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Manjunath AK, Bloom DA, Fried JW, Bieganowski T, Slover JD, Macaulay WB, Schwarzkopf R. Pain-management protocol aimed at reducing opioids following total knee arthroplasty does not negatively impact patient satisfaction. Knee 2023; 43:106-113. [PMID: 37385111 DOI: 10.1016/j.knee.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 05/08/2023] [Accepted: 06/05/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Prior research has demonstrated that the prescription of opioid medications may be associated with the desire to treat pain in order to achieve favorable patient satisfaction. The purpose of the current study was to investigate the effect of decreased opioid prescribing following total knee arthroplasty (TKA) on survey-administered patient satisfaction scores. METHOD This study is a retrospective review of prospectively collected survey data for patients who underwent primary elective TKA for the treatment of osteoarthritis (OA) between September 2014 and June 2019. All patients included had completed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAPS) survey information. Patients were stratified into two cohorts based on whether their surgery took place prior to or subsequent to the implementation of an institutional-wide opioid-sparing regimen. RESULTS Of the 613 patients included, 488 (80%) were in the pre-protocol cohort and 125 (20%) in the post-protocol cohort. Rate of opioid refills (33.6% to 11.2%; p < 0.001) as well as length of stay (LOS, 2.40 ± 1.05 to 2.13 ± 1.13 days; p = 0.014) decreased significantly after protocol change while rate of current smokers increased significantly (4.1% to 10.4%; p = 0.011). No significant difference was observed in "top box" percentages for satisfaction with pain control (Pre: 70.5% vs Post: 72.8%; p = 0.775). CONCLUSIONS Protocols calling for reduced prescription of opioids following TKA resulted in significantly lower rates of opioid refills, and were associated with significantly shorter LOS, while causing no statistically significant deleterious changes in patient satisfaction, as measured by HCAPS survey. LOE: III. CLINICAL RELEVANCE This study suggests that HCAPS scores are not negatively impacted by a reduction in postoperative opioid analgesics.
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Affiliation(s)
- Amit K Manjunath
- Department of Orthopedic Surgery, NYU Langone Health, New York, USA
| | - David A Bloom
- Department of Orthopedic Surgery, NYU Langone Health, New York, USA
| | - Jordan W Fried
- Department of Orthopedic Surgery, NYU Langone Health, New York, USA
| | | | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, New York, USA
| | | | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, USA.
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Analysis of Negative Reviews of Orthopedic Oncology Surgeons: An Investigation of Reviews from Healthgrades, Vitals, and Google. Sarcoma 2022; 2022:4351427. [DOI: 10.1155/2022/4351427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/13/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
Background. Physician review websites (PRWs) are increasing in usage and popularity. Our purpose is to characterize one-star reviews of orthopedic oncology surgeons to understand factors in healthcare that contribute to patient satisfaction. Methods. Orthopedic oncology surgeons were randomly selected from the Musculoskeletal Tumor Society. A search for one-star reviews was performed on Google Reviews, Healthgrades, and Vitals.com. Reviews were classified as clinical or nonclinical. Statistical analyses were performed regarding the frequency of reviews and complaints for each category. Results. Of the 7,733 reviews discovered, 908 (11.7%) were identified as one-star reviews. Of 907 usable complaints, 362 (40.8%) were clinical and 545 (59.2%) were nonclinical. The most common nonclinical complaints included bedside manner (65%) and limited time with providers (19%). The most common clinical complaints included complications (26%) and disagreements with the treatment plan (26%). There were 120 surgical and 221 nonsurgical reviews. Surgical patients had a higher rate of clinical complaints. Nonsurgical patients had a higher rate of total complaints. Conclusion. To the best of our knowledge, this is the first study examining PRWs regarding orthopedic oncology surgeons. Most one-star reviews were due to nonclinical complaints from nonsurgical patients. The most common factors are bedside manner, limited time with provider, phone communication issues, and rude/unprofessional conduct.
