of Health & Human Performance, Sahmyook University, Seoul 03722, Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (J.K.); (E.-C.P.)
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea
| | - Sung-In Jang
- Institute of Health Services Research, Yonsei University, Seoul 03722, Korea; (J.K.); (E.-C.P.)
- Department of Preventive Medicine, College of Medicine, Yonsei University, Seoul 03722, Korea
- Correspondence: ; Tel.: +82-2-2228-1862; Fax: +82-2-392-8133
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Kung JE, Zhang T, Aneizi A, Koenig S, Shasti K, Wahl AJ, Packer JD, Meredith SJ, Henn RF. Predictors of two-year patient satisfaction following elective knee surgery. J Clin Orthop Trauma 2021; 20:101486. [PMID: 34277340 PMCID: PMC8267497 DOI: 10.1016/j.jcot.2021.101486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/16/2021] [Accepted: 06/24/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Patient satisfaction metrics are increasingly being utilized as tools to evaluate the quality of healthcare and affect reimbursements. The objectives of this study were to (1) identify factors associated with two-year patient satisfaction after elective knee surgery, (2) compare the Surgical Satisfaction Questionnaire-8 (SSQ-8) and a numeric satisfaction scale (NSS), and (3) determine if two-year patient satisfaction can be predicted based on preoperative factors. METHODS A total of 365 patients undergoing elective knee surgery at a single center were administered questionnaires to assess demographics, medical history, and various patient-reported outcomes preoperatively and at two years postoperatively. Patient satisfaction was measured at two years postoperatively with SSQ-8 and NSS. Bivariate and multivariate statistical analyses were performed to identify significant associations and independent predictors of satisfaction. RESULTS SSQ-8 and NSS scores were significantly correlated (rs = 0.68, P < 0.0001). Lower SSQ-8 and NSS scores were associated with black race, higher BMI, more comorbidities, unemployment, smoking, higher ASA score, and greater Met Expectations (P < 0.05). Better scores on patient-based outcome measures and better improvement from baseline were significantly correlated with higher satisfaction on both SSQ-8 and NSS. Multivariable analysis identified greater Met Expectations and higher two-year Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference scores as independent predictors of greater SSQ-8 scores (adjusted r2 = .52). Greater Met Expectations and better two-year PROMIS Social Satisfaction scores were independent predictors of NSS score (adjusted r2 = .41). In contrast, when only preoperative variables were considered, the multivariable regression model accounted for only 14% of the variance in SSQ-8 and 6% of the variance in NSS. CONCLUSION While there are multiple preoperative factors that are associated with two-year patient satisfaction after knee surgery, those factors contribute relatively little to satisfaction. Meeting expectations and better patient-based outcomes at two years are more important.
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Affiliation(s)
| | | | | | | | | | | | | | | | - R. Frank Henn
- Corresponding author. Chief of Sports Medicine University of Maryland School of Medicine 2200 Kernan Drive Baltimore, MD 21207, USA.
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Bollinger M, Pyne J, Goudie A, Han X, Hudson TJ, Thompson JW. Enrollee Experience with Providers in the Arkansas Medicaid Expansion Program. J Gen Intern Med 2021; 36:1673-1681. [PMID: 33532967 PMCID: PMC8175535 DOI: 10.1007/s11606-020-06552-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Patient ratings of their healthcare experience as a quality measure have become critically important since the implementation of the Affordable Care Act (ACA). The ACA enabled states to expand Medicaid eligibility to reduce uninsurance nationally. Arkansas gained approval to use Medicaid funds to purchase a qualified health plan (QHP) through the ACA marketplace for newly eligible beneficiaries. OBJECTIVE We compare patient-reported satisfaction between fee-for-service Medicaid and QHP participants. DESIGN The Consumer Assessment of Healthcare Providers and Systems (CAHPS) was used to identify differences in Medicaid and QHP enrollee healthcare experiences. Data were analyzed using a regression discontinuity design. PARTICIPANTS Newly eligible Medicaid expansion participants enrolled in Medicaid during 2013 completed the Consumer Assessment of Health Providers and Systems (CAHPS) survey in 2014. Survey data was analyzed for 3156 participants (n = 1759 QHP/1397 Medicaid). MEASURES Measures included rating of personal and specialist provider, rating of all healthcare received, and whether the provider offered to communicate electronically. Demographic and clinical characteristics of the enrollees were controlled for in the analyses. METHODS Regression-discontinuity analysis was used to evaluate differential program effects on positive ratings as measured by the CAHPS survey while controlling for demographic and health characteristics of participants. KEY RESULTS Adjusted logistic regression models for overall healthcare (OR = 0.71, 95%CI = 0.56-0.90, p = 0.004) and personal doctor (OR = 0.68, 95%CI = 0.53-0.87, p = 0.002) predicted greater satisfaction among QHP versus Medicaid participants. Results were not significant for specialists or for use of electronic communication with provider. CONCLUSIONS Using a quasi-experimental statistical approach, we were able to control for observed and unobserved heterogeneity showing that among participants with similar characteristics, including income, QHP participants rated their personal providers and healthcare higher than those enrolled in Medicaid. Access to care, utilization of care, and healthcare and health insurance literacy may be contributing factors to these results.
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Affiliation(s)
- Mary Bollinger
- Department of Psychiatry, Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA.
| | - Jeff Pyne
- Department of Psychiatry, Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Anthony Goudie
- Arkansas Center for Health Improvement (ACHI), Little Rock, AR, USA
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Xiaotong Han
- Department of Psychiatry, Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Teresa J Hudson
- Department of Psychiatry, Center for Health Services Research, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
| | - Joseph W Thompson
- Arkansas Center for Health Improvement (ACHI), Little Rock, AR, USA
- Department of Health Policy and Management, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Li Y(C, Hapidou EG. Patient Satisfaction With Chronic Pain Management: Patient Perspectives of Improvement. J Patient Exp 2021; 8:23743735211007834. [PMID: 34179424 PMCID: PMC8205408 DOI: 10.1177/23743735211007834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Integrating satisfaction measures with pain-related variables can highlight global change and improvement from the patients' perspective. This study examined patient satisfaction in an interdisciplinary chronic pain management program. Nine hundred and twenty-seven (n = 927) participants completed pre- and post-treatment measures of pain, depression, catastrophizing, anxiety, stages of change, and pain acceptance. Multiple regression was used to examine these variables at admission and discharge as predictors of patient satisfaction. Pain-related variables explained 50.6% of the variance (R2 = .506, F 22,639 = 29.79, P < .001) for general satisfaction, and 38.9% of the variance (R2 = 0.389, F 22,639 = 18.49, P < .001) for goal accomplishment. Significant predictors of general satisfaction included depression (β = -0.188, P < .001) and the maintenance stage of change (β = 0.272, P < .001). The latter was also a significant predictor of goal accomplishment (β = 0.300, P < .001). Discharge pain-related measures are more influential than admission measures for predicting patient satisfaction. Patient satisfaction is significantly related to establishing a self-management approach to pain.
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Affiliation(s)
- Yuelin (Cindy) Li
- Department of Psychology, Neuroscience and Behaviour (PNB), 3710McMaster University, Hamilton, Ontario, Canada
| | - Eleni G Hapidou
- Department of Psychology, Neuroscience and Behaviour (PNB), 3710McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Pain Clinic, McMaster University Medical Centre, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
- Bachelor of Health Sciences (Honour’s) Program, McMaster University, Hamilton, Ontario, Canada
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15
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Adhikari M, Paudel NR, Mishra SR, Shrestha A, Upadhyaya DP. Patient satisfaction and its socio-demographic correlates in a tertiary public hospital in Nepal: a cross-sectional study. BMC Health Serv Res 2021; 21:135. [PMID: 33579283 PMCID: PMC7881603 DOI: 10.1186/s12913-021-06155-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 02/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background Patient satisfaction is one proxy indicator of the health care quality; however, enhancing patient satisfaction in low-income settings is very challenging due to the inadequacy of resources as well as low health literacy among patients. In this study, we assess patient satisfaction and its correlates in a tertiary public hospital in Nepal. Methods We conducted a cross sectional study at outpatient department of Bhaktapur Hospital of Nepal. To recruit participants for the study, we applied a systematic random sampling method. Our study used a validated Patient Satisfaction Questionnaire III (PSQ-III) developed by RAND Corporation including various contextual socio-demographic characteristics. We calculated mean score and percentages of satisfaction across seven dimensions of patient satisfaction. To determine the association between various dimensions of patient satisfaction and socio-demographic characteristics of the patient, we used a multi-ordinal logistic regression. Results Among 204 patients, we observed a wide variation in patient satisfaction across seven dimensions. About 39% of patients were satisfied in the dimension of general satisfaction, 92% in interpersonal manner, and 45% in accessibility and convenience. Sociodemographic factors such as age (AOR: 6.42; CI: 1.30–35.05), gender (AOR: 2.81; CI: 1.41–5.74), and ethnicity (AOR: 0.26; CI: 0.08–0.77) were associated with general satisfaction of the patients. Other sociodemographic variables such as education, occupation, and religion were associated with a majority of the dimensions of patient satisfaction (p < 0.05). Age was found to be the strongest predictor of patient satisfaction in five out of seven dimensions. Conclusions We concluded that patient satisfaction varies across different dimensions. Therefore, targeted interventions that direct to improve the dimensions of patient satisfaction where the proportion of satisfaction is low are needed. Similar studies should be conducted regularly at different levels of health facilities across the country to capture a wider picture of patient satisfaction at various levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06155-3.
