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Ochoa-Dominguez CY, Pickering TA, Navarro S, Rodriguez C, Farias AJ. Healthcare Experiences Are Associated with Colorectal Cancer Mortality but only for Specific Racial Groups: a SEER-CAHPS Study. J Racial Ethn Health Disparities 2024; 11:2224-2235. [PMID: 37369914 PMCID: PMC11236924 DOI: 10.1007/s40615-023-01690-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/01/2023] [Accepted: 06/18/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND The objective of this study was to determine whether racial/ethnic disparities exist in patient-reported experiences with care after colorectal cancer diagnosis and whether they are associated with mortality. METHODS We conducted a retrospective cohort study of colorectal cancer patients diagnosed from 1997 to 2011, ≥ 65 years, and completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey at least 6 months after a cancer diagnosis. We leverage the National Cancer Institute's SEER-CAHPS dataset of Medicare beneficiaries. CAHPS survey responses were used to generate four composite measures of patient experiences with 1) getting needed care, 2) getting needed prescription drugs, 3) getting care quickly, and 4) physician communication. We used multivariable linear regression models to examine racial differences in patient experiences with aspects of their care and multivariable Cox proportional hazards models to identify the risk of mortality associated with each composite score by racial group. RESULTS Of the 5135 patients, 76.86% were non-Hispanic White, 7.58% non-Hispanic Black, 8.30% Hispanic, and 7.26% non-Hispanic Asian. Overall, patients reported the highest scores for composite measures regarding "getting all needed prescriptions" and the lowest score for "getting care quickly." In our adjusted models, we found that Hispanics, non-Hispanic Black, and non-Hispanic Asian patients reported significantly lower scores for getting needed prescription drugs (B = - 4.34, B = - 4.32, B = - 5.66; all p < 0.001) compared to non-Hispanic Whites. Moreover, non-Hispanic Black patients also reported lower scores for getting care quickly (B = - 3.44, p < 0.05). We only found one statistically significant association between composite scores of patient experience and mortality. For non-Hispanic Black patients, a 3-unit increase in getting needed care was associated with 0.97 times the hazard of mortality (p = 0.003). CONCLUSION Our research underscores that CAHPS patient experiences with care are an important patient-centered quality-of-care metric that may be associated with cancer outcomes and that there may be differences in these relationships by race and ethnicity. Thus, highlighting how patients' perceptions of their healthcare experiences can contribute to disparities in colorectal cancer outcomes.
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Affiliation(s)
- Carol Y Ochoa-Dominguez
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, San Diego, CA, USA
| | - Trevor A Pickering
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Stephanie Navarro
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA
| | - Claudia Rodriguez
- Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, CA, USA
| | - Albert J Farias
- Department of Population and Public Health Sciences, Keck School of Medicine of the University of Southern California, 2001 N. Soto St., Suite 318B, Los Angeles, CA, 90032, USA.
- Gehr Family Center for Health System Science, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA.
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Shaw NM, Hills N, Holler J, Fernandez A, Davis D, Palmer NR, Sliwka D, Breyer BN. The Impact of Patient-Physician Racial and Gender Concordance on Patient Satisfaction with Outpatient Clinic Visits. J Racial Ethn Health Disparities 2024; 11:2083-2092. [PMID: 37341950 DOI: 10.1007/s40615-023-01676-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 05/10/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Patient and provider race and gender concordance (patient and physician identify as the same race/ethnicity or gender) may impact patient experience and satisfaction. OBJECTIVE We sought to examine how patient and physician racial and gender concordance effect patient satisfaction with outpatient clinical encounters. Furthermore, we examined factors that changed satisfaction among concordant and discordant dyads. DESIGN Consumer Assessment of Healthcare Provider and Systems (CAHPS) Patient Satisfaction Survey Scores were collected from outpatient clinical encounters between January 2017 and January 2019 at the University of California, San Francisco. PARTICIPANTS Patients who were seen in the eligible time period, who voluntarily provided physician satisfaction scores. Providers with fewer than 30 reviews and encounters with missing data were excluded. MAIN MEASURES Primary outcome was rate of top satisfaction score. The provider score (1-10 scale) was dichotomized as "top score (9-10)" and "low scores (<9)." KEY RESULTS A total of 77,543 evaluations met inclusion criteria. Most patients identified as White (73.5%) and female (55.4%) with a median age of 60 (IQR 45, 70). Compared to White patients, Asian patients were less likely to give a top score even when controlling for racial concordance (OR: 0.67; CI 0.63-0.714). Telehealth was associated with increased odds of a top score relative to in-person visits (OR 1.25; CI 1.07-1.48). The odds of a top score decreased by 11% in racially discordant dyads. CONCLUSIONS Racial concordance, particularly among older, White, male patients, is a nonmodifiable predictor of patient satisfaction. Physicians of color are at a disadvantage, as they receive lower patient satisfaction scores, even in race concordant pairs, with Asian physicians seeing Asian patients receiving the lowest scores. Patient satisfaction data is likely an inappropriate means of determining physician incentives as such may perpetuate racial and gender disadvantages.
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Affiliation(s)
- Nathan M Shaw
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Nancy Hills
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Jordan Holler
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Alicia Fernandez
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Denise Davis
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Nynikka R Palmer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
- Division on General Internal Medicine at Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA, USA
| | - Diane Sliwka
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA, USA.
- Department of Epidemiology and Biostatistics, University of California San Francisco, 1001 Potrero Suite 3A, San Francisco, CA, 94110, USA.
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Marte MJ, Addesso D, Kiran S. Association Between Social Determinants of Health and Communication Difficulties in Poststroke U.S. Hispanic and Non-Hispanic White Populations. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:248-261. [PMID: 37956702 PMCID: PMC11000792 DOI: 10.1044/2023_ajslp-23-00232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 11/15/2023]
Abstract
PURPOSE The relationship among ethnicity, social determinants of health (SDOH), and disparities in poststroke outcomes is complex, and the impact on communication difficulties is unclear. This study investigated the presence and nature of communication difficulties in poststroke non-Hispanic White (PsnHw) and Hispanic U.S. populations using population-level data. METHOD We performed a cross-sectional analysis of 2,861 non-Hispanic White and 353 Hispanic poststroke respondents included in the 2014-2018 National Health Interview Survey. Respondents self-reported difficulties communicating in their usual language, in addition to providing information relating to demographics and lifestyle, health care access and utilization, health status, and SDOH. We used univariate statistics, generalized linear models, and an exploratory mediation analysis, to characterize the pattern of differences between these cohorts, examine associations between variables and communication difficulties, and determine the potential intermediate role of cumulative SDOH on the likelihood of reporting communication difficulties. RESULTS Findings indicated a more challenging life context for the poststroke Hispanic population due to SDOH disparities. Poverty and Internet use were associated with greater and lower odds of communication difficulties for PsnHw, respectively. The mediation analysis showed that ethnicity significantly affected communication difficulties, but only when mediated by SDOH. SDOH accounted for approximately two thirds of the total effect on reporting communication difficulties. CONCLUSIONS This study underscores the need for uniform measures of SDOH in prospective research and for interventions aimed at mitigating health disparities through addressing disparities in SDOH. Future research should focus on evaluating the effectiveness of such strategies in diverse ethnic and socioeconomic poststroke populations. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24521419.
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Affiliation(s)
- Manuel Jose Marte
- Center for Brain Recovery, Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - David Addesso
- Center for Brain Recovery, Department of Speech, Language, and Hearing Sciences, Boston University, MA
| | - Swathi Kiran
- Center for Brain Recovery, Department of Speech, Language, and Hearing Sciences, Boston University, MA
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Brown KK, Kindratt TB, Brannon GE, Sankuratri BYV, Boateng GO. Patient Experience with Their Health Care Provider Among Non-Pregnant Women of Childbearing Age with Diabetes Mellitus by Race and Ethnicity in the United States. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:20-30. [PMID: 36727093 PMCID: PMC9883667 DOI: 10.1089/whr.2022.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/26/2023]
Abstract
Objectives The study objective was to investigate differences in patient experiences with health care providers among non-pregnant women of childbearing age with diabetes mellitus (DM) by race/ethnicity. Design This study used cross-sectional data from the 2012-2018 Medical Expenditure Panel Survey. The sample was limited to women of childbearing age (18-45 years) who have ever been told they had diabetes (n = 763; weighted n = 903,670). The key independent variable was race/ethnicity. The variables of interest included patient experiences with health care in the past 12 months: patient-provider communication (PPC); patient-provider racial/ethnic concordance; patient-provider gender concordance; and satisfaction. Results After adjusting for age, marital status, education, poverty level, health insurance, and perceived health status, non-Hispanic (NH) Black women had lower odds (adjusted odds ratio [aOR] = 0.04; 95% confidence interval [CI] = 0.01-0.11) of receiving care from a health care provider of the same race compared with NH white women. Similar results were found among Hispanic and NH women of other or multiple races. Hispanic women had lower odds (aOR = 0.18; 95% CI = 0.06-0.50) of seeing a health care provider of the same race/ethnicity compared with NH white women in adjusted models. There were no statistically significant differences in PPC, patient-provider gender concordance, and satisfaction with their health care provider among Hispanic, NH Black, or NH women of other or multiple races in comparison to NH White women. Conclusion There is a need to improve PPC quality and satisfaction in this patient population. Patient-provider racial/ethnic discordance among women of color with DM is concerning given the existing diabetes-related disparities. More research on women with DM is needed to inform and improve patient experience and health outcomes.
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Affiliation(s)
- Kyrah K. Brown
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA.,Address correspondence to: Kyrah K. Brown, PhD, Department of Kinesiology, University of Texas at Arlington, 500 W. Nedderman Drive, Arlington, TX 76019, USA,
| | - Tiffany B. Kindratt
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
| | - Grace Ellen Brannon
- Department of Communication, University of Texas at Arlington, Arlington, Texas, USA
| | | | - Godfred O. Boateng
- Department of Kinesiology, University of Texas at Arlington, Arlington, Texas, USA
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Wu KK, Armstrong AW. Differences in Face-to-Face Time Spent With a Dermatologist Among Patients With Psoriasis Based on Race and Ethnicity. JAMA Dermatol 2022; 158:1210-1212. [PMID: 35921118 PMCID: PMC9350842 DOI: 10.1001/jamadermatol.2022.2426] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kevin K Wu
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
| | - April W Armstrong
- Department of Dermatology, Keck School of Medicine, University of Southern California, Los Angeles
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Lung Cancer Mortality Racial/Ethnic Disparities in Patient Experiences with Care: a SEER-CAHPS Study. J Racial Ethn Health Disparities 2022:10.1007/s40615-022-01358-8. [PMID: 35767217 DOI: 10.1007/s40615-022-01358-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/16/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND To determine whether there are racial/ethnic disparities in patient experiences with care among lung cancer survivors, whether they are associated with mortality. METHODS A retrospective cohort study of lung cancer survivors > 65 years old who completed a CAHPS survey > 6 months after the date of diagnosis. We used data from the SEER-Consumer Assessment of Healthcare Providers Systems (SEER-CAHPS®) database from 2000 to 2013 to assess racial/ethnic differences in patient experiences with care multivariable Cox proportional hazards models to assess the association between patient experience with care scores mortality in each racial/ethnic group. RESULTS Within our cohort of 2603 lung cancer patients, Hispanic patients reported lower adjusted mean score with their ability to get needed care compared to white patients (B: - 5.21, 95% CI: - 9.03, - 1.39). Asian patients reported lower adjusted mean scores with their ability to get care quickly (- 4.25 (- 8.19, - 0.31)), get needed care (- 7.06 (- 10.51, - 3.61)), get needed drugs (- 9.06 (- 13.04, - 5.08)). For Hispanic patients, a 1-unit score increase in their ability to get all needed care (HR: 1.02, 1.00-1.03) care coordination (1.06, 1.02-1.09) was associated with higher risk of mortality. Among black patients, a 1-unit score increase in their ability to get needed care (HR: 0.99, 95% CI 0.98-0.99) care coordination (0.97, 0.94-0.99) was associated with lower risk mortality. CONCLUSIONS There are racial/ethnic disparities in lung cancer patient experiences with care that may impact mortality. Patient experiences with care are important risk factors of mortality for certain racial/ethnic groups.