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Gambrah HA, Hagedorn JC, Dmochowski RR, Johnsen NV. Sexual Dysfunction in Women after Traumatic Pelvic Fracture Negatively Affects Quality of Life and Mental Health. J Sex Med 2022; 19:1759-1765. [PMID: 36220747 DOI: 10.1016/j.jsxm.2022.08.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND While the impact of female sexual dysfunction (FSD) on mental health and overall health-related quality of life (HrQOL) has been previously documented, no prior work has evaluated this relationship in women following traumatic pelvic injuries. AIM This study aims to understand the relationship of FSD with HrQOL and depression in women with a history of traumatic pelvic fracture. METHODS Data were collected with an electronic survey that included queries regarding mental and sexual health. Inverse probability weighting and multivariate regression models were utilized to assess the relationships between sexual dysfunction, depression and HrQOL. OUTCOMES Study outcome measures included the Female Sexual Function Index (FSFI) to evaluate sexual functioning, the 8-item patient health questionnaire (PHQ-8) to assess depression symptoms, and the visual analog scale (VAS) component of the EuroQol 5 Dimensions Questionnaire (EQ-5D) to determine self-reported HrQOL. RESULTS Women reporting FSD had significantly higher PHQ-8 scores with a median PHQ-8 score of 6 (IQR 2, 11) relative to those without FSD who had a median score of 2 (IQR 0, 2) (P < .001). On multivariate linear regression, presence of FSD was significantly associated with higher PHQ-8 scores (β = 4.91, 95% CI 2.8-7.0, P < .001). FSFI score, time from injury, and age were all independently associated with improved HrQOL, with FSFI having the largest effect size (β = 0.62, 95% CI 0.30-0.95, P < .001). CLINICAL IMPLICATIONS These results underscore importance of addressing not just sexual health, but also mental health in female pelvic fracture survivors in the post-injury setting. STRENGTHS AND LIMITATIONS This study is one of the first to examine women with traumatic pelvic fractures who did not sustain concomitant urinary tract injuries. Study limitations include low response rate and the inherent limitations of a cross-sectional study design. CONCLUSION Patients with persistent, unaddressed FSD after pelvic fracture are at unique risk for experiencing depression and reporting worse health-related quality of life due to complex biopsychosocial mechanisms. Gambrah HA, Hagedorn JC, Dmochowski RR, et al. Sexual Dysfunction in Women after Traumatic Pelvic Fracture Negatively Affects Quality of Life and Mental Health. J Sex Med 2022;19:1759-1765.
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Affiliation(s)
- Helen A Gambrah
- Vanderbilt University School of Medicine, Nashville, TN, USA; Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
| | | | - Roger R Dmochowski
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niels V Johnsen
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
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Bloom DA, Manjunath AK, Dinizo M, Fried JW, Jazrawi LM, Protopsaltis TS, Fischer CR. Reducing Postoperative Opioid-prescribing Following Posterior Lumbar Fusion Does Not Significantly Change Patient Satisfaction. Spine (Phila Pa 1976) 2022; 47:34-41. [PMID: 34091561 DOI: 10.1097/brs.0000000000004138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective comparative; LOE-3. OBJECTIVE The purpose of this study was to investigate what effect, if any, an institutional opioid reduction prescribing policy following one- or two-level lumbar fusion has on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results. SUMMARY OF BACKGROUND DATA Previous research has demonstrated that high levels of opioid-prescribing may be related, in part, to a desire to produce superior patient satisfaction. METHODS A retrospective review of prospectively collected data was conducted on patients who underwent one- or two-level lumbar fusions L3-S1 between October 2014 and October 2019 at a single institution. Patients with complete survey information were included in the analysis. Patients with a history of trauma, fracture, spinal deformity, fusions more than two levels, or prior lumbar fusion surgery L3-S1 were excluded. Cohorts were based on date of surgery relative to implementation of an institutional opioid reduction policy, which commenced in October 1, 2018. To better compare groups, opioid prescriptions were converted into milligram morphine equivalents (MME). RESULTS A total of 330 patients met inclusion criteria: 259 pre-protocol, 71 post-protocol. There were 256 one-level fusions and 74 two-level fusions included. There were few statistically significant differences between groups with respect to patient demographics (P > 0.05) with the exception of number of patients who saw the pain management service, which increased from 36.7% (95) pre-protocol to 59.2% (42) post-protocol; P < 0.001. Estimated blood loss (EBL) decreased from 533 ± 571 mL to 346 ± 328 mL (P = 0.003). Percentage of patients who underwent concomitant laminectomy decreased from 71.8% to 49.3% (P < 0.001). Average opioids prescribed on discharge in the pre-protocol period was 534 ± 425 MME, compared to after initiation of the protocol, that is 320 ± 174 MME (P < 0.001). There was no statistically significant difference with respect to satisfaction with pain control, 4.49 ± 0.85 pre-protocol versus 4.51 ± 0.82 post-protocol (P = 0.986). CONCLUSION A reduction in opioids prescribed at discharge after one- or two-level lumbar fusion is not associated with any statistically significant change in patient satisfaction with pain management, as measured by the HCAHPS survey.Level of Evidence: 3.