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Affiliation(s)
- Mukesh Adhikari
- Department of Health Services, Ministry of Health and Population, Kathmandu, Nepal. .,Department of Health Policy and Management, Yale School of Public Health, Yale University, New Haven, CT, USA. .,Institute for Implementation Science and Health, Kathmandu, Nepal.
| | | | - Shiva Raj Mishra
- World Heart Federation Rue de Malatrex 32, 1201, Geneva, Switzerland.,Nepal Development Society, Bharatpur-10, Chitwan, Nepal
| | - Archana Shrestha
- Institute for Implementation Science and Health, Kathmandu, Nepal.,Department of Public Health, Kathmandu University, Kathmandu, Nepal
| | - Dipak Prasad Upadhyaya
- Central Department of Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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16
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Sharif A, Haque N, Jogezai S, Rahim H, Ghilzai D, Iqbal Q, Haider S, Sadaf N, Anwar M, Saleem F. A cross-sectional assessment of patient satisfaction with pharmacy performance attending a public healthcare institute of Quetta city, Pakistan. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01100-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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17
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Fahad M, Iqbal Q, Haider S, Khalid A, Hassali MA, Saleem F. The Patient Satisfaction with Pharmacist Services Questionnaire (PSPSQ 2.0): translation and validation study of the Urdu version. BRAZ J PHARM SCI 2021. [DOI: 10.1590/s2175-97902020000419008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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18
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Rabah NM, Khan HA, Levin JM, Winkelman RD, Mroz TE, Steinmetz MP. The association between patient rating of their spine surgeon and quality of postoperative outcome. J Neurosurg Spine 2020:1-7. [PMID: 33339000 DOI: 10.3171/2020.7.spine20478] [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: 04/01/2020] [Accepted: 07/13/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey was developed by the Centers for Medicare and Medicaid Services as a result of their value-based purchasing initiative. It allows patients to rate their experience with their provider in the outpatient setting. This presents a unique situation in healthcare in which the patient experience drives the marketplace, and since its creation, providers have sought to improve patient satisfaction. Within the spine surgery setting, however, the question remains whether improved patient satisfaction correlates with improved outcomes. METHODS All patients who had undergone lumbar spine surgery between 2009 and 2017 and who completed a CG-CAHPS survey after their procedure were studied. Demographic and surgical characteristics were then obtained. The primary outcomes of this study include patient-reported health outcomes measures such as the Patient-Reported Outcomes Measurement Information System Global Health (PROMIS-GH) surveys for both mental health (PROMIS-GH-MH) and physical health (PROMIS-GH-PH), and the visual analog scale for back pain (VAS-BP). A multivariable linear regression analysis was used to assess whether patient satisfaction with their provider was associated with changes in each health status measure after adjusting for potential confounders. RESULTS The study population included 647 patients who had undergone lumbar spine surgery. Of these, 564 (87%) indicated that they were satisfied with the care they received. Demographic and surgical characteristics were largely similar between the two groups. Multivariable linear regression demonstrated that patient satisfaction with their provider was not a significant predictor of change in two of the three patient-reported outcomes (PROMIS-GH-MH and PROMIS-GH-PH) assessed at 1 year. However, top-box patient satisfaction with their provider was a significant predictor of improvement in VAS-BP scores at 1 year. CONCLUSIONS The authors found that after adjusting for patient-level covariates such as age, diagnosis of disc displacement, self-reported mental health, self-reported overall health, and preoperative patient-reported outcome measure status, a significant association was observed between top-box overall provider rating and 1-year improvement in VAS-BP, but no such association was observed for PROMIS-GH-PH and PROMIS-GH-MH. This suggests that pain-related outcome measures may serve as better predictors of patients' satisfaction with their spine surgeons. Furthermore, this suggests that the current method by which patient satisfaction is being assessed and publicly reported may not necessarily correlate with validated measures that are used within the spine surgery setting to assess surgical efficacy.
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Affiliation(s)
- Nicholas M Rabah
- 1Center for Spine Health, Cleveland Clinic.,2Case Western Reserve University School of Medicine, Cleveland.,3Department of Neurosurgery, Cleveland Clinic; and.,4Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Hammad A Khan
- 1Center for Spine Health, Cleveland Clinic.,2Case Western Reserve University School of Medicine, Cleveland.,3Department of Neurosurgery, Cleveland Clinic; and.,4Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Jay M Levin
- 1Center for Spine Health, Cleveland Clinic.,2Case Western Reserve University School of Medicine, Cleveland.,3Department of Neurosurgery, Cleveland Clinic; and.,4Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Robert D Winkelman
- 1Center for Spine Health, Cleveland Clinic.,2Case Western Reserve University School of Medicine, Cleveland.,3Department of Neurosurgery, Cleveland Clinic; and.,4Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Thomas E Mroz
- 1Center for Spine Health, Cleveland Clinic.,3Department of Neurosurgery, Cleveland Clinic; and.,4Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael P Steinmetz
- 1Center for Spine Health, Cleveland Clinic.,3Department of Neurosurgery, Cleveland Clinic; and.,4Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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19
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The association between patient experience and healthcare outcomes using SEER-CAHPS patient experience and outcomes among cancer survivors. J Geriatr Oncol 2020; 12:623-631. [PMID: 33277226 DOI: 10.1016/j.jgo.2020.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/15/2020] [Accepted: 11/18/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To understand the relationship between patient experience, as measured by scores on the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, and clinical and financial outcomes among older cancer survivors. MATERIALS AND METHODS We analyzed the records of all Fee-for-Service (FFS) Medicare beneficiaries 66 years and older who completed one CAHPS survey from 2001 to 2004 or 2007-2013 with one of the five following cancer types: breast, bladder, colorectal, lung, or prostate; and completed a CAHPS survey within 5 years of cancer diagnosis date. We conducted a multivariate analysis, controlling for clinical and demographic variables, to evaluate the association between excellent CAHPS scores and the following clinical and financial outcomes: mortality, emergency department visits, and total healthcare expenditures. RESULTS A total of 7395 individuals were present in our cohort, with 57% being male and 85.7% non-Hispanic White. Breakdown of the cohort by cancer site is as follows: prostate (40.4%), breast (28.6%), colorectal (14.0%), lung (9.4%), and bladder (7.6%). When looking at the relationship between CAHPS scores and clinical outcomes, there was no significant difference between excellent and non-excellent CAHPS score respondents in all three of the clinical outcomes studied. Furthermore, there was no association between ED utilization and patient experience scores when stratifying by cancer site and race/ethnicity among this cohort. CONCLUSION In this cohort, a highly rated patient experience, as measured by responses on the CAHPS survey, is not associated with improved clinical outcomes among older cancer survivors.
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Public opinion about the health care system in Armenia: findings from a cross-sectional telephone survey. BMC Health Serv Res 2020; 20:1005. [PMID: 33143718 PMCID: PMC7640423 DOI: 10.1186/s12913-020-05863-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 10/25/2020] [Indexed: 11/13/2022] Open
Abstract
Background Few studies have examined public opinion about the health care system in the former Soviet region. The objective of our study was to evaluate the population’s satisfaction with the health care system and identify factors associated with it in Armenia. Methods We conducted a cross-sectional telephone survey among 576 adult residents of the capital Yerevan using Random Digit Dialing technique. Simple and multivariate logistic regression explored associations between potential determinants and satisfaction. Results A substantial proportion of respondents (45.5%) were dissatisfied or very dissatisfied with the health system. About 49% of respondents negatively evaluated the ability of the system to provide equal access to care. About 69% of respondents thought that the responsibility for an individual’s health should be equally shared between the individual and the government or that the government’s share should be larger. The adjusted odds of satisfaction were higher among individuals with better health status, those who positively rated equal access and respect to patients in the system, those thinking that the responsibility for health should be equally shared between the individual and the government, and those who tended to trust the government. Conclusions This study enriched our understanding of factors that shape the population’s satisfaction with the health care system in different cultural and political environments. We recommend further exploration of public opinion about those system attributes that are not directly linked to patient experiences with care, but might be equally important for explaining the phenomenon of satisfaction. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12913-020-05863-6.
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Howard B, Aneizi A, Nadarajah V, Sajak PM, Ventimiglia DJ, Burt CI, Zhan M, Akabudike NM, Henn RF. Early patient satisfaction following orthopaedic surgery. J Clin Orthop Trauma 2020; 11:S823-S828. [PMID: 32999563 PMCID: PMC7503134 DOI: 10.1016/j.jcot.2020.06.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/05/2020] [Accepted: 06/26/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The healthcare industry is shifting its focus from traditional clinical outcome measures to patient satisfaction metrics. This change has caused orthopaedic surgeons to become increasingly interested in factors influencing patient satisfaction, which would allow them to potentially modify these factors in an effort to increase postoperative satisfaction. The objective of this study was to identify factors associated with patient satisfaction two weeks following extremity orthopaedic surgery. METHODS Patients completed questionnaires preoperatively to assess demographics, activity, pain, expectations, and Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive testing for Physical Function, Pain Interference, Social Satisfaction, Depression, Anxiety, and Fatigue. Two weeks after their operation, patients completed the same questionnaires in addition to an Improvement Survey and Met Expectations. Satisfaction was assessed with the Surgical Satisfaction Questionnaire. RESULTS Greater surgical satisfaction two weeks following orthopaedic surgery was associated with higher education, alcohol use, better scores on all PROMIS domains at baseline and two weeks, greater activity levels at baseline and two weeks, less bodily pain at baseline and two weeks, less pain in the surgical site at two weeks, greater met expectations, and greater improvement (p < 0.05). CONCLUSION This study provides important information about patient satisfaction two weeks after orthopaedic surgery.