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Ochoa CY, Toledo G, Iyawe-Parsons A, Navarro S, Farias AJ. Multilevel Influences on Black Cancer Patient Experiences With Care: A Qualitative Analysis. JCO Oncol Pract 2021; 17:e645-e653. [PMID: 33974829 DOI: 10.1200/op.21.00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Black patients with cancer report worse experiences with health care compared with White patients; however, little is known about what influences these ratings. The objective of this study is to explore the multilevel factors that influence global ratings of care for Black cancer survivors. METHODS We conducted semistructured in-depth interviews with 18 Black cancer survivors. We assessed the global ratings of their personal doctor, specialist, health plan, prescription drug plan, and overall health care, and asked patients to elaborate on their rating. We analyzed the interviews with a deductive grounded theory approach using the socioecologic model to identify the individual, interpersonal, organizational, and environmental influences on Black cancer patient experiences with global ratings of care. We used an inductive constant comparison approach to identify additional themes that emerged. Two coauthors separately coded a set of transcripts and met to refine the codebook. RESULTS On average, participants reported the highest mean rating for their specialist (9.39/10) and the lowest mean rating for their personal doctor (7.33/10). Emerging themes that influenced patient ratings were perceptions about their interaction with medical providers, physician communication, the doctor's expertise, and aspects of the physical facilities. Global ratings of care measures were widely influenced by patient interactions with their providers that were empathetic, nondiscriminatory, and where the doctors addressed all concerns. CONCLUSION This grounded theory study identifies multiple aspects of health care that intervention researchers, health care administrators, and providers may target to improve Black cancer patient experiences with care.
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Affiliation(s)
- Carol Y Ochoa
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA
| | - Gabriela Toledo
- UCL Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Aisa Iyawe-Parsons
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Stephanie Navarro
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA.,Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Albert J Farias
- Department of Preventive Medicine, The Gehr Family Center for Health Systems Science, University of Southern California, Los Angeles, CA
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8
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Park C, Zakare-Fagbamila RT, Dickson W, Garcia AN, Gottfried ON. The limited influence of neurosurgeons' behavior on inpatient satisfaction: a retrospective multihospital analysis. J Neurosurg 2021; 134:1983-1989. [PMID: 32736359 DOI: 10.3171/2020.5.jns20923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/04/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a survey that assesses patient satisfaction, which is an important measure of the quality of hospital care and ultimately the overall hospital rating (OHR). However, the survey covers several elements of patient satisfaction beyond the patient-surgeon interaction. In this study, authors investigated which admission and experience factors had the highest impact on the OHR. METHODS This was a retrospective cohort analysis of HCAHPS surveys from patients who, in the period between August 1, 2016, and January 31, 2018, had been discharged from the neurosurgical or orthopedic service at three hospitals serving a single metropolitan area. The top-box score was defined as the highest rating obtainable for each survey question. Baseline admission attributes were obtained, and multivariate logistic regression was used to determine predictors of the top-box OHR. RESULTS After application of the inclusion and exclusion criteria, 1470 patients remained in the analysis. Categories on the HCAHPS included OHR, communication, education, environment, pain management, and responsiveness. After excluding identifying questions from the survey and adjusting for subspecialty and hospital, 7 of 17 HCAHPS survey items were significant predictors of OHR. Only 2 of these were related to the surgeon: 1) discharge, "Did you get information in writing about what symptoms or health problems to look out for after you left the hospital?" (OR 5.93, 95% CI 2.52-13.94); and 2) doctor, "Did doctors explain things in a way you could understand?" (OR 2.78, 95% CI 1.73-4.46). The top three strongest correlating items were 1) discharge; 2) nursing, "Did nurses treat you with courtesy and respect?" (OR 3.86, 95% CI 2.28-6.52); and 3) hospital environment, "Were your room and bathroom kept clean?" (OR 2.86, 95% CI 1.96-4.17). CONCLUSIONS The study findings demonstrated that there are several nonmodifiable factors (i.e., specialty, experience) and items that are not under the direct purview of the neurosurgeon (e.g., nursing communication, hospital environment) that are significant influences on overall inpatient satisfaction on the HCAHPS survey. Furthermore, components of the survey that ultimately influence the OHR vary across different hospitals. Hence, HCAHPS survey results should be broadly interpreted as a way to make health systems more aware of the overall hospital factors that can improve quality of care and patient experience.
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Affiliation(s)
- Christine Park
- 1Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
| | | | - Wes Dickson
- 3Department of Performance Services, Duke University Health System, Durham; and
| | - Alessandra N Garcia
- 4Division of Doctor of Physical Therapy, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Oren N Gottfried
- 1Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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Kirby JB, Berdahl TA, Torres Stone RA. Perceptions of Patient-Provider Communication Across the Six Largest Asian Subgroups in the USA. J Gen Intern Med 2021; 36:888-893. [PMID: 33559065 PMCID: PMC8041938 DOI: 10.1007/s11606-020-06391-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Asians are the fastest-growing racial/ethnic minority group in the USA and many face communication barriers when seeking health care. Given that a high proportion of Asians are immigrants and have limited English proficiency, poor patient-provider communication may explain Asians' relatively low ratings of care. Though Asians are linguistically, economically, and culturally heterogeneous, research on health care disparities typically combines Asians into a single racial/ethnic category. OBJECTIVES To estimate racial/ethnic differences in perceptions of provider communication among the six largest Asian subgroups. DESIGN AND PARTICIPANTS Using a nationally representative sample of adults from the 2014-2017 Medical Expenditure Panel Survey (N = 136,836, round-specific response rates range from 72% to 98%), we estimate racial/ethnic differences in perceptions of provider communication, adjusted for English proficiency, immigration status, and sociodemographic characteristics. MAIN MEASURES The main dependent variable is a 4-item scale ranging from 0 to 100 measuring how positively patients view their health care providers' communication, adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS©) program. Respondents report how often their providers explain things clearly, show respect, listen carefully, and spend enough time with them. KEY RESULTS Asians, overall, had less positive perceptions of their providers' communication than either Whites or Latinxs. However, only Chinese-White differences remained after differences in English proficiency and immigration status were controlled (difference = - 2.67, 95% CI - 4.83, - 0.51). No other Asian subgroup differed significantly from Whites. CONCLUSIONS Negative views of provider communication are not pervasive among all Asians but, rather, primarily reflect the perceptions of Chinese and, possibly, Vietnamese patients. Researchers, policymakers, health plan executives, and others who produce or use data on patients' experiences with health care should, if possible, avoid categorizing all Asians into a single group.
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Affiliation(s)
- James B Kirby
- Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, MD, USA.
| | - Terceira A Berdahl
- Agency for Healthcare Research and Quality, Center for Financing, Access and Cost Trends, Rockville, MD, USA
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Ahmedov M, Pourat N, Liu H, Hays RD. Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey of experiences with ambulatory healthcare for Asians and non-Hispanic Whites in the United States. J Patient Rep Outcomes 2021; 5:29. [PMID: 33763755 PMCID: PMC7990982 DOI: 10.1186/s41687-021-00303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Differences in experiences of care reported by Asian Americans (Asians) compared to non-Hispanic Whites (Whites) may be due to lack of measurement invariance. Methods We evaluated the three-factor structure and the equivalence of responses to the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinical and Group (CG-CAHPS) Adult Visit Survey 1.0 and compared care experiences of Asians and Whites. Thirteen questions were used to elicit reports about specific aspects of care and two questions assessed overall care perceptions. This analysis of the CAHPS database included 769 providers and 266,327 respondents. Most surveys (98%) were administered by mail and the rest (2%) by phone. Only 0.5% of the surveys were administered in Spanish. The sample was 64% female, 89% White and 2% Asian, 39% 65 years or older, and 32% were high school graduates or less. Results A three-factor model was supported by categorical confirmatory factor analysis using weighted least squares with mean and variance adjustment: confirmatory fit index (CFI) = 0.99 and root mean squared error of approximation (RMSEA) = 0.03). A multi-group configural invariance model also fit the data well: (CFI = 0.993, RMSEA = 0.031). Regression models indicated that Asians reported worse access, lower scores on office staff courtesy and helpfulness and rating their doctors and were less likely to recommend their doctors to family/friends than did Whites. Conclusions Use of the CG-CAHPS Adult Visit Survey 1.0 to assess perceptions of care by Asians and Whites is supported. Quality improvement efforts are needed to address worse experiences of care among Asians in the United States. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00303-3.
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Affiliation(s)
- Mohir Ahmedov
- Health, Nutrition and Population Global Practice, World Bank, Washington, DC, USA
| | - Nadereh Pourat
- Center for Health Policy Research, University of California, Los Angeles, California, USA
| | - Honghu Liu
- School of Dentistry, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - Ron D Hays
- Division of General Internal Medicine & Health Services Research, David Geffen School of Medicine, University of California Los Angeles, 1100 Glendon Avenue, Los Angeles, CA, 90024, USA.
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Roncoroni J, Frank M, Hudson A, Whitaker S, Edelman A, Garcia P, Leeper E, Carrasco V, Melendez D, Ratchford J. Latinx Patients' Perceptions of Culturally Sensitive Health Care and their Association with Patient Satisfaction, Patient-Provider Communication, and Therapeutic Alliance. J Racial Ethn Health Disparities 2021; 9:620-629. [PMID: 33721290 DOI: 10.1007/s40615-021-00994-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 02/06/2021] [Accepted: 02/07/2021] [Indexed: 11/25/2022]
Abstract
Latinx in the USA experience disparities in morbidity and mortality when compared to their non-Hispanic White counterparts. Patient-centered culturally sensitive health care (PC-CSHC) has been deemed a best practice approach to alleviate and eliminate these disparities. However, literature on how Latinx patients perceive their care and what indicators of PC-CSHC may be most related to treatment outcomes is limited. This study collected data from 81 adult Latinx participants who had been admitted to an inpatient care unit to understand the following: (a) their perception of their providers' PC-CSHC in three different areas: Competence/Confidence, Sensitivity/Interpersonal, and Respect/Communication; (b) whether there are differences between English- and Spanish-speaking Latinx patients in their perception of their providers' PC-CSHC; and (c) whether these PC-CSHC indicators were associated to patient satisfaction, patient-provider communication, and therapeutic alliance. Participants were mostly male, older than 55 years of age, and working or lower class, with English as their primary language. Results showed that patients rated their providers' Competence (M = 3.57, SD = .46) higher than both Sensitivity, t(68) = .04, p = .04, (M = 3.49, SD =.54), and Respect, t(53) = 2.765, p = .008, (M = 3.38, SD = .57). English-speaking Latinx were overall less satisfied with their providers than Spanish-speaking Latinx, in particular in their communication. Finally, higher provider cultural sensitivity appears to be a predictor of patient satisfaction, patient-provider communication, and working alliance. Implications for refining provider trainings to treat this vulnerable and understudied (i.e., Latinx) population are discussed.