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The Majority of Complaints About Orthopedic Sports Surgeons on Yelp Are Nonclinical. Arthrosc Sports Med Rehabil 2021; 3:e1465-e1472. [PMID: 34746847 PMCID: PMC8551418 DOI: 10.1016/j.asmr.2021.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/12/2021] [Indexed: 12/15/2022] Open
Abstract
Purpose To examine and characterize extremely negative Yelp reviews of orthopedic sports surgeons in the United States. Methods A search for reviews was performed using the keywords “Orthopedic Sports Medicine” on Yelp.com for 8 major metropolitan areas. Single-star reviews were isolated for analysis, and individual complaints were then categorized as clinical or nonclinical. The reviews were classified as surgical or nonsurgical. Results A total of 11,033 reviews were surveyed. Of these, 1,045 (9.5%) were identified as 1-star, and 289 were ultimately included in the study. These reviews encompassed 566 total complaints, 133 (23%) of which were clinical, and 433 (77%) of which were nonclinical in nature. The most common clinical complaints concerned complications (32 complaints; 6%), misdiagnosis (29 complaints; 5%), and uncontrolled pain (21 complaints; 4%). The most common nonclinical complaints concerned physicians’ bedside manner (120 complaints; 21%), unprofessional staff (98 complaints; 17%), and finances (78 complaints; 14%). Patients who had undergone surgery wrote 47 reviews that resulted in 114 complaints (20.5% of total complaints), whereas nonsurgical patients were responsible for 242 reviews and a total of 452 complaints (81.3% of total complaints). The difference in the number of complaints by patients after surgery and patients without surgery was statistically significant (P < 0.05) for all categories except for uncontrolled pain, delay in care, bedside manner of midlevel staff, and facilities. Conclusion Our study of extremely negative Yelp reviews found that 77% of negative complaints were nonclinical in nature. The most common clinical complaints were complications, misdiagnoses and uncontrolled pain. Only 16% of 1-star reviews were from surgical patients. Clinical Relevance Patients use online review platforms when choosing surgeons. A comprehensive understanding of factors affecting patient satisfaction and dissatisfaction is needed. The results of our study could be used to guide future quality-improvement measures and to assist surgeons in maintaining favorable online reputations.
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Choi JS, Kim JH, Park S, Lin M, Abdur-Rahman F, Mack WJ, Volker CCJ. Telemedicine in Otolaryngology During COVID-19: Patient and Physician Satisfaction. Otolaryngol Head Neck Surg 2021; 167:56-64. [PMID: 34491856 DOI: 10.1177/01945998211041921] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine patient and physician satisfaction with telemedicine in otolaryngology during COVID-19 and identify associated factors. STUDY DESIGN Prospective cohort study. SETTING Tertiary care center. METHODS Patient satisfaction was rated by patients (age ≥18 years) who had encounters from May to July 2020 (n = 407). Physician satisfaction was rated by 15 otolaryngologists for specific encounters delivered from May to June 2020 (n = 1011). Patient satisfaction was measured with a Press Ganey questionnaire and a Telemedicine Satisfaction Questionnaire. Mean Press Ganey satisfaction scores of telemedicine encounters during COVID-19 were compared with the pre-COVID-19 Press Ganey scores from in-person encounters (n = 3059) to test a noninferiority hypothesis. Physician satisfaction was measured with a Provider Satisfaction Questionnaire. RESULTS The mean Press Ganey patient satisfaction score for telemedicine encounters was 94.5 (SD, 8.8), no worse than that for in-person encounters prior to COVID-19 at 93.7 (SD, 15.5; Δ = 0.8 [95% CI, -0.5 to 2.1, excluding the noninferiority margin of -1]). Encounters with videoconference (vs telephone) and patients reporting higher income were associated with higher Telemedicine Satisfaction Questionnaire scores. Physician satisfaction scores during COVID-19 with telemedicine encounters were overall high at 83.3 (95% CI, 77.5-89.1), slightly lower when compared with the scores with in-person encounters at 88.4 (95% CI, 82.5-94.3; Δ = -5.2 [95% CI, -6.6 to -3.8]). Encounters with videoconference (vs telephone) and patients with English as a preferred language and follow-up visits were associated with higher Provider Satisfaction Questionnaire scores. CONCLUSIONS Telemedicine is a feasible alternative format in otolaryngology during COVID-19 with overall high patient and physician satisfaction. Patient satisfaction with telemedicine encounters during COVID-19 was no worse than in-person encounters prior to the pandemic. Physician satisfaction with telemedicine was relatively lower in comparison with in-person encounters.