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Affiliation(s)
- Bailey Howard
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vidushan Nadarajah
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Orthopaedic Surgery and Rehabilitation, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Patrick M.J. Sajak
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Dominic J. Ventimiglia
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cameran I. Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Min Zhan
- Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ngozi M. Akabudike
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
- Corresponding author. University of Maryland Rehabilitation and Orthopaedic Institute, 2200 Kernan Drive Baltimore, MD, 21207, USA.
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Schreurs AMF, Dancet EAF, Apers S, van Hoefen Wijsard M, Kuchenbecker WKH, van de Ven PM, Lambalk CB, Nelen WLDM, van der Houwen LEE, Mijatovic V. A systematic review and secondary analysis of two studies identifying demographic and medical characteristics determining patient-centeredness in endometriosis care as experienced by patients. Hum Reprod Open 2020; 2020:hoaa041. [PMID: 32995565 PMCID: PMC7508026 DOI: 10.1093/hropen/hoaa041] [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: 12/13/2019] [Revised: 07/10/2020] [Indexed: 12/21/2022] Open
Abstract
STUDY QUESTION What are the patient-specific determinants associated with patient-centered endometriosis care as measured by the ENDOCARE questionnaire (ECQ)? SUMMARY ANSWER ‘Overall grade for endometriosis care’, ‘educational level’, ‘membership of a patient organization’ and ‘having seen other specialists for endometriosis complaints’ are correlated with overall patient-centeredness scores (PCS). WHAT IS KNOWN ALREADY Patient-centeredness of endometriosis care can be evaluated using the validated ECQ. The ECQ leads to an overall PCS and separate PCS for 10 dimensions of endometriosis care. Previously, educational level and quality of life scores were found to be associated with ECQ results. STUDY DESIGN, SIZE, DURATION First, a systematic literature review was performed (PROSPERO registration number: CRD42020169872). MEDLINE, Cochrane CENTRAL and EMBASE databases were searched from inception to May 2020 for studies in any language reporting on the results of the ECQ in patients with endometriosis. Two studies were identified. From the two studies, all original data were merged. In total, data from 546 patients were available for analysis. Second, univariate and multivariate regression analyses were performed to identify determinants for patient-centeredness of endometriosis care. PARTICIPANTS/MATERIALS, SETTING, METHODS The two included studies evaluated patient-centeredness in four endometriosis care centers in Belgium and the Netherlands. All participants had surgically proven endometriosis. Possible patient-specific determinants were selected from the demographic and medical questions from the first part of the ECQ. These determinants were evaluated using linear regression analysis and all possible determinants with a P > 0.2 in the univariate analysis were selected for stepwise multivariate analysis. Separate analyses were performed for overall PCS and each of the 10 dimensions. MAIN RESULTS AND THE ROLE OF CHANCE The two included studies provided data from 546 patients. After adjustment for care center, multivariate analysis showed that a higher ‘grade for endometriosis care’ (B = 0.66), a ‘lower educational level’ (B = 0.50), ‘being member of a patient organization’ (B = 0.49) and ‘having seen other specialists for endometriosis complaints’ (B = 0.34) were independently associated with higher overall PCS (R2 = 0.41). ‘Grade for endometriosis care’ was a determinant for all dimensions of endometriosis care. ‘Having seen other specialists for endometriosis complaints’ was positively associated with the care dimensions ‘respect for patients’ values, preferences and expressed needs’, ‘continuity and transition’ and ‘technical skills’. Members of a patient organization showed higher scores on the care dimensions ‘emotional support and alleviation of fear and anxiety’, ‘continuity and transition’ and ‘endometriosis clinic staff’. Furthermore, we found that having a higher level of education is associated with lower scores in the care dimensions ‘physical comfort’, ‘emotional support and alleviation of fear and anxiety’ and ‘involvement of significant other’. LIMITATIONS, REASONS FOR CAUTION These results delineate the patient-specific determinants of patient-centered care as measured using the Dutch ECQ. Whether results are generalizable to other countries should be investigated in an international study. This requires the ECQ to be validated in other languages first. WIDER IMPLICATIONS OF THE FINDINGS The aforementioned determinants of patient-centered care are of value for studies benchmarking clinics for their patient-centeredness. In addition, they help clinicians to determine how to tailor their care to individual patients. At every visit, patients could be asked to grade the endometriosis care (on a scale of 0–10) to easily investigate patient-centeredness. When there is more time, women with endometriosis should be asked to complete the entire ECQ to investigate patient-centeredness in depth. STUDY FUNDING/COMPETING INTEREST(S) The department of reproductive medicine (involving C.B.L. and V.M.) of the Amsterdam UMC, Vrije Universiteit Amsterdam has received several research and educational grants from Guerbet, Merck and Ferring. The authors have no conflict of interest related to this manuscript.
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Affiliation(s)
- A M F Schreurs
- Endometriosis Center Amsterdam UMC, Department of Reproductive Medicine, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - E A F Dancet
- Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
| | - S Apers
- Department of Development and Regeneration, KU Leuven, University of Leuven, Leuven, Belgium
| | - M van Hoefen Wijsard
- Endometriosis Center Amsterdam UMC, Department of Reproductive Medicine, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - W K H Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Clinics, Zwolle, The Netherlands
| | - P M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universtiteit Amsterdam, Amsterdam, The Netherlands
| | - C B Lambalk
- Endometriosis Center Amsterdam UMC, Department of Reproductive Medicine, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - W L D M Nelen
- Department of Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L E E van der Houwen
- Endometriosis Center Amsterdam UMC, Department of Reproductive Medicine, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - V Mijatovic
- Endometriosis Center Amsterdam UMC, Department of Reproductive Medicine, Research Institute Amsterdam Reproduction & Development, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Brancazio S, Eskildsen SM, Abimbola F, Olcott CW, Kamath GV, Del Gaizo DJ. Unmet Patient Expectations for Interventions Decrease Provider Satisfaction Scores. Orthopedics 2020; 43:e378-e382. [PMID: 32602914 DOI: 10.3928/01477447-20200619-05] [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: 02/22/2019] [Accepted: 05/21/2019] [Indexed: 02/03/2023]
Abstract
As health care reimbursement evolves, physicians will continue to be evaluated based on the quality of care that they provide. One measure of quality is based on patient satisfaction as reported through the Consumer Assessment of Healthcare Providers and Systems Survey (CAHPS). Although previous studies have explored expectations and their role in patient satisfaction, no studies have investigated the role of patient expectations for interventions in surgical specialty clinics. Patients (N=126) were given 2 surveys, a pre-visit and a post-visit questionnaire, with options based on the CAHPS survey. Patients were asked to select common orthopedic services that they expected to receive from their appointments, rate their physicians on Likert scales, and report the services that were actually provided. Patients who left with unmet expectations for interventions (45%) rated their physicians lower than patients who had all of their expectations met (9.0±1.4 vs 9.5± 0.8; P<.05). For most individual interventions, there was no difference in satisfaction between patients with met and unmet expectations. However, patients who expected surgery and did not have their expectations met rated their physician lower than patients whose expectations for surgery were met (9.0±1.3 vs 9.7±0.6; P<.05). No statistically significant difference was found in physician rating with increased numbers of unmet expectations, individual surgeon rating, perceptions of their providers, and wait time. This study reports that patient expectations for interventions, and particularly a recommendation for surgery, may alter a patient's reported satisfaction, particularly when surgical expectations are unmet. [Orthopedics. 2020;43(5):e378-e382.].
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Dalal J, Williams JS, Walker RJ, Campbell JA, Davis KS, Egede LE. Association Between Dissatisfaction With Care and Diabetes Self-Care Behaviors, Glycemic Management, and Quality of Life of Adults With Type 2 Diabetes Mellitus. DIABETES EDUCATOR 2020; 46:370-377. [PMID: 32780004 DOI: 10.1177/0145721720922953] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to examine the associations between patient dissatisfaction and diabetes outcomes among patients with type 2 diabetes. METHODS Primary data from 615 adults with type 2 diabetes from 2 adult primary care clinics completed validated questionnaires. Patient dissatisfaction was measured by asking participants to what degree over the past 12 months were they very dissatisfied with the care they received from their primary care provider. Diabetes outcomes included self-care behaviors, quality of life, and A1C. A1C was abstracted from the medical record. Multiple linear regression models were used to assess associations between patient dissatisfaction, self-care, blood glucose, and quality of life. RESULTS After adjusting for covariates, this study demonstrated that higher patient dissatisfaction was significantly associated with poor general diet, worse blood glucose levels, and lower mental component score for quality of life. CONCLUSIONS In patients with type 2 diabetes, patient dissatisfaction had a significant association with higher blood glucose levels, poor general diet, and low quality of life. Demographic factors driving patient dissatisfaction included young age, low income, and low health literacy. Future studies should investigate how to address patient satisfaction in an effort to improve health outcomes.