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Affiliation(s)
- J Roncoroni
- Department of Counseling Psychology, University of Denver, Denver, CO, USA.
| | - Maria Frank
- Department of Medicine, Denver Health Hospital Authority, Denver, CO, USA
| | - Amy Hudson
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - S Whitaker
- Department of Research Methods and Statistics, University of Denver, Denver, CO, USA
| | - A Edelman
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - P Garcia
- Discovering Greatness, LLC, Rio Rancho, NM, USA
| | - E Leeper
- Pathways Transtion Programs, Inc., Decatur, GA, USA
| | - V Carrasco
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
| | - D Melendez
- First Year Advising Center, Utah Valley University, Orem, UT, USA
| | - J Ratchford
- Department of Counseling Psychology, University of Denver, Denver, CO, USA
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Takeshita J, Wang S, Loren AW, Mitra N, Shults J, Shin DB, Sawinski DL. Association of Racial/Ethnic and Gender Concordance Between Patients and Physicians With Patient Experience Ratings. JAMA Netw Open 2020; 3:e2024583. [PMID: 33165609 PMCID: PMC7653497 DOI: 10.1001/jamanetworkopen.2020.24583] [Citation(s) in RCA: 340] [Impact Index Per Article: 85.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The Press Ganey Outpatient Medical Practice Survey is used to measure the patient experience. An understanding of the patient- and physician-related determinants of the patient experience may help identify opportunities to improve health care delivery and physician ratings. OBJECTIVE To evaluate the associations between the patient experience as measured by scores on the Press Ganey survey and patient-physician racial/ethnic and gender concordance. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional analysis of Press Ganey surveys returned for outpatient visits within the University of Pennsylvania Health System between 2014 and 2017 was performed. Participants included adult patient and physician dyads for whom surveys were returned. Data analysis was performed from January to June 2019. EXPOSURES Patient-physician racial/ethnic and gender concordance. MAIN OUTCOMES AND MEASURES The primary outcome was receipt of the maximum score for the "likelihood of your recommending this care provider to others" question in the Care Provider domain of the Press Ganey survey. Secondary outcomes included each of the remaining 9 questions in the Care Provider domain. Generalized estimating equations clustering on physicians with exchangeable intracluster correlations and cluster-robust standard errors were used to investigate associations between the outcomes and patient-physician racial/ethnic and gender concordance. RESULTS In total, 117 589 surveys were evaluated, corresponding to 92 238 unique patients (mean [SD] age, 57.7 [15.6] years; 37 002 men [40.1%]; 75 307 White patients [81.6%]) and 747 unique physicians (mean [SD] age 45.5 [10.6] years; 472 men [63.2%]; 533 White physicians [71.4%]). Compared with racially/ethnically concordant patient-physician dyads, discordance was associated with a lower likelihood of physicians receiving the maximum score (adjusted odds ratio [OR], 0.88; 95% CI, 0.82-0.94; P < .001). Black (adjusted OR, 0.73; 95% CI, 0.68-0.78; P < .001) and Asian (adjusted OR, 0.55; 95% CI, 0.50-0.60; P < .001) patient race were both associated with lower patient experience ratings. Patient-physician gender concordance was not associated with Press Ganey scores (adjusted OR, 1.00; 95% CI, 0.96-1.04; P = .90). CONCLUSIONS AND RELEVANCE In this study, higher Press Ganey survey scores were associated with racial/ethnic concordance between patients and their physicians. Efforts to improve physician workforce diversity are imperative. Delivery of health care in a culturally mindful manner between racially/ethnically discordant patient-physician dyads is also essential. Furthermore, Press Ganey scores may differ by a physician's patient demographic mix; thus, care must be taken when publicly reporting or using Press Ganey scores to evaluate physicians on an individual level.
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Affiliation(s)
- Junko Takeshita
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Shiyu Wang
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Alison W. Loren
- Hematology/Oncology Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Justine Shults
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Daniel B. Shin
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Deirdre L. Sawinski
- Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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13
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Perkins HS, Freed AA, Cortez JD, Hazuda HP. Inpatient Culture and Satisfaction With Care: A Novel Perspective. Am J Med Sci 2020; 361:226-232. [PMID: 33097197 DOI: 10.1016/j.amjms.2020.08.028] [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: 03/18/2020] [Revised: 07/17/2020] [Accepted: 08/25/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hospital professionals must attend to patients' satisfaction with care. Along with technical quality of care, patients' personal characteristics may affect that satisfaction, but standard demographics research often overlooks cultural links. METHODS We, therefore, asked 58 San Antonio, Texas, inpatients their satisfaction with care and examined responses for attitudes related to ethnic-Mexican-American (MA), Euro-American (EA), or African-American (AA)-and gender cultures. RESULTS Many attitudes occurred widely. Most respondents expected doctors to attend them faithfully, inform them honestly, and pursue their needs and wishes singularly. Most also trusted doctors, and expressed satisfaction with doctors' generally exemplary character and service ethic. But most respondents also feared hospital treatments, and some expressed dissatisfaction that doctors had inadequately informed them or ignored their wishes. Only rare attitudes distinguished particular ethnic-gender groups. Unlike other groups few EA or AA men expressed dissatisfactions. But some MA and EA women said hospitals use too many caregivers or coordinate care poorly. Furthermore, most AA women expressed no explicit trust in doctors, and most EA women expressed actual distrust of doctors, often doubting their technical competence or altruism. CONCLUSIONS These findings suggest a novel perspective: a unique inpatient culture, largely unaffected by ethnic group or gender. Patients interpret their hospital experience through that culture. Hospital professionals might respond with both universal measures (addressing patients' fears, dissatisfactions, and distrust) and targeted ones (explicitly asking EA and AA men about dissatisfactions, and AA and EA women about distrust). Such culturally grounded measures may help maintain or increase inpatients' satisfaction.
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Affiliation(s)
- Henry S Perkins
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas; Ecumenical Center for Religion and Health, San Antonio, Texas; Ecumenical Center for Religion and Health, Cincinnati, Ohio.
| | - Alisa A Freed
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas; South Shore Medical Center, South Shore Health System, Norwell, Massachusetts
| | - Josie D Cortez
- Intercultural Development Research Association, San Antonio, Texas
| | - Helen P Hazuda
- Department of Medicine, The University of Texas Health Science Center, San Antonio, Texas
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14
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Liao L, Chung S, Altamirano J, Garcia L, Fassiotto M, Maldonado B, Heidenreich P, Palaniappan L. The association between Asian patient race/ethnicity and lower satisfaction scores. BMC Health Serv Res 2020; 20:678. [PMID: 32698825 PMCID: PMC7374891 DOI: 10.1186/s12913-020-05534-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/13/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Patient satisfaction is increasingly being used to assess, and financially reward, provider performance. Previous studies suggest that race/ethnicity (R/E) may impact satisfaction, yet few practices adjust for patient R/E. The objective of this study is to examine R/E differences in patient satisfaction ratings and how these differences impact provider rankings. METHODS Patient satisfaction survey data linked to electronic health records from two large outpatient centers in northern California - a non-profit organization of community-based clinics (Site A) and an academic medical center (Site B) - was collected and analyzed. Participants consisted of adult patients who received outpatient care at Site A from December 2010 to November 2014 and Site B from March 2013 to August 2014, and completed Press-Ganey Medical Practice Survey questionnaires (N = 216,392 (Site A) and 30,690 (Site B)). Self-reported non-Hispanic white (NHW), Black, Latino, and Asian patients were studied. For six questions each representing a survey subdomain, favorable ratings were defined as top-box ("very good") compared to all other categories ("very poor," "poor," "fair," and "good"). Using multivariable logistic regression with provider random effects, we assessed whether the likelihood of giving favorable ratings differed by patient R/E, adjusting for patient age and sex. RESULTS Asian, younger and female patients provided less favorable ratings than other R/E, older and male patients. After adjustment, Asian patients were less likely than NHW patients to provide top-box ratings to the overall assessment question "likelihood of recommending this practice to others" (Site A: Asian predicted probability (PP) 0.680, 95% confidence interval (CI): 0.675-0.685 compared to NHW PP 0.820, 95% CI: 0.818-0.822; Site B: Asian PP 0.734, 95% CI: 0.733-0.736 compared to NHW PP 0.859, 95% CI: 0.859-0.859). The effect sizes for Asian R/E were greater than the effect sizes for older age and female sex. An absolute 3% decrease in mean composite score between providers serving different percentages of Asian patients translated to an absolute 40% drop in national ranking. CONCLUSIONS Patient satisfaction scores may need to be adjusted for patient R/E, particularly for providers caring for high panel percentages of Asian patients.
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Affiliation(s)
- Lillian Liao
- Department of Health Research and Policy, Stanford University School of Medicine, Stanford, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
- Columbia University Vagelos College of Physicians and Surgeons, 50 Haven Avenue Box #B-26, New York, NY10032 USA
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, USA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Luis Garcia
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Bonnie Maldonado
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, USA
| | - Paul Heidenreich
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
| | - Latha Palaniappan
- Department of Medicine, Stanford University School of Medicine, Stanford, USA
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15
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Abstract
The role of gender, race, and socioeconomic status in outcomes and satisfaction are reflected in patient-reported outcomes using measurement tools representing outcome domains. These domains include pain relief, physical and emotional functioning, adverse events, participant disposition, and patient satisfaction. Measurement tools exist for each of the outcomes in both acute and chronic pain. Patients with lower economic status have greater difficulty accessing care, are involved less in shared decision-making process, and are less satisfied with their care. Blacks, Hispanics, and Asians also have increased difficulty in accessing good quality care. Women have inferior outcomes after medical and surgical interventions.
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Affiliation(s)
- Natalie Kozlov
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Feinberg Pavilion, Suite 5-704, 251 E. Huron Street, Chicago, IL 60611, USA
| | - Honorio T Benzon
- Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Feinberg Pavilion, Suite 5-704, 251 E. Huron Street, Chicago, IL 60611, USA.
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16
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Cervantes-Ortega M, Du S, Biegler KA, Al-Majid S, Davis KC, Chen Y, Kobsa A, Mukamel DB, Sorkin DH. Participatory decision-making for cancer care in a high-risk sample of low income Mexican-American breast cancer survivors: The role of acculturation. ACTA ACUST UNITED AC 2020; 6:35-43. [PMID: 33898743 DOI: 10.5430/ijh.v6n2p35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Despite declining cancer incidence and mortality rates, Latina patients continue to have lower 5-year survival rates compared to their non-Hispanic white counterparts. Much of this difference has been attributed to lack of healthcare access and poorer quality of care. Research, however, has not considered the unique healthcare experiences of Latina patients. Methods Latina women with prior diagnoses of stage 0-III breast cancer were asked to complete a cross-sectional survey assessing several socio-demographic factors along with their experiences as cancer patients. Using a series of linear regression models in a sample of 68 Mexican-American breast cancer survivors, we examined the extent to which patients' ratings of provider interpersonal quality of care were associated with patients' overall healthcare quality, and how these associations varied by acculturation status. Results Findings for Latina women indicated that both participatory decision-making (PDM) (β = 0.62, p < .0001) and trust (β = 0.53, p = .02) were significantly associated with patients' ratings of healthcare quality. The interaction between acculturation and PDM further suggested that participating in the decision-making process mattered more for less acculturated than for more acculturated patients (β = -0.51, p ≤ .01). Conclusions The variation across low and high acculturated Latinas in their decision-making process introduces a unique challenge to health care providers. Further understanding the relationship between provider-patient experiences and ratings of overall healthcare quality is critical for ultimately improving health outcomes.
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Affiliation(s)
| | - Senxi Du
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Kelly A Biegler
- Department of Medicine, University of California Irvine, Irvine, USA
| | - Sadeeka Al-Majid
- School of Nursing, California State University Fullerton, Fullerton, USA
| | - Katelyn C Davis
- Department of Medicine, University of California Irvine, Irvine, USA
| | - Yunan Chen
- Department of Informatics, University of California Irvine, Irvine, USA
| | - Alfred Kobsa
- Department of Informatics, University of California Irvine, Irvine, USA.,Department of Computer Science, University of California Irvine, Irvine, USA
| | - Dana B Mukamel
- Department of Medicine, University of California Irvine, Irvine, USA
| | - Dara H Sorkin
- Department of Medicine, University of California Irvine, Irvine, USA
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17
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Zakare-Fagbamila RT, Howell E, Choi AY, Cheng TZ, Clement M, Neely M, Gottfried ON. Clinic Satisfaction Tool Improves Communication and Provides Real-Time Feedback. Neurosurgery 2020; 84:908-918. [PMID: 29669027 DOI: 10.1093/neuros/nyy137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 03/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient-reported assessments of the clinic experience are increasingly important for improving the delivery of care. The Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) survey is the current standard for evaluating patients' clinic experience, but its format gives 2-mo delayed feedback on a small proportion of patients in clinic. Furthermore, it fails to give specific actionable results on individual encounters. OBJECTIVE To develop and assess the impact of a single-page Clinic Satisfaction Tool (CST) to demonstrate real-time feedback, individualized responses, interpretable and actionable feedback, improved patient satisfaction and communication scores, increased physician buy-in, and overall feasibility. METHODS We assessed CST use for 12 mo and compared patient-reported outcomes to the year prior. We assessed all clinic encounters for patient satisfaction, all physicians for CG-CAHPS global rating, and physician communication scores, and evaluated the physician experience 1 yr after implementation. RESULTS During implementation, 14 690 patients were seen by 12 physicians, with a 96% overall CST utilization rate. Physicians considered the CST superior to CG-CAHPS in providing immediate feedback. CG-CAHPS global scores trended toward improvement and were predicted by CST satisfaction scores (P < .05). CG-CAHPS physician communication scores were also predicted by CST satisfaction scores (P < .01). High CST satisfaction scores were predicted by high utilization (P < .05). Negative feedback dropped significantly over the course of the study (P < .05). CONCLUSION The CST is a low-cost, high-yield improvement to the current method of capturing the clinic experience, improves communication and satisfaction between physicians and patients, and provides real-time feedback to physicians.