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Affiliation(s)
- Janet S Choi
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - James H Kim
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Soyun Park
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Matthew Lin
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Faiz Abdur-Rahman
- Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Wendy J Mack
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Courtney C J Volker
- Caruso Department of Otolaryngology-Head and Neck Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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The Impact of Nursing on Trauma Patient Satisfaction: An Analysis of HCAHPS From 112,283 Patients. J Trauma Nurs 2021; 28:219-227. [PMID: 34210939 DOI: 10.1097/jtn.0000000000000589] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Assessment of patient satisfaction is central to understanding and improving system performance with the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) national standard survey. However, no large, multi-institutional study exists, which examines the role of nurses in trauma patient satisfaction. OBJECTIVE To assess the impact of nurses on trauma patient satisfaction. METHODS This retrospective, descriptive study of Level I-IV trauma centers in a multistate hospital system evaluated patients 18 years and older admitted with at least an overnight stay. Data were obtained electronically for patients discharged in 2018-2019 who returned an HCAHPS survey. Surveys were linked by an honest broker to demographic and injury data from the trauma registry, and then anonymized prior to analysis. Patients were categorized as "trauma" per the National Trauma Data Standard (NTDS) definition or as "medical" or "surgical" per the HCAHPS definition. RESULTS Of 112,283 surveys from 89 trauma centers, "trauma" patients (n = 5,126) comprised 4.6%, "surgical" 39.0% (n = 43,763), and "medical" 56.5% (n = 63,394). Nurses had an overwhelming impact on "trauma" patient satisfaction, accounting for 63.9% (p < .001) of the variation (adjusted R2) in the overall score awarded the institution-larger than for "surgery" (59.6%; p < .001) or "medical" (58.4%; p < .001) patients. The most important individual domain contributor to the overall rating of a facility was "nursing communication." CONCLUSIONS The magnitude of the effect of trauma nurses was noteworthy, with their communication ability being the single biggest driver of institutional ratings. These data provide insight for future performance benchmark development and emphasize the critical impact of trauma nurses on the trauma patient experience.
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Grip and shoulder strength correlation with validated outcome instruments in patients with rotator cuff tears. J Shoulder Elbow Surg 2021; 30:1088-1094. [PMID: 32822876 DOI: 10.1016/j.jse.2020.07.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/20/2020] [Accepted: 07/26/2020] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS/BACKGROUND The ability to better define preoperatively the extent of rotator cuff (RC) dysfunction is desired. The study's purpose was to prospectively examine the relationships between absolute and percentage loss (affected compared to unaffected) of grip and shoulder strength, and RC dysfunction. METHODS Forty-seven consecutive patients with proven RC tears participated in this study. Prior to surgery, bilateral strengths of grip, shoulder abduction, and shoulder external rotation (ER) were measured with a handheld dynamometer, and subjective outcome measures were gathered. RC tear size was determined via arthroscopy. Patient-reported outcomes were gathered on the day of the examination or via e-mail following initial evaluation. Descriptive statistics, difference analysis, and correlation coefficients (reported as either direct or negative) were used to analyze data. Grip, abduction and ER strengths, and percentage loss of grip, abduction, and ER strengths (percentage loss affected vs. unaffected), and tear size were analyzed in relation to all of the scores on selected subjective outcome measurement tools. The P value was set at .05. RESULTS Fair direct correlations were found between grip strength and the Veterans RAND 12-Item Health Survey (VR-12) mental health scores, ER strength and Simple Shoulder Test (SST), abduction strength, and both the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) function score and SST score. Abduction and ER strengths were also found to possess a fair direct correlation. Fair negative correlations were found between the ASES function score and each of the following: percentage loss of abduction strength, percentage loss of ER strength, and tear size in centimeters. Another fair negative correlation was found between the Single Assessment Numerical Evaluation (SANE) score and tear size in centimeters. DISCUSSION Our findings suggest that as shoulder strength decreases, ipsilateral shoulder RC dysfunction increases. Grip strength was not related to shoulder RC dysfunction. CONCLUSION Grip strength was not found to correlate with RC tears. Those with decreased abduction and ER strengths and low ASES scores should be considered more likely to have an RC tear.