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Affiliation(s)
- Jugal Dalal
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Joni S Williams
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rebekah J Walker
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jennifer A Campbell
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Kimberly S Davis
- Department of Medicine, Division of General Internal Medicine and Geriatrics, Medical University of South Carolina, Charleston, South Carolina
| | - Leonard E Egede
- Department of Medicine, Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.,Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, Wisconsin
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Mehta R, Tsilimigras DI, Paredes AZ, Dillhoff M, Cloyd JM, Ejaz A, Tsung A, Pawlik TM. Is Patient Satisfaction Dictated by Quality of Care Among Patients Undergoing Complex Surgical Procedures for a Malignant Indication? Ann Surg Oncol 2020; 27:3126-3135. [DOI: 10.1245/s10434-020-08788-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022]
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Lopes J, Oliveira A, Baptista A, Ferreira EO. Factors influencing patient and parents' satisfaction on pediatric dermatologic surgery. Int J Dermatol 2020; 59:e340-e341. [PMID: 32613607 DOI: 10.1111/ijd.15044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/04/2020] [Accepted: 06/10/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Jorge Lopes
- Department of Dermatology, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal
| | - Ana Oliveira
- Department of Dermatology, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal
| | - Armando Baptista
- Department of Dermatology, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal
| | - Eduarda O Ferreira
- Department of Dermatology, Centro Hospitalar Vila Nova de Gaia/ Espinho, Vila Nova de Gaia, Portugal
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Yee TJ, Fearer KJ, Oppenlander ME, Kashlan ON, Szerlip N, Buckingham MJ, Swong K, Chang V, Schwalb JM, Park P. Correlation Between the Oswestry Disability Index and the North American Spine Surgery Patient Satisfaction Index. World Neurosurg 2020; 139:e724-e729. [DOI: 10.1016/j.wneu.2020.04.117] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 04/13/2020] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
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Uren AD, Cotterill N, Hashim H, Worthington J, Kapoor D, Abrams P. International Consultation on Incontinence Questionnaire‐Satisfaction: psychometric testing of a new patient‐reported outcome measure for the evaluation of satisfaction after urological surgery. BJU Int 2020; 126:286-291. [PMID: 32320131 DOI: 10.1111/bju.15091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Alan D. Uren
- Bristol Urological Institute Southmead Hospital Bristol UK
| | - Nikki Cotterill
- Bristol Urological Institute Southmead Hospital Bristol UK
- University of the West of England Bristol UK
| | - Hashim Hashim
- Bristol Urological Institute Southmead Hospital Bristol UK
| | | | | | - Paul Abrams
- Bristol Urological Institute Southmead Hospital Bristol UK
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Liu JJ, Goldberg HR, Lentz EJ, Matelski JJ, Alam A, Bell CM. Association Between Web-Based Physician Ratings and Physician Disciplinary Convictions: Retrospective Observational Study. J Med Internet Res 2020; 22:e16708. [PMID: 32406851 PMCID: PMC7256745 DOI: 10.2196/16708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/14/2020] [Accepted: 02/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Physician rating websites are commonly used by the public, yet the relationship between web-based physician ratings and health care quality is not well understood. OBJECTIVE The objective of our study was to use physician disciplinary convictions as an extreme marker for poor physician quality and to investigate whether disciplined physicians have lower ratings than nondisciplined matched controls. METHODS This was a retrospective national observational study of all disciplined physicians in Canada (751 physicians, 2000 to 2013). We searched ratings (2005-2015) from the country's leading online physician rating website for this group, and for 751 matched controls according to gender, specialty, practice years, and location. We compared overall ratings (out of a score of 5) as well as mean ratings by the type of misconduct. We also compared ratings for each type of misconduct and punishment. RESULTS There were 62.7% (471/751) of convicted and disciplined physicians (cases) with web-based ratings and 64.6% (485/751) of nondisciplined physicians (controls) with ratings. Of 312 matched case-control pairs, disciplined physicians were rated lower than controls overall (3.62 vs 4.00; P<.001). Disciplined physicians had lower ratings for all types of misconduct and punishment-except for physicians disciplined for sexual offenses (n=90 pairs; 3.83 vs 3.86; P=.81). Sexual misconduct was the only category in which mean ratings for physicians were higher than those for other disciplined physicians (3.63 vs 3.35; P=.003). CONCLUSIONS Physicians convicted for disciplinary misconduct generally had lower web-based ratings. Physicians convicted of sexual misconduct did not have lower ratings and were rated higher than other disciplined physicians. These findings may have future implications for the identification of physicians providing poor-quality care.
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Affiliation(s)
- Jessica Janine Liu
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
| | - Hanna R Goldberg
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
| | - Eric Jm Lentz
- Faculty of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Asim Alam
- Department of Anesthesia and Surgery, North York General Hospital, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Chaim M Bell
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
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Ayele Y, Hawulte B, Feto T, Basker GV, Bacha YD. Assessment of patient satisfaction with pharmacy service and associated factors in public hospitals, Eastern Ethiopia. SAGE Open Med 2020; 8:2050312120922659. [PMID: 32435492 PMCID: PMC7223202 DOI: 10.1177/2050312120922659] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 04/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background: A comprehensive understanding of the extent of patient satisfaction and its determinants are crucial in improving the quality of service. Hence, this research was designed to measure patient satisfaction with pharmacy service. Methods: A cross-sectional study was conducted among 422 patients to assess satisfaction with pharmacy service in public hospitals located in Eastern Ethiopia from September to January 2018. Data were collected through an exit interview using structured questionnaires. Then, it was entered into EpiData version 3.1 and exported to STATA version 14.2 for analysis. Associations between dependent and independent variables were assessed by multiple logistic regression using an adjusted odds ratio at a 95% confidence interval and the p values of less than 0.05. Results: A total of 407 samples were included in the final analysis. The mean overall satisfaction of clients measured out of five was 2.29 (standard deviation ± 0.56). The proportion of overall satisfaction was 46.19%. Patients within the age range of 26–35 years and 36–50 years were found to have 50% (adjusted odds ratio = 0.5, 95% confidence interval: 0.3, 0.9) and 60% (adjusted odds ratio = 0.4, 95% confidence interval: 0.2, 0.8) decreased likelihood of satisfaction compared with patients within the range of 18–25 years, respectively. Likewise, patients who attended only secondary education compared to their counterpart (a certificate and above) were less likely to be satisfied (adjusted odds ratio = 0.4, 95% confidence interval: 0.2, 0.8). In contrast, rural dwellers and patients who collected all their medications from the respective hospital were found to be more satisfied compared with their equivalent (adjusted odds ratio = 3, 95% confidence interval: 1.8, 5.2) and (adjusted odds ratio = 2.2, 95% confidence interval: 1.4, 3.5), respectively. Conclusion: Patient satisfaction with pharmacy service was found to be very low considering the current health-care system movement toward delivering quality service. Hence, health-care providers and administrators should give due attention to contributing factors in order to improve the quality of service and ultimately increase patient satisfaction.
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Affiliation(s)
- Yohanes Ayele
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Behailu Hawulte
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tilaye Feto
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - G Vijai Basker
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie Bacha
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Schulz PJ, Rothenfluh F. Influence of Health Literacy on Effects of Patient Rating Websites: Survey Study Using a Hypothetical Situation and Fictitious Doctors. J Med Internet Res 2020; 22:e14134. [PMID: 32250275 PMCID: PMC7171560 DOI: 10.2196/14134] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/10/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022] Open
Abstract
Background Physician rating websites (PRWs) are a device people use actively and passively, although their objective capabilities are insufficient when it comes to judging the medical performance and qualification of physicians. PRWs are an innovation born of the potential of the Internet and boosted very much by the longstanding policy of improving and encouraging patient participation in medical decision-making. A mismatch is feared between patient motivations to participate and their capabilities of doing so well. Awareness of such a mismatch might contribute to some skepticism of patient-written physician reviews on PRWs. Objective We intend to test whether health literacy is able to dampen the effects that a patient-written review of a physician’s performance might have on physician choice. Methods An experiment was conducted within a survey interview. Participants were put into a fictitious decision situation in which they had to choose between two physicians on the basis of their profiles on a PRW. One of the physician profiles contained the experimental stimulus in the form of a friendly and a critical written review. The dependent variable was physician choice. An attitude differential, trust differential, and two measures of health literacy, the newest vital sign as an example of a performance-based measure and eHealth Literacy Scale as an example of a perception-based measure, were tested for roles as intermediary variables. Analysis traced the influence of the review tendency on the dependent variables and a possible moderating effect of health literacy on these influences. Results Reviews of a physician’s competence and medical skill affected participant choice of a physician. High health literacy dampened these effects only in the case of the perception-based measure and only for the negative review. Correspondingly, the effect of the review tendency appeared to be stronger for the positive review. Attitudes and trust only affected physician choice when included as covariants, considerably increasing the variance explained by regression models. Conclusions Findings sustain physician worries that even one negative PRW review can affect patient choice and damage doctors’ reputations. Hopes that health literacy might raise awareness of the poor basis of physician reviews and ratings given by patients have some foundation.