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Affiliation(s)
| | | | - Ashley Y Choi
- School of Medicine, Duke University, Durham, North Carolina
| | - Tracy Z Cheng
- School of Medicine, Duke University, Durham, North Carolina
| | - Mary Clement
- Department of Musculoskeletal and Spine Services, Duke University Medical Center, Durham, North Carolina
| | - Megan Neely
- Depart-ment of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Oren N Gottfried
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina
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18
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Hayek S, Derhy S, Smith ML, Towne SD, Zelber-Sagi S. Patient satisfaction with primary care physician performance in a multicultural population. Isr J Health Policy Res 2020; 9:13. [PMID: 32213194 PMCID: PMC7098152 DOI: 10.1186/s13584-020-00372-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 03/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A key component of the quality of health care is patient satisfaction, particularly in regard to Primary Care Physician (PCP), which represents the first contact with health care services. Patient satisfaction is associated with ethnic, regional and socio-demographic differences, due to differences in service quality, patient-doctor communication, and the patient's perceptions. The aim of this study was to evaluate patients' satisfaction related to primary care physicians' (PCP) performance and to explore potential differences by ethnicity in a multicultural population. METHODS A national cross-sectional telephone survey was conducted, among a random sample of the Israeli population aged ≥25 years. Satisfaction level from performance of PCP was assessed using a validated questionnaire (30 items; 6 different domains). RESULTS The final sample included (n = 827 Jews; n = 605 Arabs, mean age 54.7(±14.9). In the adjusted logistic regression models, Arabs reported lower general satisfaction related to PCPs' performance as compared to Jews (adjusted odds ratio (AOR), 0.63; (95% CI: 0.40-0.98). Arabs reported lower satisfaction related to PCPs' performance across the following domains: communication skills (AOR, 0.42; 95% CI, 0.22-0.82); interpersonal manners (AOR, 0.37; 95% CI, 0.24-0.58); and time spent with the patients (AOR, 0.60; 95% CI, 0.43-0.85). CONCLUSIONS Jews and Arabs were very satisfied with PCPs' performance. However, there are ethnic differences in the extent of satisfaction level related to the performance of PCP. Satisfaction from PCPs' performance may be achieved by improving the communication skills of the PCP, encouraging interpersonal interaction between the PCP and the patient, and devoting more time to the patient during the visits.
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Affiliation(s)
- Samah Hayek
- School of Public Health, University of Haifa, Haifa, Israel. .,, Memphis, USA.
| | - Shany Derhy
- School of Public Health, University of Haifa, Haifa, Israel
| | - Mathew Lee Smith
- Center for Population Health and Aging, Texas A&M University, College Station, TX, 77843, USA.,Department of Environmental and Occupational Health, School of Public Health, Texas A &M University, College Station, TX, 77843, USA.,Department of Health Promotion and Behavior, College of Public Health, The University of Georgia, Athens, GA, 30602, USA
| | - Samuel D Towne
- Center for Population Health and Aging, Texas A&M University, College Station, TX, 77843, USA.,Department of Health Management and Informatics, University of Central Florida, Orlando, FL, 32816, USA.,Disability, Aging and Technology Faculty Cluster Initiative, University of Central Florida, Orlando, FL, 32816, USA
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19
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Sehlbach C, Govaerts MJB, Mitchell S, Teunissen TGJ, Smeenk FWJM, Driessen EW, Rohde GGU. Perceptions of people with respiratory problems on physician performance evaluation-A qualitative study. Health Expect 2019; 23:247-255. [PMID: 31747110 PMCID: PMC6978864 DOI: 10.1111/hex.12999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Despite increasing calls for patient and public involvement in health-care quality improvement, the question of how patient evaluations can contribute to physician learning and performance assessment has received scant attention. OBJECTIVE The objective of this study was to explore, amid calls for patient involvement in quality assurance, patients' perspectives on their role in the evaluation of physician performance and to support physicians' learning and decision making on professional competence. DESIGN A qualitative study based on semi-structured interviews. SETTING AND PARTICIPANTS The study took place in a secondary care setting in the Netherlands. The authors selected 25 patients from two Dutch hospitals and through the Dutch Lung Foundation, using purposive sampling. METHODS Data were analysed according to the principles of template analysis, based on an a priori coding framework developed from the literature about patient empowerment, feedback and performance assessment. RESULTS The analysis unearthed three predominant patient perspectives: the proactive perspective, the restrained perspective and the outsider perspective. These perspectives differed in terms of perceived power dynamics within the doctor-patient relationship, patients' perceived ability, and willingness to provide feedback and evaluate their physician's performance. Patients' perspectives thus affected the role patients envisaged for themselves in evaluating physician performance. DISCUSSION AND CONCLUSION Although not all patients are equally suitable or willing to be involved, patients can play a role in evaluating physician performance and continuing training through formative approaches. To involve patients successfully, it is imperative to distinguish between different patient perspectives and empower patients by ensuring a safe environment for feedback.
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Affiliation(s)
- Carolin Sehlbach
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,School of Health Professions Education, Maastricht University, Maastricht, The Netherlands
| | - Marjan J B Govaerts
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | | | - Truus G J Teunissen
- Patient Contributor, and Researcher at the Department of Medical Humanities, Amsterdam Public Health research institute (APH), Amsterdam UMC Free University Medical Centre, Amsterdam, The Netherlands
| | - Frank W J M Smeenk
- School of Health Professions Education, Maastricht University, Maastricht, The Netherlands.,Respiratory Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Erik W Driessen
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Gernot G U Rohde
- Department of Respiratory Medicine, University Hospital, Goethe University, Frankfurt, Germany
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20
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Press Ganey Administration of Hospital Consumer Assessment of Healthcare Providers and Systems Survey Result in a Biased Responder Sample for Hip and Knee Arthroplasties. J Arthroplasty 2019; 34:2538-2543. [PMID: 31331703 DOI: 10.1016/j.arth.2019.06.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Press Ganey administration of Hospital Consumer Assessment of Healthcare Providers and Systems Survey after discharge is sometimes used to monitor hospital performance and adjust reimbursements. HYPOTHESIS significant differences exist between responders and nonresponders. We assessed baseline characteristic differences between responders and nonresponders; sampling bias; responding predictability in total joint arthroplasty patients; and differences in sampling and response rates among different hospitals. METHODS A prospective database of arthroplasty patients from January 1, 2016 to September 30, 2016 was used to compare responders' and nonresponders' baseline characteristics at 4 hospitals. A univariate analysis between groups was performed. A multiple logistic regression model was used to assess whether Press Ganey sampling was predictable. We identified receiving and responding predictors. RESULTS We captured 96.6% (3255 of 3369) of hip and knee arthroplasties. Hospital Consumer Assessment of Healthcare Providers and Systems Survey sampling rate was 60% and response rate was 36% (1157). Responders were more likely Caucasians, nonsmokers, discharged home, have shorter hospital stays, have higher baseline joint pain and physical composite scores, and have better mental health composite scores. Concordance indices suggest reasonable-to-very-strong model predictability for those sampled (range 0.56-0.91) and those responding (range 0.61-0.78). Completion predictors were Caucasian race (P < .0001), younger ages (P < .0001), discharged home (P < .0001), negative smoking status (P = .02), quit smoking (P = .0026), higher baseline mental health composite scores (P = .0096), and diagnoses of femoroacetabular impingement (P = .0056), osteoarthritis (P = .0111), or prosthesis failure (P = .0036). CONCLUSION Responders/nonresponders were significantly different in several characteristics. It can be predicted who will likely be sampled and who will complete. Responders were not representative of arthroplasty population. Research is needed for more representative sampling methods. LEVEL OF EVIDENCE Level III.
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21
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Mbanya VN, Terragni L, Gele AA, Diaz E, Kumar BN. Access to Norwegian healthcare system - challenges for sub-Saharan African immigrants. Int J Equity Health 2019; 18:125. [PMID: 31412853 PMCID: PMC6693278 DOI: 10.1186/s12939-019-1027-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/28/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Immigrants face barriers in accessing healthcare services in high-income countries. Inequalities in health and access to healthcare services among immigrants have been previously investigated. However, little is known on the sub-Saharan African immigrants' (SSA) access to the Norwegian healthcare system. METHODS The study had a qualitative research design. We used the snowball technique to recruit participants from networks including faith-based organizations and cultural groups. Forty-seven qualitative in-depth interview and two focus group discussions with immigrants from sub-Saharan African were conducted from October 2017 to July 2018 in Oslo and its environs. Interviews were conducted in Norwegian, English or French, audio-recorded and transcribed verbatim into English. The analysis was based on a thematic approach, using NVivo software. Interview data were analyzed searching for themes and sub-themes that emerged inductively from the interviews. RESULTS Our findings reveal barriers in two main categories when accessing the Norwegian healthcare services. The first category includes difficulties before accessing the healthcare system (information access, preference for doctors with an immigrant background, financial barriers, long waiting time and family and job responsibility). The second category includes difficulties experienced within the system (comprehension/expression and language, the black elephant in the room and dissatisfaction with healthcare providers). CONCLUSION Healthcare is not equally accessible to all Norwegian residents. This ultimately leads to avoidance of the healthcare system by those most in need. Lack of seeking healthcare services by immigrants from Sub Saharan Africa may have significant implications for the long-term health of this group of immigrants. Therefore measures to address the issues raised should be prioritized and further examined.
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Affiliation(s)
- Vivian N Mbanya
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Laura Terragni
- Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway
| | - Abdi A Gele
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
| | - Esperanza Diaz
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Bernadette N Kumar
- Unit for Migration Health, Norwegian Institute of Public Health Oslo, Oslo, Norway
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22
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Rotman LE, Alford EN, Shank CD, Dalgo C, Stetler WR. Is There an Association Between Physician Review Websites and Press Ganey Survey Results in a Neurosurgical Outpatient Clinic? World Neurosurg 2019; 132:e891-e899. [PMID: 31382063 DOI: 10.1016/j.wneu.2019.07.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent studies suggest a poor association between physician review websites and the validated metrics used by the Centers for Medicare and Medicaid Services. The purpose of this study was to evaluate the association between online and outpatient Press Ganey (PG) measures of patient satisfaction in a neurosurgical department. METHODS We obtained PG survey results from one large academic institution's outpatient neurosurgery clinic. Popular physician review websites were searched for each of the faculty captured in the PG data. Average physician rating and percent Top Box scores were calculated for each physician. PG data were separated into new and established clinic visits for subset analysis. Spearman's rank correlation coefficients were calculated to determine associations. RESULTS Twelve neurosurgeons were included. Established patients demonstrated greater PG scores as compared with new patients, with an average physician rating increase of 0.55 and an average Top Box increase of 12.5%. Online physician ratings were found to demonstrate strong agreement with PG scores for the entire PG population, new patient subset, and established patient subset (ρ = 0.77-0.79, P < 0.05). Online Top Box scores demonstrated moderate agreement with overall PG Top Box scores (ρ = 0.59, P = 0.042), moderate agreement with the new patient population Top Box scores (ρ = 0.56, P = 0.059), and weak agreement with established patient population Top Box scores (ρ = 0.38, P = 0.217). CONCLUSIONS Our findings demonstrated a strong agreement between PG ratings and online physician ratings and a poorer correlation when comparing PG Top Box scores with online physician Top Box scores, particularly in the established patient population.