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Bloom DA, Manjunath AK, Gotlin MJ, Hurley ET, Jazrawi LM, Virk MS, Kwon YM, Zuckerman JD. Institutional reductions in opioid prescribing do not change patient satisfaction on Press Ganey surveys after total shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:858-864. [PMID: 32712454 DOI: 10.1016/j.jse.2020.07.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND With an ongoing opioid epidemic in the United States, it is important to examine if decreased opioid prescribing can affect patient experience, namely satisfaction with pain control. PURPOSE The purpose of this study was to investigate what effect, if any, decreased opioid prescribing after total shoulder arthroplasty had on Press Ganey satisfaction surveys. METHODS A retrospective review was conducted on patients who underwent primary anatomic or reverse total shoulder arthroplasty between October 2014 and October 2019. Patients with complete Press Ganey survey information and no history of trauma, fracture, connective tissue disease, or prior shoulder arthroplasty surgery were included in the analysis. Patients were segregated into 2 groups, pre-protocol and post-protocol, based on the date of surgery relative to implementation of an institutional opioid reduction protocol, which occurred in October 2018. Prescriptions were converted to morphine milligram equivalents (MME) for direct comparison between different opioid medications. RESULTS A total of 201 patients met inclusion criteria, and there were 110 reverse total shoulder arthroplasties and 91 anatomic total shoulder arthroplasties. Average opioids prescribed on discharge for the pre-protocol group were 426.3 ± 295 MME (equivalent to 56.8 tablets of oxycodone 5 mg), whereas after the initiation of the protocol, they were 193.8 ± 199 MME (equivalent to 25.8 tablets of oxycodone 5 mg); P < .0001. Average satisfaction with pain control did not change significantly between pre-protocol and post-protocol (4.71 ± 0.65 pre-protocol and 4.74 ± 0.44 post-protocol, P = .82). CONCLUSION A reduction in opioids prescribed after a total shoulder replacement is not associated with any negative effects on patient satisfaction, as measured by the Press Ganey survey.
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Affiliation(s)
- David A Bloom
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
| | - Amit K Manjunath
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Matthew J Gotlin
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Mandeep S Virk
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Young M Kwon
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Joseph D Zuckerman
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Stephens AR, Presson AP, Chen D, Tyser AR, Kazmers NH. Inter-specialty variation of the Press Ganey Outpatient Medical Practice Survey. Medicine (Baltimore) 2021; 100:e25211. [PMID: 33761706 PMCID: PMC9281982 DOI: 10.1097/md.0000000000025211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 01/22/2021] [Accepted: 02/24/2021] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Measuring patient satisfaction scores and interpreting factors that impact their variation is of importance as scores influence various aspects of health care administration. Our objective was to evaluate if Press Ganey scores differ between medical specialties.New patient visits between January 2014 and December 2016 at a single tertiary academic center were included in this study. Press Ganey scores were compared between specialties using a multivariable logistic mixed effects model. Secondary outcomes included a comparison between surgical versus non-surgical specialties, and pediatric versus adult specialties. Due to the survey's high ceiling effect, satisfaction was defined as a perfect total score.Forty four thousand four hundred ninety six patients met inclusion criteria. Compared to internal medicine, plastic surgery, general surgery, dermatology, and family medicine were more likely to achieve a perfect overall score, as, with odds ratios of 1.46 (P = .02), 1.29 (P = .002), 1.22 (P = .004), and 1.16 (P = .02) respectively. Orthopaedics, pediatric medicine, pediatric neurology, neurology, and pain management were less likely to achieve satisfaction with odds ratios of 0.85 (P = .047), 0.71 (P < .001), 0.63 (P = .005), 0.57 (P < .001), and 0.51 (P = .006), respectively. Compared to pediatric specialties, adult specialties were more likely to achieve satisfaction (OR 1.73; P < .001). There were no significant differences between surgical versus non-surgical specialties.Press Ganey scores systematically differ between specialties within the studied institution. These differences should be considered by healthcare systems that use patient satisfaction data to modify provider reimbursement.