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Mordhorst TR, McCormick ZL, Presson AP, Collier WH, Spiker WR. Examining the relationship between epidural steroid injections and patient satisfaction. Spine J 2020; 20:207-212. [PMID: 31563577 DOI: 10.1016/j.spinee.2019.09.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Hospitals and policy makers have placed increasing importance on patient satisfaction with medical care. Minimal research exists on patient satisfaction in the context of epidural steroid injections (ESIs) for radicular pain. PURPOSE Describe patient satisfaction with ESIs for the treatment of radicular pain and identify patient demographic and clinical characteristics associated with patient satisfaction. STUDY DESIGN/SETTING This was a retrospective study conducted at a large, academic medical center. METHODS This was a single-center retrospective study of prospectively collected registry data including patients treated with ESIs from August 2006 to May 2018. The primary outcomes were: overall Press Ganey (PG) score, patient satisfaction with the physician, and likelihood to recommend both the physician and the practice. Age, body mass index, Charlson Comorbidity Index, immediate change in pain, sex, spinal segmental level of injection, prior opioid use, insurance status, and ethnicity were compared with the four PG measures of satisfaction using both univariable and multivariable regression analysis. No sources of funding were used for this project. The authors report no conflict of interest in relation to this manuscript. RESULTS Two-hundred ninety patients underwent 377 injections. Overall, patients were highly satisfied; 86% recommend their physician and 85% recommend the practice, each with the highest possible PG score. The median overall PG score was 97.2 (interquartile range [IQR]: 89.3, 100), and the median physician satisfaction score was 100 (IQR: 95, 100). The median immediate reduction in pain was 3 points (IQR: -5,-2) on the numerical rating scale scale postinjection. Increased age was associated with increased satisfaction with the physician (reported rate ratios [Relative Risk (RR)] for dissatisfaction: 0.73, 95% confidence interval [CI]: 0.58, 0.93, p=.011) and increased likelihood to recommend the physician (odds ratio: 1.46, 95% CI: 1.06, 2.01, p=.022) in multivariable analysis. Medicare as opposed to private insurance was associated with higher dissatisfaction with the physician (RR: 2.04, 95% CI: 1.15, 3.61, p=.014) and decreased likelihood to recommend the practice (RR: 0.38, 95% CI: 0.15, 0.94, p=.037). CONCLUSIONS The present data, based on PG scores, demonstrated that ESIs are associated with greater patient satisfaction with increasing age, but lower satisfaction in patients with Medicare compared with private insurance when controlling for other demographic factors. Satisfaction was not associated with the degree of pain relief.
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Affiliation(s)
- Trevor R Mordhorst
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Zachary L McCormick
- Department of Physical Medicine and Rehabilitation, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Angela P Presson
- Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84132, USA; Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Willem H Collier
- Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84132, USA
| | - William R Spiker
- Department of Orthopedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
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Zawisza K, Galas A, Tobiasz-Adamczyk B. Factors associated with patient satisfaction with health care among Polish older people: results from the polish part of the COURAGE in Europe. Public Health 2020; 179:169-177. [DOI: 10.1016/j.puhe.2019.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/12/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
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Hospital staff shortages: Environmental and organizational determinants and implications for patient satisfaction. Health Policy 2020; 124:380-388. [PMID: 31973906 DOI: 10.1016/j.healthpol.2020.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/03/2019] [Accepted: 01/02/2020] [Indexed: 11/21/2022]
Abstract
Recent discussions and previous research often indicate that German hospitals are affected by a shortage of healthcare personnel on the labor market. However, until now, research has provided only limited insights into how environmental and organizational factors explain variations in staff shortages, how staff shortage measures relate to staffing ratios, and what relevance staff shortages have for patients. Regression analyses based on survey data of 104 German hospitals from 2015 to 2016, combined with labor market and patient satisfaction data, show that several environmental and organizational factors are significantly related to hospital staff shortages, measured by self-reports, vacancies, and turnover. These three measures of staff shortage do not correlate to the same degree for physicians and nurses, and none of the three significantly relate to nursing ratios, which indicates that the latter is a distinct concept rather than a direct consequence of staff shortage. The analyses further show that hospital staff shortages relate significantly to patient satisfaction with physician and nursing care. The findings suggest that hospitals are, to a certain extent, able to influence the degree to which they are affected by staff shortages and that hospitals' decisions about staffing levels depend on more than staff availability.
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Aiwerioghene EM, Singh M, Ajmera P. Modelling the factors affecting Nigerian medical tourism sector using an interpretive structural modelling approach. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1677036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Mahavir Singh
- Faculty of Health & Allied Sciences, Amity University, Haryana, India
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Hopkins BS, Patel MR, Yamaguchi JT, Cloney MB, Dahdaleh NS. Predictors of patient satisfaction and survey participation after spine surgery: a retrospective review of 17,853 consecutive spinal patients from a single academic institution. Part 1: Press Ganey. J Neurosurg Spine 2019; 30:382-388. [PMID: 30611140 DOI: 10.3171/2018.8.spine18594] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPress Ganey surveys are common modalities used to assess patient satisfaction scores in an outpatient setting. Despite the existence of data, neurosurgical and orthopedic literature on patient satisfaction following spinal surgery is scarce.METHODSA total of 17,853 patients who underwent spinal procedures at the authors' institution were analyzed retrospectively for Press Ganey survey participation. Appropriate demographic, surgical, comorbidity, and complication data were collected; 1936 patients had patient satisfaction survey data, and further survey metrics were collected for this subset of patients.RESULTSMale patients, patients with urgent/emergency procedures, and patients with longer length of stay (LOS) were less likely to fill out Press Ganey surveys (OR 0.822, p < 0.001; OR 0.781, p = 0.010; and OR 0.983, p < 0.001, respectively). Posterior approach was negatively associated with Press Ganey participation (OR 0.907, p = 0.055). Patients undergoing fusion procedures were more likely to participate in Press Ganey surveys (OR 1.419, p < 0.001). Of the patients who filled out surveys, there were no positive predictors associated with receiving perfect scores on Press Ganey surveys. High Charlson Comorbidity Index (OR 0.959, p = 0.02), increasing elapsed time since surgery or discharge (OR 0.996, p = 0.03), and increasing LOS (OR 0.965, p = 0.009) were all negatively associated with receiving a perfect score. Patients who underwent a posterior-approach procedure compared with other approaches were less likely to report a low Press Ganey score (OR 0.297, p = 0.046). Patient sex and race did not influence the likelihood of receiving perfect or low Press Ganey scores. Finally, the perceived skill of the surgeon was not a significant predictor for perfect (p > 0.99) or low (p = 0.828) Press Ganey scores.CONCLUSIONSPatient participation in Press Ganey surveys strongly correlated with preoperative factors such as procedure approach and type, as well as postoperative factors such as LOS and complications. No factors were associated with an increased likelihood of receiving a perfect Press Ganey score. Similarly, LOS and time elapsed since surgery to survey completion were significant negative predictors of perfect Press Ganey scores. Skill of surgeon, sex, and race did not correlate with a predictive value for Press Ganey outcomes. In addition, overall comorbid disease burden was found to be a significant negative predictor for high patient satisfaction scores. Further study on predictors of patient satisfaction within spine surgery is needed to better assist physicians in improving the surgical experience for patients.
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Hopkins BS, Patel MR, Yamaguchi JT, Cloney MB, Dahdaleh NS. Predictors of patient satisfaction and survey participation after spine surgery: a retrospective review of 17,853 consecutive spinal patients from a single academic institution. Part 2: HCAHPS. J Neurosurg Spine 2019; 30:389-396. [PMID: 30611139 DOI: 10.3171/2018.8.spine181024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/27/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPatient satisfaction is a new and important metric in the American healthcare system. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a common modality used to assess patient satisfaction in inpatient settings. Despite the existence of data, neurosurgical literature on patient satisfaction following spinal surgery is scarce.METHODSA total of 17,853 patients who underwent spinal procedures at the authors' institution were analyzed retrospectively for HCAHPS survey participation. Appropriate demographic, surgical, comorbidity, and complication data were collected; 1118 patients had patient satisfaction survey data, and further survey metrics were collected for this subset of patients.RESULTSMale patients, patients with urgent/emergency procedures, and patients with a longer length of stay were less likely to complete an HCAHPS survey (OR 0.820, p < 0.001; OR 0.818, p = 0.042; and OR 0.983, p < 0.001, respectively). Posterior approach was negatively associated with HCAHPS survey participation (OR 0.868, p = 0.007). Patients undergoing fusion procedures were more likely to participate in HCAHPS surveys (OR 1.440, p < 0.001). Of the completed HCAHPS surveys, there were no positive predictors associated with perfect scores. High Charlson Comorbidity Index (OR 0.931, p = 0.007), increasing elapsed time since surgery or discharge (OR 0.992, p = 0.004), and increasing length of stay (OR 0.928, p < 0.001) were all negatively associated with a perfect score. Finally, patient sex and race did not influence the likelihood of a perfect or low survey score.CONCLUSIONSParticipation in HCAHPS surveys was correlated with preoperative and postoperative factors. Among these, procedure approach and type, length of stay, and complications seemed to influence participation the most. No factors were associated with an increased likelihood of receiving a perfect score. Similarly, length of stay and time elapsed since surgery to survey completion were significant negative predictors of receiving perfect HCAHPS survey scores. Increasing comorbid burden was also found to be a negative predictor for high scores. Further study on predictors of inpatient satisfaction within spine surgery is needed.
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Lee HQ, Kow CY, Ng JS, Chan P, Ton L, Etherington G, Liew S, Hunn M, Fitzgerald M, Tee J. Correlation of Anterior Interbody Graft Choice With Patient-Reported Outcomes in Cervical Spine Trauma. Global Spine J 2019; 9:735-742. [PMID: 31552155 PMCID: PMC6745640 DOI: 10.1177/2192568219828720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
STUDY DESIGN Ambispective observational cohort study. OBJECTIVES Synthetic graft usage avoids morbidity associated with harvest and reduces operative time. This study aims to evaluate outcomes of anterior cervical stabilization surgery using a synthetic cage in comparison with iliac crest bone graft (ICBG) following cervical spine trauma. METHODS An ambispective review was conducted on patients from the Alfred Trauma Registry. Consecutive patients treated at a level 1 trauma center, aged 18 years and older who were treated with standalone anterior cervical stabilization following spine trauma (2011-2016) were included in the study. Primary outcome measures were patient overall satisfaction, Neck Disability Index (NDI), neck pain 10-point visual analogue scale (VAS-neck) and arm pain 10-point visual analogue scale (VAS-arm). Secondary outcome measures were radiographic evidence of fusion and rate of revision surgery. All patients had follow-up for at least 1 year. RESULTS Between 2011 and 2016, 114 traumatic disc levels in 104 patients were treated. ICBG was used in 32% and polyetheretherketone (PEEK) cage in 68% of the patients. Both groups had similar demographic metrics. There was no significant difference in primary outcome measures between the graft types: (1) patient satisfaction (P = .15), (2) NDI (P = .11), (3) VAS-neck (P = .13), and (4) VAS-arm (P = .20). Radiology based fusion assessment 6 months postsurgery did not show statistical significance (P = .10). The rates of revision surgery were similar. CONCLUSIONS This study showed no significant difference in patient-reported outcome measures when comparing the usage of PEEK cage and ICBG in anterior stand alone cervical spine stabilization. Level 1 evidence studies are required to further investigate this finding.