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Affiliation(s)
- Lauren E Rotman
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Elizabeth N Alford
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher D Shank
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Caitlin Dalgo
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William R Stetler
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Pham T, Kuznetsova A, Gim H, Cordrey K, Milanaik R. The Internet's Effect on Parental Trust in Pediatrician Diagnosis of Autism and Likelihood of Seeking a Second Opinion. J Autism Dev Disord 2019; 49:4355-4362. [PMID: 31317368 DOI: 10.1007/s10803-019-04140-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study assessed how web-based information affects parental trust in physician's diagnosis of autism (PDA) and likelihood of seeking a second opinion. Participants of an online survey were randomly allocated to one of three hypothetical scenarios, all were given a vignette of a non-verbal 18-month-old child followed by (1) not viewing Internet results, (2) viewing results suggesting autism, or (3) viewing results suggesting language delay and rated their trust and likelihood of seeking a second opinion. When Internet results contradicted PDA, parents reported less trust in PDA and greater likelihood of seeking a second opinion. Due to the Internet's influence on parents' response to PDA, clinicians should discuss their differential diagnosis with parents, address Internet-related concerns, and recommend trustworthy sources.
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Affiliation(s)
- Tammy Pham
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY, 11042, USA
| | - Anna Kuznetsova
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY, 11042, USA
| | - Haelynn Gim
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY, 11042, USA
| | - Kyla Cordrey
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY, 11042, USA
| | - Ruth Milanaik
- Division of Developmental and Behavioral Pediatrics, Steven and Alexandra Cohen Children's Medical Center of New York, 1983 Marcus Ave, Suite 130, Lake Success, NY, 11042, USA.
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Assari S. Psychosocial Determinants of Communication Satisfaction in Racially Concordant and Discordant Patient-Physician Interactions. JOURNAL OF MEDICAL RESEARCH AND INNOVATION 2019; 3:e000165. [PMID: 34734151 PMCID: PMC8562862 DOI: 10.32892/jmri.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/07/2019] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Although socioeconomic and race-related factors both influence the quality of medical encounters, it is not known how these effects differ between racially concordant and discordant medical visits. The current study investigated psychosocial determinants of physician visit satisfaction of Black adults based on a racial concordance of the medical encounter. MATERIALS AND METHODS Data came from the Detroit Area Study, a community survey of adults in Michigan, United States. The current analysis included 336 Black individuals who had visited a White (n = 191) or a Black (n = 145) physician in the last year. The outcome was satisfaction with the quality of communication with the doctor. Demographics (age and gender), socioeconomic status (education and income), psychosocial factors (control beliefs and social support), race-related factors (having a close White friend, negative attitudes about Blacks, discrimination), and health status (chronic disease count, self-rated health, and distress) of the patient as well as race of the doctor were measured. We used multi-group structural equation modeling for data analysis, where the two groups were racially concordant (those who met a Black physician) and racially discordant (those who met a White physician) visits. RESULTS Satisfaction with physician visit was lower in racially discordant than racially concordant encounters. In racially concordant visits, high education was associated with higher satisfaction; however, racial discrimination was associated with lower satisfaction. In racially discordant visits ((i.e., with a White doctor), having a White friend as well as high sense of control were associated with higher satisfaction, while negative attitudes about Blacks was associated with a lower level of satisfaction. CONCLUSIONS Racially concordant and discordant visits have different satisfaction levels. Racially concordant and discordant visits also have different predictors of communication satisfaction among Black patients. Socioeconomic status as well as racial attitudes and experiences impact the quality of communication of the Black patients with their doctors; however, these effects depend on the race of the doctor.
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Affiliation(s)
- Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, USA
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Karimi-Dehkordi M, Spiers J, Clark AM. An evolutionary concept analysis of "patients' values". Nurs Outlook 2019; 67:523-539. [PMID: 31072646 DOI: 10.1016/j.outlook.2019.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 02/27/2019] [Accepted: 03/15/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients' values are everywhere and nowhere in nursing: frequently invoked and associated with effective nursing care but seldom explicitly defined or subject to dedicated analysis. Clarification of the concept of patients' values is pivotal because respecting and supporting patients' values are widely recognized as crucial for ethical nursing care. Despite this and the pervasive employment of the term patients' values in theories, approaches, and clinical guidelines, the concept remains ambiguous. PURPOSE We sought to understand the key elements of the concept by investigating its use in theoretical and empirical literature. METHOD This study used Rodgers' evolutionary concept analysis approach. FINDINGS We found that values are core individual beliefs that function in hierarchical systems; however, in the context of disease, the priority assigned to values by the individual may change. This is important, given that values play a foundational role in health-related decisions, such as in the context of chronic diseases. DISCUSSION Values are influenced by both individual intrinsic needs and the social context, but importantly, are involved in guiding decision-making. The attributes of the values may vary according to the context of the disease, the type of disease, and the decision at hand.
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Affiliation(s)
| | - Jude Spiers
- University of Alberta, Faculty of Nursing, Edmonton, AB, Canada
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Umeh KF. Ethnic inequalities in doctor-patient communication regarding personal care plans: the mediating effects of positive mental wellbeing. ETHNICITY & HEALTH 2019; 24:57-72. [PMID: 28385036 DOI: 10.1080/13557858.2017.1315056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE There is limited understanding of ethnic inequalities in doctor-patient communication regarding personal care plans (PCPs). This study investigated the mediating effects of positive mental wellbeing on differences in PCP-related doctor-patient communication amongst South Asian and Caucasian UK residents. DESIGN Data from 10,980 respondents to the 2013 Health Survey for England was analysed using bootstrapping methods. Constructs from the WEMWBS (Warwick and Edinburgh Mental Wellbeing Scale) (Stewart-Brown, S., and K. Janmohamed. 2008. Warwick, UK) were assessed as mediators of relations between ethnicity and several doctor-patient communication variables, including PCP-related interactions; (a) had a PCP-related discussion about a long-term condition with a doctor/nurse, and (b) had this conversation within the past year, (c) agreed to a PCP with a health professional; and (d) talked to a doctor in the past 2 weeks. RESULTS Bootstrapped mediation analysis (Hayes, A. F. 2013. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-based Approach. New York, NY: The Guilford Press) showed that three positive mind-sets mediated associations between ethnicity and doctor-patient contact, including PCP-related communication. Being able to make up one's mind (ab = -0.05; BCa CI [-0.14, 0.01]) mediated the effect of ethnicity on agreeing to a PCP, while having energy to spare (ab = 0.07; BCa CI [-0.04, 0.12]), and feeling good about oneself (ab = 0.03; BCa CI [0.01, 0.07]), mediated ethnic effects on talking to a doctor during the past fortnight. The mediating effect of reported energy persisted after controlling for medical history, perceived health, and other covariates. CONCLUSIONS Ethnic disparities in doctor-patient interaction, including PCP-related communication, are partly explained by positive mental wellbeing. Gauging positive psychological moods in patients, particularly self-worth, self-perceived vigour and decisiveness, are relevant to addressing ethnic inequalities in doctor-patient communication. As PCPs may have direct implications for patient health it is important for health professionals to address deficits in psychological functioning that may precipitate ethnic inequalities in setting up PCPs.
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Affiliation(s)
- Kanayo F Umeh
- a School of Natural Sciences & Psychology , Liverpool John Moores University , Liverpool , UK
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Otalora ML, Rosenbaum MS, Orejula AR. Understanding health care service quality in developing Latin America. Health Mark Q 2018; 35:167-185. [PMID: 30588870 DOI: 10.1080/07359683.2018.1514733] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Researchers have overlooked how poor consumers judge service quality in health care settings in Latin America. This research addresses this void by exploring how vulnerable consumers evaluate quality in a public hospital. The results show that vulnerable consumers evaluate hospitals on service delivery process, physician-patient relationship, and medical service reliability. Vulnerable consumers judge health care quality foremost on a provider's ability to provide them with fairness. The results also show that vulnerable consumers view the quality of their relationship with a physician just as important as reliability. Hospitals that serve vulnerable patients should strive to emphasize fairness and empathy.
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Affiliation(s)
| | - Mark S Rosenbaum
- b Department of Retailing, University of South Carolina , Columbia , SC , USA
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Chung S, Mujal G, Liang L, Palaniappan LP, Frosch DL. Racial/ethnic differences in reporting versus rating of healthcare experiences. Medicine (Baltimore) 2018; 97:e13604. [PMID: 30558033 PMCID: PMC6320096 DOI: 10.1097/md.0000000000013604] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Asians are reported to have poorer healthcare experience than non-Hispanic Whites (NHWs), but the sources of the differences are not understood. One explanation is Asian's reluctance to choose extreme responses in survey. We thus sought to compare NHW-Asian differences in responses to healthcare experience surveys when asked to report versus rate their experiences. Patients of an outpatient care system in 2013 to 2014 in the United States were studied. Patient experience surveys were sent after randomly selected clinic visits. Responses from 6 major Asian subgroups and NHWs were included (N = 61,115). The surveys used a combined questionnaire of Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Press Ganey surveys. CG-CAHPS questions are framed as "reporting" and Press Ganey questions as "rating" of experiences. We compared the proportion of favorable (or top box) responses to 2 related questions, one from CG-CAHPS and another from Press Ganey, and assessed racial/ethnic differences when using each of the 2 related questions, using a Pearson chi-squared test for independence. All Asian subgroups were less likely to select top box than NHWs for all questions. The Asian-NHW differences in 'rating" questions were larger than the difference in related "reporting" questions. Of those who chose top box to CG-CAHPS questions (e.g., "Yes" on a question asking "Waited < 15 minutes"), their responses to related Press Ganey questions varied widely: 47% to 57% of Asian subgroups versus 67% of NHWs rated wait time as "Very good." The extent of racial/ethnic differences in patient-reported experiences varies based on how questions are framed. The observed poorer experiences by Asians are in part explained by their worse rating of similar objectively measurable experiences.
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Affiliation(s)
- Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | - Gabriella Mujal
- Department of Health Administration, Saint Louis University, St Louis, MO
| | - Lily Liang
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA
| | | | - Dominick L. Frosch
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA
- Department of Medicine, University of California Los Angeles, Los Angeles, CA
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Palmer NR, Gregorich SE, Livaudais-Toman J, Jih J, Kaplan CP. Racial and Ethnic Differences in Prostate Cancer Survivors' Perceived Engagement in Treatment Decision-Making. J Racial Ethn Health Disparities 2018; 5:1273-1283. [PMID: 29516434 PMCID: PMC6526935 DOI: 10.1007/s40615-018-0475-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 02/19/2018] [Accepted: 02/23/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE We examined prostate cancer patients' perceived engagement in treatment decision-making and associated factors by race/ethnicity in a multiethnic sample. METHOD We identified patients through the California Cancer Registry. Patients completed a cross-sectional telephone interview in English, Spanish, Cantonese, or Mandarin. Multivariable logistic regression models, stratified by race/ethnicity, estimated the associations of patient demographic and health status characteristics on (1) doctor asked patient to help decide treatment plan and (2) patient and doctor worked out a treatment plan together. RESULTS We included 855 prostate cancer patients: African American (19%), Asian American (15%), Latino (24%), and White (42%). Asian American patients were less likely than White patients to report that their doctors asked them to help decide a treatment plan (OR = 0.31; 95% CI = 0.18-0.53) and that they worked out a treatment plan with their doctors (OR = 0.54; 95% CI = 0.33-0.90). Language of interview was a significant contributing factor in stratified analysis for both outcomes. CONCLUSION Asian American prostate cancer patients reported less engagement in treatment decision-making, with Chinese language being a significant contributing factor. Future research should identify patient-centered strategies that effectively engage underserved patients and support healthcare providers in shared decision-making with multiethnic and multilingual patients.