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Affiliation(s)
- Andrew R. Stephens
- Department of Orthopaedics, University of Utah, 590 Wakara Way
- University of Utah, School of Medicine, 30N 1900E
| | - Angela P. Presson
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT
| | - Danli Chen
- University of Utah, Division of Public Health, 375 Chipeta Way, Salt Lake City, UT
| | - Andrew R. Tyser
- Department of Orthopaedics, University of Utah, 590 Wakara Way
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Bloom DA, Manjunath AK, Wang C, Egol AJ, Meislin RJ, Youm T, Gonzalez-Lomas G. Institutional Reductions in Opioid Prescribing Following Hip Arthroscopy Do Not Change Patient Satisfaction Scores. Arthrosc Sports Med Rehabil 2021; 3:e463-e469. [PMID: 34027456 PMCID: PMC8129453 DOI: 10.1016/j.asmr.2020.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 10/27/2020] [Indexed: 11/16/2022] Open
Abstract
Purpose To investigate what effect decreased opioid prescribing following hip arthroscopy had on Press-Ganey satisfaction survey scores. Methods A retrospective review of prospectively collected data was conducted on patients who underwent primary hip arthroscopy for femoroacetabular impingement between October 2014 and October 2019. Inclusion criteria consisted of complete Press-Ganey survey information, no history of trauma, fracture, connective tissue disease, developmental hip dysplasia, autoimmune disease, or previous hip arthroscopy. Groups were separated based on date of surgery relative to implementation of an institutional opioid reduction policy that occurred in October 2018. Prescriptions were converted to milligram morphine equivalents (MME) for direct comparison between different opioids. Results A total of 113 patients met inclusion criteria, 88 preprotocol and 25 postprotocol. There were no statistically significant differences between groups with respect to patient demographics or intraoperative pathologies (P > .05). Average opioid prescription dropped from 249.6 ± 152 MME (equivalent to 33.3 tablets of oxycodone 5 mg) preprotocol to 108.6 ± 84.7 MME (equivalent to 14.5 tablets of oxycodone 5 mg) postprotocol; P = .0002. There were no statistically significant differences in Press-Ganey survey scores between pre- and postprotocol groups (P > .05). Conclusions A reduction in opioids prescribed after a hip arthroscopy is not associated with any statistically significant difference in patient satisfaction with pain management, as measured by the Press-Ganey survey. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
| | | | | | | | | | - Thomas Youm
- NYU Langone Health, New York, New York, U.S.A
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Wang E, Vasquez-Montes D, Jain D, Hutzler LH, Bosco JA, Protopsaltis TS, Buckland AJ, Fischer CR. Trends in Pain Medication Prescriptions and Satisfaction Scores in Spine Surgery Patients at a Single Institution. Int J Spine Surg 2021; 14:1023-1030. [PMID: 33560264 DOI: 10.14444/7153] [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: 11/20/2022] Open
Abstract
BACKGROUND As the opioid crisis has gained national attention, there have been increasing efforts to decrease opioid usage. Simultaneously, patient satisfaction has been a crucial metric in the American health care system and has been closely linked to effective pain management in surgical patients. The purpose of this study was to examine rates of pain medication prescription and concurrent patient satisfaction in spine surgery patients. METHODS A total of 1729 patients undergoing spine surgery between June 25, 2017, and June 30, 2018, at a single institution by surgeons performing ≥20 surgeries per quarter, with medication data during hospitalization available, were assessed. Patients were evaluated for nonopioid pain medication prescription rates and morphine milligram equivalents (MME) of opioids used during hospitalization. Of the total cohort, 198 patients were evaluated for Press Ganey Satisfaction Survey responses. A χ2 test of independence was used to compare percentages, and 1-way analysis of variance was used to compare means across quarters. RESULTS The mean total MME per patient hospitalization was 574.46, with no difference between quarters. However, mean MME per day decreased over time (P = .048), with highest mean 91.84 in Quarter 2 and lowest 77.50 in Quarter 4. Among all procedures, acetaminophen, nonsteroidal anti-inflammatory drugs, and steroid prescription rates increased, whereas benzodiazepine and γ-aminobutyric acid-analog prescriptions decreased. There were no significant differences between quarters for mean hospital ratings (P = .521) nor for responses to questions from the Press Ganey Satisfaction Survey regarding how often staff talk about pain (P = .164), how often staff talk about pain treatment (P = .595), or whether patients recommended the hospital (P = .096). There were also no differences between quarters for responses in all other patient satisfaction questions (P value range, .359-.988). CONCLUSIONS Over the studied time period, opioid use decreased and nonopioid prescriptions increased during hospitalization, whereas satisfaction scores remained unchanged. These findings indicate an increasing effort in reducing opioid use among providers and suggest the ability to do so without affecting overall satisfaction rates. LEVEL OF EVIDENCE 4. CLINICAL RELEVANCE The opioid epidemic has highlighted the need to reduce opioid usage in orthopedic spine surgery. This study reviews the trends for inpatient management of post-op pain in orthopedic spine surgery patients in relation to patient satisfaction. There was a significant increase in non-opioid analgesic pain medications, and a reduction in opioids during the study period. During this time, patient satisfaction as measured by Press-Ganey surveys did not show a decrease. This demonstrates that treatment of post-operative pain in orthopedic spine surgery patients can be managed with less opioids, more multimodal analgesia, and patient satisfaction will not be affected.