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Affiliation(s)
- Hui Qing Lee
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia,National Trauma Research Institute (NTRI), Melbourne, Australia
| | - Chien Yew Kow
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | - Jay Shen Ng
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | - Patrick Chan
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | - Lu Ton
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne,
Australia
| | - Greg Etherington
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne,
Australia
| | - Susan Liew
- Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne,
Australia
| | - Martin Hunn
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia
| | - Mark Fitzgerald
- Trauma Service, The Alfred Hospital, Melbourne, Australia,National Trauma Research Institute (NTRI), Melbourne, Australia
| | - Jin Tee
- Department of Neurosurgery, The Alfred Hospital, Melbourne, Australia,National Trauma Research Institute (NTRI), Melbourne, Australia,Jin Tee, Department of Neurosurgery, The Alfred
Hospital, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
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Chierigo F, Capogrosso P, Dehò F, Pozzi E, Schifano N, Belladelli F, Montorsi F, Salonia A. Long-Term Follow-Up After Penile Prosthesis Implantation-Survival and Quality of Life Outcomes. J Sex Med 2019; 16:1827-1833. [PMID: 31501062 DOI: 10.1016/j.jsxm.2019.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/29/2019] [Accepted: 08/04/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Hydraulic penile prostheses have shown an overall good mechanical reliability up to 10 years after surgery; however, few data have been published on very long-term follow-up. AIM We looked at long-term (≥15 years) complications, including functional and quality of life (QoL) outcomes, after 3-piece inflatable penile prosthesis (IPP) implantation in patients with erectile dysfunction (ED). METHODS Data regarding 149 patients submitting to IPP placement before 2001 were analyzed. All patients were implanted with AMS CX and Ultrex Plus 3-piece prostheses. MAIN OUTCOME MEASURE Patients were reassessed to evaluate rates of complications and functional outcomes. The validated questionnaire Quality of Life and Sexuality with Penile Prosthesis (QoLSPP) was used to assess patient QoL. Kaplan-Meier analysis estimated the probability of prosthesis survival (defined as working device/not-explanted). RESULTS Median follow-up of 51 patients was 206 months (interquartile range [IQR], 145-257). The etiology of ED was vasculogenic (n = 20; 39%), Peyronie's disease (n = 15; 29%), pelvic surgery (n = 4; 7.8%), organic other than vasculogenic (n = 3; 5.9%), or other (n = 9; 18%). Throughout the follow-up, 24 patients (49%) experienced complications: mechanical failure (n = 19; 79%), pain (n = 3; 12%), orgasmic dysfunctions (n = 1; 4.5%), or device infection (n = 1; 4.5%). The estimated IPP survival was 53% (95% CI, 36-67) at 20-year follow-up. Baseline characteristics (age, Charlson comorbidity index, body mass index, and erectile dysfunction etiology) were not significantly associated with the risk of IPP failure over time by Cox regression analysis. At 20-year follow-up, 41% (95% CI, 19-49) of the patients were still using the device. Among them, QoLSPP median domain scores were high: functional 22/25 (IQR, 20-23), relational 17/20 (IQR, 15-18), personal 14/15 (IQR, 12-15), and social 14/15 (IQR, 11-15). CLINICAL IMPLICATIONS The longevity of the device and long-term satisfaction rates should be comprehensively discussed during patient consultation for IPP surgery. STRENGTHS & LIMITATIONS To our knowledge, this is the first study reporting long-term QoL outcomes using a dedicated questionnaire for penile prostheses. The low response rate for the telephone interviews, the retrospective design of the study, and the relatively small number of patients are the main limitations. CONCLUSION Long-term follow-up data after IPP placement showed that almost half of the devices still worked properly 20 years after the original penile implant, as 60% of patients were still using the device with high satisfaction and adequate QoL outcomes. Both patients and physicians should be aware of the expected life and outcomes of IPP implants. Chierigo F, Capogrosso P, Dehò, et al. Long-Term Follow-Up After Penile Prosthesis Implantation-Survival and Quality of Life Outcomes. J Sex Med 2019;16:1827-1833.
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Affiliation(s)
- Francesco Chierigo
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Edoardo Pozzi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Nicolò Schifano
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Belladelli
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Università Vita-Salute San Raffaele, Milan, Italy.
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Eftekhary N, Feng JE, Anoushiravani AA, Schwarzkopf R, Vigdorchik JM, Long WJ. Hospital Consumer Assessment of Healthcare Providers and Systems: Do Patient Demographics Affect Outcomes in Total Knee Arthroplasty? J Arthroplasty 2019; 34:1570-1574. [PMID: 31053469 DOI: 10.1016/j.arth.2019.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/03/2019] [Accepted: 04/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a nationally standardized tool to assess patient experience between hospitals. The HCAHPS survey can affect hospital reimbursement. This study aims to determine if HCAHPS scores vary by a number of demographic variables in patients undergoing primary total knee arthroplasty (TKA). METHODS Patients who underwent primary TKA and returned a completed HCAHPS survey were included in this study. HCAHPS surveys were collected from our institution's Center for Quality and Patient Safety department, which was cross-referenced with our hospital's electronic data warehouse. Patient demographics, surgical factors, and quality outcomes were queried, and multivariable linear regression was performed. RESULTS In total, 1028 HCAHPS questionnaires after primary TKA were evaluated. The average age of patients was 65.9 ± 9.0 years and 67.9% (698 patients) were female. Average body mass index was 32.5 ± 6.9 kg/m2. Sixty-nine percent of the patients (1287 patients) were discharged home versus 10.3% (106 patients) to another facility. Mean length of stay was 2.9 ± 1.4 days. Age was correlated with a 0.3% decrease in top-box response rate (P < .01) for each 1-year increase in age. Compared to Caucasian race, African American race was correlated with a 5.6% increased rate for top-box response (P < .01), while Asian race (P = .42) and unknown race (P = 1.00) demonstrated no significant difference. Marital status demonstrated that divorced/separated status resulted in a significant 5.4% decrease in top-box response rates (P < .05). Similarly, single (P = .12) and widowed (P = .09) statuses also demonstrated a trend toward lower top-box response rates when compared to married or partnered patients. For each day increase in length of stay, HCAHPS top-box response rates decrease by 1.6% (P < .01). Gender, body mass index, smoking status, insurance type, and discharge disposition were not found to be significantly correlated with HCHAPS top-box response rate (P > .05). CONCLUSION HCAHPS scores in patients undergoing primary TKA are influenced not just by hospital and surgeon factors such as length of stay but by demographic variables such as age, race, and marital status. As surgeons become more involved with the burden of improving patient experience, they should be aware that static demographic variables can have a significant effect on HCAHPS scores.
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Affiliation(s)
- Nima Eftekhary
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - James E Feng
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Insall Scott Kelly Institute for Orthopaedics and Sports Medicines, New York, NY
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Govender N, Suleman F. Comparison of patient satisfaction with pharmaceutical services of postal pharmacy and community pharmacy. Health SA 2019; 24:1105. [PMID: 31934415 PMCID: PMC6917432 DOI: 10.4102/hsag.v24i0.1105] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 01/30/2019] [Indexed: 11/01/2022] Open
Abstract
Background The growing drive in South Africa to contain medicine cost has seen the emergence of postal pharmacy as an alternative mechanism to dispense chronic medicines. Patient satisfaction with pharmaceutical services has received limited attention in South Africa. Aim The aim of this study was to compare the level of patient satisfaction with pharmaceutical services between postal and community pharmacies. Setting The research was conducted in the eThekwini Municipality, KwaZulu- Natal Province, South Africa in July and August 2014. Methods A cross-sectional quantitative study using a randomised, telephonic questionnaire survey was conducted. Selected land telephone numbers were called until a sample size of 250 community pharmacy participants and 125 postal pharmacy participants was obtained. Results Nine hundred and five telephone calls were made to obtain a sampling frame of 375 (41.44%) respondents, 250 for community and 125 for postal. After adjusting overall satisfaction by removing financial satisfaction, there was no significant difference between satisfaction in the two groups (p = 0.471). Postal pharmacy participants reported a higher level of financial satisfaction (p = 0.001). Community pharmacy participants reported a higher level of satisfaction with counselling or explanation (p = 0.028) and less medicine wastage (p < 0.001). Conclusions Patient satisfaction with pharmaceutical services provided by either community or postal pharmacy was not significantly different. However, community pharmacies tend to address patients' specific concerns more effectively. With the move to National Health Insurance, policymakers need to ensure that they provide high-quality pharmaceutical services and are more inclusive of community pharmacies to deliver quality care.