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Affiliation(s)
- Nynikka R Palmer
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California, 1001 Potrero Avenue, Building 10, 3rd Floor, UCSF Box 1364, San Francisco, CA, 94143, USA.
| | - Steven E Gregorich
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jennifer Livaudais-Toman
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jane Jih
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Celia P Kaplan
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Do patients' demographic characteristics affect their perceptions of self-care actions to find safe and decent care? Appl Nurs Res 2018; 43:24-29. [DOI: 10.1016/j.apnr.2018.06.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/27/2018] [Indexed: 11/19/2022]
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Perry H, Eisenberg RL, Swedeen ST, Snell AM, Siewert B, Kruskal JB. Improving Imaging Care for Diverse, Marginalized, and Vulnerable Patient Populations. Radiographics 2018; 38:1833-1844. [DOI: 10.1148/rg.2018180034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hannah Perry
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
| | - Ronald L. Eisenberg
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
| | - Suzanne T. Swedeen
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
| | - Aideen M. Snell
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
| | - Bettina Siewert
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
| | - Jonathan B. Kruskal
- From the Department of Radiology, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05404 (H.P.); and Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Mass (R.L.E, S.T.S., A.M.S., B.S., J.B.K.)
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Detollenaere J, Hanssens L, Schäfer W, Willems S. Can you recommend me a good GP? Describing social differences in patient satisfaction within 31 countries. Int J Qual Health Care 2018; 30:9-15. [PMID: 29281026 DOI: 10.1093/intqhc/mzx157] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 11/13/2017] [Indexed: 12/31/2022] Open
Abstract
Objective This study aims to explore social differences in patient satisfaction of their general practitioner (GP) according to patient's gender, education, household income and ethnicity in Europe. Design By using multilevel logistic modelling the impact of socioeconomic indicators (i.e. gender, education, household income and ethnicity) on patient satisfaction is estimated. In each model the authors controlled for indicators of person-focused care and strength of the primary care system. Setting Primary care in 31 European countries. Participants Patients who were sitting in the waiting room of the GP were asked to participate. They filled in the questionnaire after the consultation with the GP. Intervention Describing social differences in patient satisfaction among European primary care patients. Main Outcome Measure(s) Patient satisfaction. Results This study confirms previous research and reveals high levels of satisfaction with primary care in Europe. On average, 92.1% of the respondents would recommend their GP to their family or relatives. Variance in patient satisfaction is mostly explained at patient level, ~75% of the variance can be assigned to patient characteristics. Likewise, women, low-income groups and first generation migrants are less satisfied with their GP. Lastly, all indicators of person-focused care are positively associated with patient satisfaction, showing that the more person-focused the care, the higher the satisfaction among the patients. Conclusions Notwithstanding the high satisfaction rates in Europe, patient satisfaction is still determined by patients' socioeconomic status (gender and household income), migration background and the degree of person-centred care. Therefore, policymakers and health professionals should target these population groups in order to improve the satisfaction rates in their country.
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Affiliation(s)
- Jens Detollenaere
- Department of Family Medicine and Primary Health Care, Ghent University, Campus UZ, 6K3, De Pintelaan 185, 9000 Ghent, Belgium
| | - Lise Hanssens
- Department of Family Medicine and Primary Health Care, Ghent University, Campus UZ, 6K3, De Pintelaan 185, 9000 Ghent, Belgium
| | - Willemijn Schäfer
- NIVEL, Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 CR Utrecht, The Netherlands
| | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Campus UZ, 6K3, De Pintelaan 185, 9000 Ghent, Belgium
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Sims T, Koopmann-Holm B, Young H, Jiang D, Fung H, Tsai JL. Asian Americans respond less favorably to excitement (vs. calm)-focused physicians compared to European Americans. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2018; 24:1-14. [PMID: 28714709 PMCID: PMC5771974 DOI: 10.1037/cdp0000171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Despite being considered a "model minority," Asian Americans report worse health care encounters than do European Americans. This may be due to affective mismatches between Asian American patients and their European American physicians. We predicted that because Asian Americans value excitement (vs. calm) less than European Americans, they will respond less favorably to excitement-focused (vs. calm) physicians. METHOD In Study 1, 198 European American, Chinese American, and Hong Kong Chinese community adults read a medical scenario and indicated their preference for an excitement-focused versus calm-focused physician. In Study 2, 81 European American and Asian American community college students listened to recommendations made by an excitement-focused or calm-focused physician in a video, and later attempted to recall the recommendations. In Study 3, 101 European American and Asian American middle-aged and older adults had multiple online encounters with an excitement-focused or calm-focused physician and then evaluated their physicians' trustworthiness, competence, and knowledge. RESULTS As predicted, Hong Kong Chinese preferred excitement-focused physicians less than European Americans, with Chinese Americans falling in the middle (Study 1). Similarly, Asian Americans remembered health information delivered by an excitement-focused physician less well than did European Americans (Study 2). Finally, Asian Americans evaluated an excitement-focused physician less positively than did European Americans (Study 3). CONCLUSIONS These findings suggest that while physicians who promote and emphasize excitement states may be effective with European Americans, they may be less so with Asian Americans and other ethnic minorities who value different affective states. (PsycINFO Database Record
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Affiliation(s)
- Tamara Sims
- Stanford University, Department of Psychology
| | | | - Henry Young
- Stanford University, Department of Psychology
| | - Da Jiang
- Chinese University of Hong Kong, Department of Psychology
- Australian National University, Centre for Research on Ageing, Health, and Wellbeing
| | - Helene Fung
- Chinese University of Hong Kong, Department of Psychology
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Aelbrecht K, De Maesschalck S, Willems S, Deveugele M, Pype P. How family physicians respond to unpleasant emotions of ethnic minority patients. PATIENT EDUCATION AND COUNSELING 2017; 100:1867-1873. [PMID: 28535925 DOI: 10.1016/j.pec.2017.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 03/29/2017] [Accepted: 04/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The diversity in our society makes patient-centered care more difficult. In this study, we aim to describe how family physicians respond to unpleasant emotions of ethnic minority patients. METHODS One hundred ninety one consultations of family physicians with ethnic minority patients were video-recorded and analyzed using the Verona Codes for Provider Responses (VR-CoDES-P) to describe physicians' responses to patients' expressed unpleasant emotions or cues (implicit) and concerns (explicit). RESULTS 42.4% (n=81) of all the consultations contained no cues or concerns, and thus no physician responses. Of the consultations containing at least one cue or concern, a mean of 3.45 cues and a mean of 1.82 concerns per consultation were found. Physicians are significantly (p≤0.001) more frequently stimulating further disclosure of patients' cues and concerns (providing space: n=339/494 or 68.6% versus reducing space: n=155/494 or 31.4%). However, these explorations are more often about the factual, medical content of the cue than about the emotion itself (n=110/494 or 22.3% versus n=79/494 or 16%). The inter-physician variation in response to patients' cues is larger than the variation in response to the patient's concerns. CONCLUSIONS Although family physicians are quite often providing room for patients' emotions, there is much room for improvement when it comes to explicitly talking about emotional issues with patients. PRACTICE IMPLICATIONS Further research should focus on a more qualitative in-depth analysis of the complex interplay between culture and language of ethnic minority patients in primary care and, consequently, create awareness among these healthcare providers about the importance of ethnic minority patients' emotions and how to respond accordingly.
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Affiliation(s)
- Karolien Aelbrecht
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium.
| | | | - Sara Willems
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
| | - Myriam Deveugele
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
| | - Peter Pype
- Department of Family Medicine and Primary Health Care, Ghent University, Belgium
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Scheepers RA, Lases LSS, Arah OA, Heineman MJ, Lombarts KMJMH. Job Resources, Physician Work Engagement, and Patient Care Experience in an Academic Medical Setting. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2017; 92:1472-1479. [PMID: 28471782 DOI: 10.1097/acm.0000000000001719] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE Physician work engagement is associated with better work performance and fewer medical errors; however, whether work-engaged physicians perform better from the patient perspective is unknown. Although availability of job resources (autonomy, colleague support, participation in decision making, opportunities for learning) bolster work engagement, this relationship is understudied among physicians. This study investigated associations of physician work engagement with patient care experience and job resources in an academic setting. METHOD The authors collected patient care experience evaluations, using nine validated items from the Dutch Consumer Quality index in two academic hospitals (April 2014 to April 2015). Physicians reported job resources and work engagement using, respectively, the validated Questionnaire on Experience and Evaluation of Work and the Utrecht Work Engagement Scale. The authors conducted multivariate adjusted mixed linear model and linear regression analyses. RESULTS Of the 9,802 eligible patients and 238 eligible physicians, respectively, 4,573 (47%) and 185 (78%) participated. Physician work engagement was not associated with patient care experience (B = 0.01; 95% confidence interval [CI] = -0.02 to 0.03; P = .669). However, learning opportunities (B = 0.28; 95% CI = 0.05 to 0.52; P = .019) and autonomy (B = 0.31; 95% CI = 0.10 to 0.51; P = .004) were positively associated with work engagement. CONCLUSIONS Higher physician work engagement did not translate into better patient care experience. Patient experience may benefit from physicians who deliver stable quality under varying levels of work engagement. From the physicians' perspective, autonomy and learning opportunities could safeguard their work engagement.
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Affiliation(s)
- Renée A Scheepers
- R.A. Scheepers is postdoctoral researcher, Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. L.S.S. Lases is PhD candidate, Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. O.A. Arah is professor, Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands, professor, Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, and professor, UCLA Center for Health Policy Research, Los Angeles, California. M.J. Heineman is professor, Professional Performance Research Group, Center for Evidence-Based Education, and member, Board of Directors, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. K.M.J.M.H. Lombarts is professor, Professional Performance Research Group, Center for Evidence-Based Education, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Baldwin PK, Pope ND, Marks AD. Cultural implications of filial obligation and the Asian Indian American family caregiver. QUALITATIVE RESEARCH IN MEDICINE & HEALTHCARE 2017. [DOI: 10.4081/qrmh.2017.6618] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Family caregivers in young adulthood from different racial/ethnic groups represent an understudied population. Of this group, Asian Indians are a diverse and fast-growing immigrant population in the US and present unique challenges for health care providers. To illustrate factors influencing a young family caregiver from an under-represented racial/ethnic population, we report on the case of a 33 year-old American from an Asian Indian background who was a caregiver for his father with Normal Pressure Hydrocephalus (NPH). With this case report, we illustrate that medical providers should attend to cultural norms of the family system, including family communication patterns, filial obligation, and decision-making.
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Forcino RC, Barr PJ, O'Malley AJ, Arend R, Castaldo MG, Ozanne EM, Percac-Lima S, Stults CD, Tai-Seale M, Thompson R, Elwyn G. Using CollaboRATE, a brief patient-reported measure of shared decision making: Results from three clinical settings in the United States. Health Expect 2017; 21:82-89. [PMID: 28678426 PMCID: PMC5750739 DOI: 10.1111/hex.12588] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 12/30/2022] Open
Abstract
Introduction CollaboRATE is a brief patient survey focused on shared decision making. This paper aims to (i) provide insight on facilitators and challenges to implementing a real‐time patient survey and (ii) evaluate CollaboRATE scores and response rates across multiple clinical settings with varied patient populations. Method All adult patients at three United States primary care practices were eligible to complete CollaboRATE post‐visit. To inform key learnings, we aggregated all mentions of unanticipated decisions, problems and administration errors from field notes and email communications. Mixed‐effects logistic regression evaluated the impact of site, clinician, patient age and patient gender on the CollaboRATE score. Results While CollaboRATE score increased only slightly with increasing patient age (OR 1.018, 95% CI 1.014‐1.021), female patient gender was associated with significantly higher CollaboRATE scores (OR 1.224, 95% CI 1.073‐1.397). Clinician also predicts CollaboRATE score (random effect variance 0.146). Site‐specific factors such as clinical workflow and checkout procedures play a key role in successful in‐clinic implementation and are significantly related to CollaboRATE scores, with Site 3 scoring significantly higher than Site 1 (OR 1.759, 95% CI 1.216 to 2.545) or Site 2 (z=−2.71, 95% CI −1.114 to −0.178). Discussion This study demonstrates that CollaboRATE can be used in diverse primary care settings. A clinic's workflow plays a crucial role in implementation. Patient experience measurement risks becoming a burden to both patients and administrators. Episodic use of short measurement tools could reduce this burden.