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Affiliation(s)
- Erik Wang
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York University, New York, NY
| | - Dennis Vasquez-Montes
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York University, New York, NY
| | - Deeptee Jain
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York University, New York, NY
| | - Lorraine H Hutzler
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York University, New York, NY
| | - Joseph A Bosco
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York University, New York, NY
| | | | - Aaron J Buckland
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York University, New York, NY
| | - Charla R Fischer
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York University, New York, NY
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Lehrich BM, Goshtasbi K, Brown NJ, Shahrestani S, Lien BV, Ransom SC, Tafreshi AR, Ransom RC, Chan AY, Diaz-Aguilar LD, Sahyouni R, Pham MH, Osorio JA, Oh MY. Predictors of Patient Satisfaction in Spine Surgery: A Systematic Review. World Neurosurg 2020; 146:e1160-e1170. [PMID: 33253954 DOI: 10.1016/j.wneu.2020.11.125] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recently, there has been increased interest in patient satisfaction measures such as Press Ganey and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. In this systematic review, the spine surgery literature is analyzed to evaluate factors predictive of patient satisfaction as measured by these surveys. METHODS A thorough literature search was performed in PubMed/MEDLINE, Google Scholar, and Cochrane databases. All English-language articles from database inception to July 2020 were screened for study inclusion according to PRISMA guidelines. RESULTS Twenty-four of the 1899 published studies were included for qualitative analysis. There has been a statistically significant increase in the number of publications across years (P = 0.04). Overall, the studies evaluated the relationship between patient satisfaction and patient demographics (71%), preoperative and intraoperative clinical factors (21%), and postoperative factors (33%). Top positive predictors of patient satisfaction were patient and nursing/medical staff relationship (n = 4; 17%), physician-patient relationship (n = 4; 17%), managerial oversight of received care (n = 3; 13%), same sex/ethnicity between patient and physician (n = 2; 8%), and older age (n = 2; 8%). Top negative predictors of patient satisfaction were high Charlson Comorbidity Index/high disability/worse overall health functioning (n = 7; 29%), increased length of hospital stay (n = 4; 17%), high rating for pain/complications/readmissions (n = 4; 17%), and psychosocial factors (n = 3; 13%). CONCLUSIONS There is heterogeneity in terms of different factors, both clinical and nonclinically related, that affect patient satisfaction ratings. More research is warranted to investigate the role of hospital consumer surveys in the spine surgical patient population.
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Affiliation(s)
- Brandon M Lehrich
- Medical Scientist Training Program, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, Pennsylvania, USA.