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Affiliation(s)
- Nishern Govender
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Fatima Suleman
- Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Durban, South Africa
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Eftekhary N, Feng JE, Anoushiravani AA, Schwarzkopf R, Vigdorchik JM, Long WJ. Revision Versus Primary Hospital Consumer Assessment of Healthcare Providers and Systems Scores in Total Joint Arthroplasty. J Arthroplasty 2019; 34:S84-S90. [PMID: 30545652 DOI: 10.1016/j.arth.2018.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/23/2018] [Accepted: 11/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score is a nationally standardized measure of a patient's inpatient experience. This study aims to assess whether HCAHPS scores differ between patients undergoing primary total joint arthroplasty (TJA) and patients undergoing revision TJA. METHODS Patients who underwent primary or revision total hip or total knee arthroplasty (THA or TKA) and returned a completed HCAHPS survey were included in this study. HCAHPS scores were collected from our institution's Center for Quality and Patient Safety department, which was cross-referenced with our hospital's electronic data warehouse. Patient demographics, surgical factors, and quality outcomes were queried. Appropriate statistical analyses were performed using MatLab 2017a and P-values less than .05 were deemed significant. RESULTS In total, 523 primary and 59 revision THA recipients completed HCAHPS surveys at our institution between October 2011 and November 2016. During this same period, 507 primary TKA recipients and 40 revision TKA recipients completed HCAHPS surveys. Compared to revision THA, primary THA patients had a significantly higher top box for overall hospital ratings (58.46% vs 41.38%), felt that nurses listened to them carefully (84.3% vs 72.88%), and felt that they clearly understood the role of each medication (69.48% vs 56.90%). Moreover, 18 of 20 HCAHPS question responses favored primary THA despite not reaching significance for the majority of HCAHPS questions. Patients with revision TKA demonstrated a significantly higher incidence of "top box" choices for quieter rooms and a trend favoring better HCAHPS scores in revision TKA in a further 12 of 20 HCAHPS responses. CONCLUSION Patients undergoing primary THA report higher HCAHPS scores than those undergoing revision THA, while revision TKA demonstrated a general trend toward higher scores when compared to primary TKA patients. This publicly reported quality measurement metric which factors into physician reimbursement may be biased by the patient's health status, the complexity of the surgical procedure, and length of stay in hospital rather than a true reflection of the quality of their hospital experience.
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Affiliation(s)
- Nima Eftekhary
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - James E Feng
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Department of Orthopedic Surgery, Albany Medical Center, Albany Medical College, Albany, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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Phillips LA, McAndrew LM. Empirical Evaluation of Veterans' Perceived Non-Concordance with Providers Regarding Medically Unexplained Symptoms. COUNSELING PSYCHOLOGIST 2019; 47:770-795. [PMID: 32015569 DOI: 10.1177/0011000019890317] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medically unexplained symptoms (MUS) are common among veterans and are difficult to treat. Optimal treatment entails continued care from providers, including primary care and counseling psychologists. Non-concordance between veterans' and providers' views of MUS may contribute to poor veteran satisfaction with care and possibly disengagement with care (e.g., non-adherence to treatment recommendations, including counseling and graded exercise). The current study surveyed 243 veterans with MUS post-deployment and evaluated the degree of non-concordance perceived by veterans with their primary care providers regarding their MUS and the effect of perceived non-concordance on treatment behaviors and outcomes. Many veterans in the current sample perceived non-concordance with their provider regarding their MUS (19% reporting quite a bit or complete disagreement). Perceived non-concordance (regarding MUS overall and specific causal perceptions) predicted important outcomes of interest, particularly veterans' satisfaction with their provider. Perceived concordance with primary care doctors may be required for sufficient adherence to MUS treatment recommendations, such as seeking and maintaining psychological counseling. Research should evaluate the effect of perceived concordance with the counseling psychologist on adherence to and outcomes from counseling for MUS.
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Affiliation(s)
| | - Lisa M McAndrew
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Healthcare System, East Orange, USA.,Department of Educational and Counseling Psychology EDU220, University at Albany, Albany, USA
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Cabitza F, Zeitoun JD. The proof of the pudding: in praise of a culture of real-world validation for medical artificial intelligence. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:161. [PMID: 31168442 PMCID: PMC6526255 DOI: 10.21037/atm.2019.04.07] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 02/20/2019] [Indexed: 02/05/2023]
Affiliation(s)
- Federico Cabitza
- IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
- University of Milano-Bicocca, Milano, Italy
| | - Jean-David Zeitoun
- Centre d’Epidémiologie Clinique, Hôtel Dieu Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Gastroenterology and Nutrition, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Smiley K, Ofori L, Spangler C, Acquaah-Arhin R, Deh D, Enos J, Manortey S, Baiden F, Finlayson S, Price R, McCrum M. Safety Culture and Perioperative Quality at the Volta River Authority Hospital in Akosombo, Ghana. World J Surg 2019; 43:16-23. [PMID: 30109388 DOI: 10.1007/s00268-018-4763-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Volta River Authority Hospital (VRAH) is a district hospital associated with a large public works project in Akosombo, Ghana, that has developed a reputation for high-quality care. We hypothesized that this stems from a culture of safety and standardized processes typical of high-risk engineering environments. To investigate this, we evaluated staff and patient perceptions of safety and quality, as well as perioperative process variability. MATERIALS AND METHODS The Safety Attitudes Questionnaire (SAQ) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys were used to evaluate staff and patient perceptions of safety. Perioperative general surgery and obstetrical procedure observations generated process maps, which were analyzed for variability and waste. RESULTS Thirty-one SAQs were administered. 83% of workers held a positive perception of teamwork, and 77.4% held a positive perception of safety culture. Fifteen HCAHPS surveys of surgical inpatients showed a median hospital rating of 10 [IQR 8.5-10] on a ten-point scale. 90% gave maximal scores for pain management and 84.4% for nurse communication. Ten general surgery and obstetrical procedures were observed for which process map analysis was notable for no consistent waste steps and 100% adherence to the World Health Organization Safe Surgery Checklist. CONCLUSIONS Surveys suggest an institutional commitment to safety with strong teamwork culture and patient communication. Perioperative process mapping supports this culture, with low levels of variability and waste, and is useful for evaluating standardization of care. VRAH demonstrates the feasibility of delivering high standards of perioperative care in a low-resource setting.
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Affiliation(s)
- Katherine Smiley
- Department of Surgery, University of Utah Center for Global Surgery, 30 N 1900 E, Rm 3B110 SOM, Salt Lake City, UT, 84132, USA
| | - Love Ofori
- Electro Volta House, Volta River Authority Hospital, 28th February Road, P.O. Box MB 77, Accra, Ghana
| | - Cindy Spangler
- Department of Surgery, University of Utah Center for Global Surgery, 30 N 1900 E, Rm 3B110 SOM, Salt Lake City, UT, 84132, USA
| | - Rebecca Acquaah-Arhin
- Electro Volta House, Volta River Authority Hospital, 28th February Road, P.O. Box MB 77, Accra, Ghana
| | - Deborah Deh
- Ensign College of Public Health, P.O. Box AK 136, Akosombo, Eastern Region, Ghana
| | - Juliana Enos
- Ensign College of Public Health, P.O. Box AK 136, Akosombo, Eastern Region, Ghana
| | - Stephen Manortey
- Ensign College of Public Health, P.O. Box AK 136, Akosombo, Eastern Region, Ghana
| | - Frank Baiden
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Samuel Finlayson
- Department of Surgery, University of Utah Center for Global Surgery, 30 N 1900 E, Rm 3B110 SOM, Salt Lake City, UT, 84132, USA
| | - Raymond Price
- Department of Surgery, University of Utah Center for Global Surgery, 30 N 1900 E, Rm 3B110 SOM, Salt Lake City, UT, 84132, USA
| | - Marta McCrum
- Department of Surgery, University of Utah Center for Global Surgery, 30 N 1900 E, Rm 3B110 SOM, Salt Lake City, UT, 84132, USA.
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Teo BJX, Koh JSB, Jiang L, Allen JC, Yeo SJ, Howe TS. Association of the 36-Item Short Form Health Survey Physical Component Summary Score With Patient Satisfaction and Improvement 2 Years After Total Knee Arthroplasty. JAMA Netw Open 2019; 2:e190062. [PMID: 30794301 PMCID: PMC6484598 DOI: 10.1001/jamanetworkopen.2019.0062] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
IMPORTANCE Increases in total knee arthroplasty (TKA) utilization rates suggest that its indications have been expanded to include patients with less severe symptoms. A recent study challenged the cost-effectiveness of TKA in this group of patients. OBJECTIVE To determine the association of the 36-Item Short Form Health Survey physical component summary score (SF-36 PCS) with patient satisfaction 2 years after TKA. DESIGN, SETTING, AND PARTICIPANTS This cohort study reviewed registry data from 2 years of follow-up of patients who underwent unilateral TKA from January 1, 2010, to December 31, 2014, at a single-center tertiary institution in Singapore. Data were acquired on April 27, 2017, and analyzed from August 15, 2017, to December 22, 2017. MAIN OUTCOMES AND MEASURES Patient satisfaction and SF-36 PCS. Preoperative disability and postoperative function as measured by the SF-36 PCS were correlated with Δ (2-year end point score minus baseline score) and patient satisfaction, scored on a 6-point Likert scale, with lower scores indicating greater satisfaction. RESULTS Of the 6659 patients, 5234 (78.6%) were female and 5753 (86.4%) were of Chinese ethnicity. Mean (SD) age was 67.0 (7.7) years, and mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) was 27.7 (4.6). At 2-year follow-up, the mean (SD) SF-36 PCS score improved from 32.2 (10.1) to 48.2 (9.5) (P < .001). There were 1680 patients (25.2%) who described their satisfaction as excellent, 2574 (38.7%) very good, 1879 (28.2%) good, 382 (5.7%) fair, 96 (1.4%) poor, and 48 (0.7%) terrible. The minimal clinically important difference (change in SF-36 PCS of 10 from baseline) was met in 4515 patients (67.8%), and overall satisfaction was 97.8% (6515 patients). Covariance analysis showed significantly higher satisfaction in patients with preoperative scores of 40 to less than 50. Patients who were unlikely to meet the minimal clinically important difference compared with those who were likely to meet it (SF-36 PCS of ≥42.1 vs <42.1) had significantly higher 2-year satisfaction (mean [SD], 2.15 [0.9] vs 2.23 [1.0]; P = .009). CONCLUSIONS AND RELEVANCE The findings suggest that a general health score, such as SF-36, is not associated with patient satisfaction 2 years after TKA. Functional assessment, preoperative counseling, and modification of expectations appear to remain vital before TKA.