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Affiliation(s)
- Rachel C Forcino
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Roger Arend
- Dartmouth-Hitchcock Patient and Family Advisory Council, Lebanon, NH, USA
| | - Molly G Castaldo
- Dartmouth Master of Health Care Delivery Science Program, Hanover, NH, USA
| | - Elissa M Ozanne
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Sanja Percac-Lima
- Harvard Medical School, Boston, MA, USA.,Massachusetts General Hospital Chelsea HealthCare Center, Chelsea, MA, USA
| | - Cheryl D Stults
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Ming Tai-Seale
- Palo Alto Medical Foundation Research Institute, Palo Alto, CA, USA
| | - Rachel Thompson
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
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Burt J, Campbell J, Abel G, Aboulghate A, Ahmed F, Asprey A, Barry H, Beckwith J, Benson J, Boiko O, Bower P, Calitri R, Carter M, Davey A, Elliott MN, Elmore N, Farrington C, Haque HW, Henley W, Lattimer V, Llanwarne N, Lloyd C, Lyratzopoulos G, Maramba I, Mounce L, Newbould J, Paddison C, Parker R, Richards S, Roberts M, Setodji C, Silverman J, Warren F, Wilson E, Wright C, Roland M. Improving patient experience in primary care: a multimethod programme of research on the measurement and improvement of patient experience. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05090] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BackgroundThere has been an increased focus towards improving quality of care within the NHS in the last 15 years; as part of this, there has been an emphasis on the importance of patient feedback within policy, through National Service Frameworks and the Quality and Outcomes Framework. The development and administration of large-scale national patient surveys to gather representative data on patient experience, such as the national GP Patient Survey in primary care, has been one such initiative. However, it remains unclear how the survey is used by patients and what impact the data may have on practice.ObjectivesOur research aimed to gain insight into how different patients use surveys to record experiences of general practice; how primary care staff respond to feedback; and how to engage primary care staff in responding to feedback.MethodsWe used methods including quantitative survey analyses, focus groups, interviews, an exploratory trial and an experimental vignette study.Results(1)Understanding patient experience data. Patients readily criticised their care when reviewing consultations on video, although they were reluctant to be critical when completing questionnaires. When trained raters judged communication during a consultation to be poor, a substantial proportion of patients rated the doctor as ‘good’ or ‘very good’. Absolute scores on questionnaire surveys should be treated with caution; they may present an overoptimistic view of general practitioner (GP) care. However, relative rankings to identify GPs who are better or poorer at communicating may be acceptable, as long as statistically reliable figures are obtained. Most patients have a particular GP whom they prefer to see; however, up to 40% of people who have such a preference are unable regularly to see the doctor of their choice. Users of out-of-hours care reported worse experiences when the service was run by a commercial provider than when it was run by a not-for profit or NHS provider. (2)Understanding patient experience in minority ethnic groups. Asian respondents to the GP Patient Survey tend to be registered with practices with generally low scores, explaining about half of the difference in the poorer reported experiences of South Asian patients than white British patients. We found no evidence that South Asian patients used response scales differently. When viewing the same consultation in an experimental vignette study, South Asian respondents gave higher scores than white British respondents. This suggests that the low scores given by South Asian respondents in patient experience surveys reflect care that is genuinely worse than that experienced by their white British counterparts. We also found that service users of mixed or Asian ethnicity reported lower scores than white respondents when rating out-of-hours services. (3)Using patient experience data. We found that measuring GP–patient communication at practice level masks variation between how good individual doctors are within a practice. In general practices and in out-of-hours centres, staff were sceptical about the value of patient surveys and their ability to support service reconfiguration and quality improvement. In both settings, surveys were deemed necessary but not sufficient. Staff expressed a preference for free-text comments, as these provided more tangible, actionable data. An exploratory trial of real-time feedback (RTF) found that only 2.5% of consulting patients left feedback using touch screens in the waiting room, although more did so when reminded by staff. The representativeness of responding patients remains to be evaluated. Staff were broadly positive about using RTF, and practices valued the ability to include their own questions. Staff benefited from having a facilitated session and protected time to discuss patient feedback.ConclusionsOur findings demonstrate the importance of patient experience feedback as a means of informing NHS care, and confirm that surveys are a valuable resource for monitoring national trends in quality of care. However, surveys may be insufficient in themselves to fully capture patient feedback, and in practice GPs rarely used the results of surveys for quality improvement. The impact of patient surveys appears to be limited and effort should be invested in making the results of surveys more meaningful to practice staff. There were several limitations of this programme of research. Practice recruitment for our in-hours studies took place in two broad geographical areas, which may not be fully representative of practices nationally. Our focus was on patient experience in primary care; secondary care settings may face different challenges in implementing quality improvement initiatives driven by patient feedback. Recommendations for future research include consideration of alternative feedback methods to better support patients to identify poor care; investigation into the factors driving poorer experiences of communication in South Asian patient groups; further investigation of how best to deliver patient feedback to clinicians to engage them and to foster quality improvement; and further research to support the development and implementation of interventions aiming to improve care when deficiencies in patient experience of care are identified.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Jenni Burt
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Gary Abel
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
- University of Exeter Medical School, Exeter, UK
| | - Ahmed Aboulghate
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Faraz Ahmed
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | - Julia Beckwith
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - John Benson
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Olga Boiko
- University of Exeter Medical School, Exeter, UK
| | - Pete Bower
- National Institute for Health Research (NIHR) School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | | | - Mary Carter
- University of Exeter Medical School, Exeter, UK
| | | | | | - Natasha Elmore
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Conor Farrington
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Hena Wali Haque
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Val Lattimer
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Nadia Llanwarne
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Cathy Lloyd
- Faculty of Health & Social Care, The Open University, Milton Keynes, UK
| | - Georgios Lyratzopoulos
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Luke Mounce
- University of Exeter Medical School, Exeter, UK
| | - Jenny Newbould
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Charlotte Paddison
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Richard Parker
- Primary Care Unit, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | | | | | | | | | - Ed Wilson
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Martin Roland
- Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge School of Clinical Medicine, Cambridge, UK
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Choi SE, Ngo-Metzger Q, Billimek J, Greenfield S, Kaplan SH, Sorkin DH. Contributors to Patients' Ratings of Quality of Care Among Ethnically Diverse Patients with Type 2 Diabetes. J Immigr Minor Health 2017; 18:382-9. [PMID: 25740551 DOI: 10.1007/s10903-015-0173-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We examined racial/ethnic differences in patients' ratings of components of interpersonal quality [participatory decision making (PDM) style, being treated as an equal partner, and feelings of trust], and evaluated the association between each of these components and patients' ratings of overall healthcare quality among non-Hispanic white (NHW), Vietnamese American, and Mexican American patients with type 2 diabetes. The findings indicated that although all three components were significantly associated with ratings of overall healthcare quality, the significant interactions between race/ethnicity and both PDM style (β = -0.09, p < 0.01) and equal partner (β = -0.06, p < 0.05) for the Vietnamese American patients suggested that the relationship between these components and patients' ratings of healthcare quality were less strong among Vietnamese American patients than among the NHW patients. Understanding racial/ethnic differences in the components of interpersonal quality that are associated with patients' ratings of overall healthcare quality is an important step for improving patients' experiences of their own care.
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Affiliation(s)
- Sarah E Choi
- Program in Nursing Science, University of California, Irvine, 100B Berk Hall, Irvine, CA, 92617-3959, USA.
| | - Quyen Ngo-Metzger
- Division of General Internal Medicine and Health Policy Research Institute, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA
| | - John Billimek
- Division of General Internal Medicine and Health Policy Research Institute, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA
| | - Sheldon Greenfield
- Division of General Internal Medicine and Health Policy Research Institute, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA
| | - Sherrie H Kaplan
- Division of General Internal Medicine and Health Policy Research Institute, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA
| | - Dara H Sorkin
- Division of General Internal Medicine and Health Policy Research Institute, University of California, Irvine, 100 Theory, Suite 110, Irvine, CA, 92697, USA
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Buchmueller TC, Gilmer T, Harris K. Health Plan Disenrollment in a Choice-Based Medicaid Managed Care Program. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2016; 41:447-60. [PMID: 15835602 DOI: 10.5034/inquiryjrnl_41.4.447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Consumer decisions to switch health plans have implications for quality of care and risk selection. We examine factors related to time to disenrollment in a Medicaid managed care program where beneficiaries face a menu of plans and can change plans every month. Several findings have direct policy relevance. Families and individuals who make active choices upon entering the program are at substantially lower risk of disenrollment than those who are auto-assigned. Interactions between enrollee ethnicity and provider language proficiency suggest that enrollee satisfaction depends on the cultural competence of providers. Differential disenrollment by risk status results in adverse retention for certain types of plans.
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Affiliation(s)
- Thomas C Buchmueller
- Graduate School of Management, University of California, Irvine, Irvine, CA 92612, USA.
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Abstract
Asian-Americans report lower levels of satisfaction with health care than other racial or ethnic groups. To determine potential reasons for this observation, we analyzed data from a national household telephone survey examining various aspects of health and health care across racial or ethnic groups. As in previous studies, Asians reported lower satisfaction with their physicians and health care services than other racial or ethnic groups, even after adjusting for demographic and health-related variables. However, Asians also reported lower satisfaction with their health insurance and with life in general and were less likely than non-Asians to have changed physicians due to dissatisfaction. We conclude that lower satisfaction ratings among Asians may be due to different response tendencies rather than to differences in quality of care. Further research is needed to explain this phenomenon and assess its potential impact on quality-of-care evaluations for clinicians and health care organizations providing care for large numbers of Asian-Americans.
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Affiliation(s)
- Somnath Saha
- Section of General Internal Medicine, Portland Veterans Affairs Medical Center, Division of General Internal Medicine, Oregon Health & Science University, Portland, OR 97239, USA.
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DeLia D, Hall A, Prinz T, Billings J. What Matters to Low-Income Patients in Ambulatory Care Facilities? Med Care Res Rev 2016; 61:352-75. [PMID: 15358971 DOI: 10.1177/1077558703257850] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Poor, uninsured, and minority patients depend disproportionately on hospital outpatient departments (OPDs) and freestanding health centers for ambulatory care. These providers confront significant challenges, including limited resources, greater demand for services, and the need to improve quality and patient satisfaction. The authors use a survey of patients in OPDs and health centers in New York City to determine which aspects of the ambulatory care visit have the greatest influence on patients’ overall site evaluation. The personal interaction between patients and physicians, provider continuity, and the general cleanliness/appearance of the facility stand out as high priorities. Access to services and interactions with other facility staff are of significant, although lesser, importance. These findings suggest ways to restructure the delivery of care so that it is more responsive to the concerns of low-income patients.
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Hu R, Shi L, Liang H, Haile GP, Lee DC. Racial/Ethnic Disparities in Primary Care Quality Among Type 2 Diabetes Patients, Medical Expenditure Panel Survey, 2012. Prev Chronic Dis 2016; 13:E100. [PMID: 27490365 PMCID: PMC4975177 DOI: 10.5888/pcd13.160113] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Racial and ethnic disparities exist in diabetes prevalence, access to diabetes care, diabetes-related complications and mortality rates, and the quality of diabetes care among Americans. We explored racial and ethnic disparities in primary care quality among Americans with type 2 diabetes. METHODS We analyzed data on adults with type 2 diabetes derived from the household component of the 2012 Medical Expenditure Panel Survey. Multiple regression and multivariate logistic regressions were used to examine the association between race/ethnicity and primary care attributes related to first contact, longitudinality, comprehensiveness, and coordination, and clusters of confounding factors were added sequentially. RESULTS Preliminary findings indicated differences in primary care quality between racial/ethnic minorities and whites across measures of first contact, longitudinality, comprehensiveness, and coordination. After controlling for confounding factors, these differences were no longer apparent; all racial/ethnic categories showed similar rates of primary care quality according to the 4 primary care domains of interest in the study. CONCLUSION Results indicate equitable primary care quality for type 2 diabetes patients across 4 key domains of primary care after controlling for socioeconomic characteristics. Additional research is necessary to support these findings, particularly when considering smaller racial/ethnic groups and investigating outcomes related to diabetes.