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Affiliation(s)
| | | | - Lei Jiang
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Seng Jin Yeo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Tet Sen Howe
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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Huetten ASJ, Antons D, F. Breidbach C, Piening EP, Salge TO. The impact of occupational stereotypes in human-centered service systems. JOURNAL OF SERVICE MANAGEMENT 2019. [DOI: 10.1108/josm-12-2016-0324] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to explore the impact that occupational stereotypes held by customers have on value co-creation processes in human-centered service systems (HCSSs) like hospitals. Specifically, by exploring if and how customers’ (i.e. patients’) stereotypes toward frontline employees (e.g. nurses) affect their satisfaction as co-creators of value, this study responds to current service research priorities attempting to understand value co-creation in collaborative contexts like healthcare, and addresses calls to investigate the changing role of health care customers therein.Design/methodology/approachA field study was conducted in the context of German hospitals, which provides unique empirical evidence into the relationship between patients’ stereotypes toward healthcare professionals and their satisfaction with health services as well as the mediating mechanisms through which such stereotypes affect patient satisfaction.FindingsNegative (positive) stereotypes patients hold toward healthcare occupations decrease (increase) their satisfaction and are associated with perceptions of reduced (improved) patient orientation and patient participation in co-creation. However, only perceived patient orientation partially mediates the link between occupational stereotypes and patient satisfaction.Originality/valueThis study develops and tests new hypotheses related to occupational stereotyping in complex HCSSs, and extends previous research on stereotypes in service by exploring the previously unknown mediating mechanisms through which these impact value co-creation processes overall. It furthermore provides important guidance for future research about stereotyping in general, and its impact on value co-creation and HCSS, in particular.
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Ramprasad C, Tamariz L, Garcia-Barcena J, Nemeth Z, Palacio A. The Use of Tablet Technology by Older Adults in Health Care Settings-Is It Effective and Satisfying? A Systematic Review and Meta Analysis. Clin Gerontol 2019; 42:17-26. [PMID: 28665775 DOI: 10.1080/07317115.2017.1322162] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This systematic review/meta-analysis examines the potential for older people to accept and use tablet technology in clinical settings by assessing satisfaction and effectiveness. METHODS A comprehensive literature search was conducted of PubMed, SCOPUS, and CINAHL through March 2017. Inclusion criteria included studies with any clinical use of a tablet technology with a median patient age above 65 years. RESULTS We included a total of 12 studies (4 randomized controlled trials, 4 cross-sectional studies, and 4 pre/post studies). Interventions included the use of tablet technology for medication self-management, post-surgery education, memory retention, cognitive rehabilitation, and exercise promotion. The use of tablet technology by older people in clinical settings was associated with high satisfaction with a pooled prevalence of satisfaction of 78%; 95% CI 27-100. We did not find evidence for effectiveness in improving clinical or behavioral outcomes. CONCLUSIONS Older people can use and are satisfied with table technology in clinical settings. More studies are needed to evaluate the effectiveness of tablet technology at promoting health outcomes. CLINICAL IMPLICATIONS Clinicians should be encouraged to utilize tablet technology in the care of older patients.
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Affiliation(s)
- Chethan Ramprasad
- a University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Leonardo Tamariz
- a University of Miami Miller School of Medicine , Miami , Florida , USA
| | | | - Zsuzsanna Nemeth
- a University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Ana Palacio
- a University of Miami Miller School of Medicine , Miami , Florida , USA
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Brady BM, Zhao B, Niu J, Winkelmayer WC, Milstein A, Chertow GM, Erickson KF. Patient-Reported Experiences of Dialysis Care Within a National Pay-for-Performance System. JAMA Intern Med 2018; 178:1358-1367. [PMID: 30208398 PMCID: PMC6233760 DOI: 10.1001/jamainternmed.2018.3756] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
IMPORTANCE Medicare's End-Stage Renal Disease Quality Incentive Program incorporates measures of perceived value into reimbursement calculations. In 2016, patient experience became a clinical measure in the Quality Incentive Program scoring system. Dialysis facility performance in patient experience measures has not been studied at the national level to date. OBJECTIVE To examine associations among dialysis facility performance with patient experience measures and patient, facility, and geographic characteristics. DESIGN In this cross-sectional analysis, patients from a national end-stage renal disease registry receiving in-center hemodialysis in the United States on December 31, 2014, were linked with dialysis facility scores on the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) survey. Of 4977 US dialysis facilities, 2939 (59.1%) reported ICH-CAHPS scores from April 8, 2015, through January 11, 2016. Multivariable linear regression models with geographic random effects were used to examine associations of facility ICH-CAHPS scores with patient, dialysis facility, and geographic characteristics and to identify the amount of total between-facility variation in patient experience scores explained by these categories. Data were analyzed from September 15, 2017, through June 1, 2018. EXPOSURES Dialysis facility, geographic characteristic, and 10% change in patient characteristics. MAIN OUTCOMES AND MEASURES Dialysis facility ICH-CAHPS scores and the total between-facility variation explained by different categories of characteristics. RESULTS Of the 2939 facilities included in the analysis, adjusted mean ICH-CAHPS scores were 2.6 percentage points (95% CI, 1.5-3.7) lower in for-profit facilities, 1.6 percentage points (95% CI, 0.9-2.2) lower in facilities owned by large dialysis organizations, and 2.3 percentage points (95% CI, 0.5-4.2) lower in free-standing facilities compared with their counterparts. More nurses per patient was associated with 0.2 percentage points (95% CI, 0.03-0.3) higher scores; a privately insured patient population was associated with 1.2 percentage points (95% CI, 0.2-2.2) higher scores. Facilities with higher proportions of black patients had 0.95 percentage points (95% CI, 0.78-1.12) lower scores; more Native American patients, 1.00 percentage point (95% CI, 0.39-1.60) lower facility scores. Geographic location and dialysis facility characteristics explained larger proportions of the overall between-facility variation in ICH-CAHPS scores than did patient characteristics. CONCLUSIONS AND RELEVANCE This study suggests that for-profit operation, free-standing status, and large dialysis organization designation were associated with less favorable patient-reported experiences of care. Patient experience scores varied geographically, and black and Native American populations reported less favorable experiences. The study findings suggest that perceived quality of care delivered in these settings are of concern, and that there may be opportunities for improved implementation of patient experience surveys as is highlighted.
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Affiliation(s)
- Brian M Brady
- Division of Nephrology, Stanford University School of Medicine, Stanford, California.,Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California
| | - Bo Zhao
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas
| | - Jingbo Niu
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas
| | - Wolfgang C Winkelmayer
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas
| | - Arnold Milstein
- Clinical Excellence Research Center, Stanford University School of Medicine, Stanford, California
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Kevin F Erickson
- Selzman Institute for Kidney Health, Section of Nephrology, Baylor College of Medicine, Houston, Texas.,Baker Institute for Public Policy, Rice University, Houston, Texas
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White MC, Randall K, Avara E, Mullis J, Parker G, Shrime MG. Clinical Outcome, Social Impact and Patient Expectation: a Purposive Sampling Pilot Evaluation of Patients in Benin Seven Years After Surgery. World J Surg 2018; 42:1254-1261. [PMID: 29026968 DOI: 10.1007/s00268-017-4296-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Access to affordable and timely surgery is not equitable around the world. Five billion people lack access, and while non-governmental organizations (NGOs) help to meet this need, long-term surgical outcomes, social impact or patient experience is rarely reported. METHOD In 2016, Mercy Ships, a surgical NGO, undertook an evaluation of patients who had received surgery seven years earlier with Mercy Ships in 2009 in Benin. Using purposive sampling, patients who had received maxillofacial, plastics or orthopedic surgery were invited to attend a surgical evaluation day. In this pilot study, we used semi-structured interviews and questionnaire responses to assess patient expectation, surgical and social outcome. RESULTS Our results show that seven years after surgery 35% of patients report surgery-related pain and 18% had sought further care for a clinical complication of their condition. However, 73% of patients report gaining social benefit from surgery, and overall patient satisfaction was 89%, despite 35% of patients saying that they were unclear what to expect after surgery indicating a mismatch of doctor/patient expectations and failure of the consent process. CONCLUSION In conclusion, our pilot study shows that NGO surgery in Benin provided positive social impact associated with complication rates comparable to high-income countries when assessed seven years later. Key areas for further study in LMICs are: evaluation and treatment of chronic pain, consent and access to further care.
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Affiliation(s)
- Michelle C White
- M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin.
- Great Ormond Street Children's Hospital, London, UK.
| | | | - Esther Avara
- M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin
| | - Jenny Mullis
- M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin
| | - Gary Parker
- M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin
| | - Mark G Shrime
- M/V Africa Mercy, Mercy Ships, Port Au Cotonou, Benin
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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