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Affiliation(s)
- Ruwei Hu
- Department of Health Management, School of Public Health, Sun Yat-sen University, China, and Johns Hopkins Primary Care Policy Center, Baltimore, Maryland
| | - Leiyu Shi
- Johns Hopkins Primary Care Policy Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Hailun Liang
- Johns Hopkins Primary Care Policy Center, Baltimore, Maryland
| | - Geraldine Pierre Haile
- Johns Hopkins Primary Care Policy Center, Baltimore, Maryland, and Mathematica Policy Research, Oakland, California
| | - De-Chih Lee
- Department of Information Management, Da-Yeh University, Dacun, Changhua 51591, Taiwan, R.O.C. . Dr Lee is also affiliated with the Johns Hopkins Primary Care Policy Center, Baltimore, Maryland, and Da-Yeh University, Taiwan
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African Americans Have Better Outcomes for Five Common Gastrointestinal Diagnoses in Hospitals With More Racially Diverse Patients. Am J Gastroenterol 2016; 111:649-57. [PMID: 27002802 DOI: 10.1038/ajg.2016.64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 02/01/2016] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We sought to characterize the relationship between hospital inpatient racial diversity and outcomes for African-American patients including rates of major complications or mortality during hospitalization for five common gastrointestinal diagnoses. METHODS Using the 2012 National Inpatient Sample database, hospital inpatient racial diversity was defined as the percentage of African-American patients discharged from each hospital. Logistic regression was used to predict major complication rates or death, long length of stay, and high total charges. Control variables included age, gender, payer type, patient location, area-associated income quartile, hospital characteristics including size, urban vs. rural, teaching vs. nonteaching, region, and the interaction of the percentage of African Americans with patient race. RESULTS There were 848,395 discharges across 3,392 hospitals. The patient population was on average 27% minority (s.d.±21%) with African Americans accounting for 14% of all patients. Overall, African-American patients had higher rates of major complications or death relative to white patients (adjusted odds ratio (aOR) 1.19; 95% confidence interval (CI) 1.16-1.23). However, when treated in hospitals with higher patient racial diversity, African-American patients experienced significantly lower rates of major complications or mortality (aOR 0.80; 95% CI 0.74-0.86). CONCLUSIONS African Americans have better outcomes for five common gastrointestinal diagnoses when treated in hospitals with higher inpatient racial diversity. This has major ramifications on total hospital charges.
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Nesbitt S, Palomarez RE. Review: Increasing Awareness and Education on Health Disparities for Health Care Providers. Ethn Dis 2016; 26:181-90. [PMID: 27103768 DOI: 10.18865/ed.26.2.181] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The focus of this review is to highlight health care disparities and trends in several common diseases in selected populations while offering evidence-based approaches to mitigating health care disparities. Health care disparities cross many barriers and affect multiple populations and diseases. Ethnic minorities, the elderly, and those of lower socioeconomic status (SES) are more at-risk than others. However, many low SES Whites and higher SES racial minorities have poorer health than their racial or SES peers. Also, recent immigrant groups and Hispanics, in particular, maintain high health ratings. The so-called Hispanic Paradox provides an example of how culture and social background can be used to improve health outcomes. These groups have unique determinants of disparity that are based on a wide range of cultural and societal factors. Providing improved access to care and reducing the social determinants of disparity is crucial to improving public health. At the same time, for providers, increasing an understanding of the social determinants promotes better models of individualized care to encourage more equitable care. These approaches include increasing provider education on disparities encountered by different populations, practicing active listening skills, and utilizing a patient's cultural background to promote healthy behaviors.
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Yavas U, Babakus E, Westbrook KW, Grant CC, Deitz GD, Rafalski E. An Investigation of Service Quality—Willingness to Recommend Relationship across Patient and Hospital Characteristics. JOURNAL OF HEALTH MANAGEMENT 2016. [DOI: 10.1177/0972063415625508] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study investigates onto which dimensions of service quality have more impact on patients’ overall quality perceptions of a hospital and seeks to determine the nature of relationship between service quality and patients’ willingness to recommend a hospital to their friends and family. The study also uncovers if the levels of service quality and recommendation behaviours and the relationship between service quality and recommendation behaviour exhibit similar patterns among male versus female, black versus white patients and small/medium versus large hospitals. Data gathered via mail questionnaires and phone interviews from a large sample of the patients of a hospital system in the Southern United States serve as the study setting. Results are presented and their implications are discussed. Avenues for future research are offered.
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Affiliation(s)
- Ugur Yavas
- Professor of Marketing and Advisory Board Faculty Fellow, Department of Management and Marketing, East Tennessee State University, Johnson City, TN, United States
| | - Emin Babakus
- Professor of Marketing and George Johnson Research Fellow, Department of Marketing & Supply Chain Management, The University of Memphis, Memphis, TN, United States
| | - Kevin W. Westbrook
- Professor of Marketing, McAfee School of Business Administration, Union University, Germantown, TN, United States
| | | | - George D. Deitz
- Associate Professor of Marketing, Department of Marketing & Supply Chain Management, The University of Memphis, Memphis, TN, United States
| | - Ed Rafalski
- Affiliate Research Professor, School of Public Health, University of Memphis, Memphis, TN, United States
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Chung S, Johns N, Zhao B, Romanelli R, Pu J, Palaniappan LP, Luft H. Clocks Moving at Different Speeds: Cultural Variation in the Satisfaction With Wait Time for Outpatient Care. Med Care 2016; 54:269-76. [PMID: 26683779 PMCID: PMC7259940 DOI: 10.1097/mlr.0000000000000473] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To explore racial/ethnic differences in satisfaction with wait time of scheduled office visits by comparing electronic health record (EHR)-based, patient-reported, and patient satisfaction with wait time STUDY SETTING : A large multispecialty ambulatory care organization in Northern California. Patient experience surveys were collected between 2010 and 2014. Surveys were mailed after randomly selected nonurgent visits. Returned survey data were linked to EHR data for surveyed visits. STUDY DESIGN Observational, retrospective study designed to assess differences in patient-reported wait time, wait-time satisfaction, and actual EHR-recorded wait time with respect to self-reported race/ethnicity. Multivariate regression models with provider random effects were used to evaluate differences. RESULTS Asian subgroups (Chinese, Asian Indian, Filipino, Japanese, Korean, and Vietnamese) and Latinos gave poorer ratings for wait time than non-Hispanic whites (NHWs). The average wait time reported by Asians was longer than that reported by NHWs. On the basis of EHR data, however, no minority group was likely to wait longer, and all, except for Japanese (10%), were more likely to be late for the appointment (16%: Filipino and 23%: Asian Indian), than NHWs (13%). CONCLUSIONS Given actual wait times, Asians perceive longer wait time and were less satisfied with wait times. Asians may have different expectations about wait time at the clinic.
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Affiliation(s)
- Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto
| | - Nicole Johns
- Bixby Center for Global Reproductive Health, University of California San Francisco, Oakland
| | - Beinan Zhao
- Palo Alto Medical Foundation Research Institute, Palo Alto
| | - Rob Romanelli
- Palo Alto Medical Foundation Research Institute, Palo Alto
| | - Jia Pu
- Palo Alto Medical Foundation Research Institute, Palo Alto
| | | | - Hal Luft
- Palo Alto Medical Foundation Research Institute, Palo Alto
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Voutilainen A, Pitkäaho T, Vehviläinen-Julkunen K, Sherwood PR. Meta-analysis: methodological confounders in measuring patient satisfaction. J Res Nurs 2015. [DOI: 10.1177/1744987115619209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The study aimed to identify methodological confounding factors affecting patient satisfaction survey results. The data gathered from CINAHL and PubMed databases consisted of 355 surveys published from 2006 to 2012. Linear regression and Bayesian models, with seven potential survey-related confounders together with patient age and gender as explanatory variables, were constructed. According to the linear model, up to 12% of the original variation in patient satisfaction was explained by confounding variables, not by the actual variation in satisfaction. The presence of an interviewer resulted in lower satisfaction levels, and the satisfaction results correlated negatively with the number of items in the questionnaire. According to the Bayesian model, if patients were over 60 years old and the questionnaire consisted mainly of positively phrased items, the probability of rating their experiences as very satisfied was 75%. The Bayesian and linear models endorsed each other and revealed specifically that the surveys reporting high patient satisfaction could be predicted on the basis of confounding variables. The following recommendations are given for constructing a patient satisfaction survey: use neutral rather than negatively or positively phrased items, and use enough items to increase the likelihood that the least satisfactory care components are also included in order to better enable comparisons across sporadic surveys.
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Affiliation(s)
- Ari Voutilainen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Taina Pitkäaho
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland
| | - Paula R Sherwood
- Department of Acute and Tertiary Care, School of Nursing, University of Pittsburgh, USA
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Variations in GP-patient communication by ethnicity, age, and gender: evidence from a national primary care patient survey. Br J Gen Pract 2015; 66:e47-52. [PMID: 26541182 PMCID: PMC4684035 DOI: 10.3399/bjgp15x687637] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 06/22/2015] [Indexed: 11/03/2022] Open
Abstract
Background Doctor–patient communication is a key driver of overall satisfaction with primary care. Patients from minority ethnic backgrounds consistently report more negative experiences of doctor–patient communication. However, it is currently unknown whether these ethnic differences are concentrated in one gender or in particular age groups. Aim To determine how reported GP–patient communication varies between patients from different ethnic groups, stratified by age and gender. Design and setting Analysis of data from the English GP Patient Survey from 2012–2013 and 2013–2014, including 1 599 801 responders. Method A composite score was created for doctor–patient communication from five survey items concerned with interpersonal aspects of care. Mixed-effect linear regression models were used to estimate age- and gender-specific differences between white British patients and patients of the same age and gender from each other ethnic group. Results There was strong evidence (P<0.001 for age by gender by ethnicity three-way interaction term) that the effect of ethnicity on reported GP–patient communication varied by both age and gender. The difference in scores between white British and other responders on doctor–patient communication items was largest for older, female Pakistani and Bangladeshi responders, and for younger responders who described their ethnicity as ‘Any other white’. Conclusion The identification of groups with particularly marked differences in experience of GP–patient communication — older, female, Asian patients and younger ‘Any other white’ patients — underlines the need for a renewed focus on quality of care for these groups.
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Asking the Patient About Patient-Centered Medical Homes: A Qualitative Analysis. J Gen Intern Med 2015; 30:1461-7. [PMID: 25876739 PMCID: PMC4579220 DOI: 10.1007/s11606-015-3312-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 03/06/2015] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND What patients perceive and experience within a patient-centered medical home (PCMH) is an understudied area, and to date, the patient perspective has not been an integral component of existing PCMH measurement standards. However, upcoming guidelines necessitate the use of patient-reported experiences and satisfaction in evaluations of practice and provider performance. OBJECTIVE To characterize patients' experiences with care after PCMH adoption and their understanding and perceptions of the PCMH model and its key components, and to compare responses by degree of practice-level PCMH adoption and patient race/ethnicity. DESIGN Qualitative study. PARTICIPANTS Adult patients with diabetes and/or hypertension (n = 48). APPROACH We surveyed and ranked all PCMH adult primary care practices affiliated with one academic medical center with at least three providers (n = 23), using an instrument quantifying the degree of PCMH adoption. We purposively sampled minority and non-minority patients from the four highest-ranked and four lowest-ranked PCMH-adopting practices to determine whether responses varied by degree of PCMH adoption or patient race/ethnicity. We conducted semi-structured telephone interviews with patients about their experiences with care and their perceptions and understanding of key PCMH domains. Interviews were recorded, transcribed, and imported into NVivo 10 for coding and analysis, using a modified grounded theory approach. KEY RESULTS We found that patients uniformly lacked awareness of the PCMH concept, and the vast majority perceived no PCMH-related structural changes, regardless of the degree of practice-reported PCMH adoption or the patient's race/ethnicity. Despite this lack of awareness, patients overwhelmingly reported positive relationships with their provider and positive overall experiences. CONCLUSIONS As we continue to redesign primary care delivery with an emphasis on patient experience measures as performance metrics, we need to better understand what, if any, aspects of practice structure relate to patient experience and satisfaction with care.
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