| | - Khodayar Goshtasbi
- School of Medicine, University of California, Irvine, Irvine, California, USA
| | - Nolan J Brown
- Department of Neurosurgery, University of California, Irvine, Irvine, California, USA
| | - Shane Shahrestani
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA; Department of Medical Engineering, California Institute of Technology, Pasadena, California, USA
| | - Brian V Lien
- Department of Neurosurgery, University of California, Irvine, Irvine, California, USA
| | - Seth C Ransom
- School of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ali R Tafreshi
- Department of Neurological Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Ryan C Ransom
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Alvin Y Chan
- Department of Neurosurgery, University of California, Irvine, Irvine, California, USA
| | - Luis D Diaz-Aguilar
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - Ronald Sahyouni
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - Martin H Pham
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - Joseph A Osorio
- Department of Neurological Surgery, University of California, San Diego, La Jolla, California, USA
| | - Michael Y Oh
- Department of Neurosurgery, University of California, Irvine, Irvine, California, USA
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Dobransky J, Gartke K, Pacheco-Brousseau L, Spilg E, Perreault A, Ameen M, Finless A, Beaulé PE, Poitras S. Relationship Between Orthopedic Surgeon's Empathy and Inpatient Hospital Experience Scores in a Tertiary Care Academic Institution. J Patient Exp 2020; 7:1549-1555. [PMID: 33457613 PMCID: PMC7786763 DOI: 10.1177/2374373520968972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Studies have examined the relationship between physician empathy and patient experience, but few have explored it in surgeons. The purpose of this study was to report on orthopedic surgeon empathy in a mutlispecialty practice and explore its association with orthopedic patient experience. Patients completed the consultation and relational empathy (CARE) measure (March 2017-August 2018) and Canadian Patient Experience Survey-Inpatient Care (CPES-IC; March 2017-February 2019) to assess empathy and patient experience, respectively. Consultation and relational empathy measures were correlated to CPES-IC for 3 surgeon-related questions pertaining to respect, listening, and explaining. Surgeon CARE scores (n = 1134) ranged from 42.0 ± 9.1 to 48.6 ± 2.4 with 50.4% of patients rating their surgeon as perfectly empathic. There were no significant differences between surgeons for CPES-IC continuous and topbox scores (n = 834) for respect and correlations between CPES-IC questions. The CARE measure for both continuous and topbox scores were weak to moderate, but none were significant. Empathy was associated with surgeon respect and careful listening, despite lack of significant correlation. Possible future work could use an empathy tool more appropriate for this surgeon population.
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Affiliation(s)
- Johanna Dobransky
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kathleen Gartke
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lissa Pacheco-Brousseau
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Physiotherapy, School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Spilg
- Division of Geriatrics, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ashley Perreault
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Mohammad Ameen
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Alexandra Finless
- Division of Orthopaedic Surgery, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Stéphane Poitras
- Department of Physiotherapy, School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
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Mao G, Gigliotti MJ, Dupre D. The use of hospital consumer assessment of healthcare services and the Press Ganey medical practice surveys in guiding surgical patient care practices. Surg Neurol Int 2020; 11:192. [PMID: 32754363 PMCID: PMC7395534 DOI: 10.25259/sni_29_2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 06/13/2020] [Indexed: 11/04/2022] Open
Abstract
Background Patient satisfaction questionaries have become popular in the past decade after the institution of the Patient Care and Affordable Care Act of 2010. This study evaluated whether the Hospital Consumer Assessment of Healthcare Services (H-CAHPS) and Press Ganey scores improved after institutional changes to the rounding system. Methods In the summer of 2017, utilizing H-CAHPS and Press Ganey scores, we asked whether switching from mid-level rounding providers to resident physicians improved patient care. Pre- and post-intervention groups, each lasting four quarters, were divided into care provided by mid-level personnel versus residents. For these periods, H-CAHPS respondent data were compared by a Chi-squared test (P < 0.05), while Press Ganey responses were analyzed with an independent samples t-test (P < 0.05). Results Significant improvement was noted in patients answering "Definitely yes" in recommending our institution in both H-CAHPS and Press Ganey satisfaction surveys. Significant improvement regarding the speed of discharge, instructions for post-hospital care, and the overall rating of care given was observed in the Press Ganey responses alone. Conclusion Significant improvement in satisfaction was noted in the Press Ganey responses regarding the discharge process and speed of discharge. The quality of this last encounter likely contributed to+ the significant improvement observed in both the H-CAPHS and Press Ganey Scores for an overall hospital stay and the percentage of those definitely recommending our institution.
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Affiliation(s)
- Gordon Mao
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh
| | - Michael Joseph Gigliotti
- Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States
| | - Derrick Dupre
- Department of Neurosurgery, Allegheny General Hospital, Pittsburgh
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16
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Simske NM, Benedick A, Rascoe AS, Hendrickson SB, Vallier HA. Patient Satisfaction Is Improved With Exposure to Trauma Recovery Services. J Am Acad Orthop Surg 2020; 28:597-605. [PMID: 32692097 DOI: 10.5435/jaaos-d-19-00266] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The purpose of this study is to assess the impact of Trauma Recovery Services (TRS), a program facilitating engagement and recovery on satisfaction after orthopaedic trauma. METHODS Two hundred ninety-four patients with surgically managed extremity fractures were prospectively surveyed. Satisfaction was assessed after 12 months using a 13-question telephone survey, rated on a Likert scale from 1 to 5 (with five being excellent). TRS resource utilization during and after hospitalization was recorded. Eighty-eight patients (30%) used TRS. RESULTS Overall satisfaction was high with a mean score of 4.32. Although no differences were observed between the control group and patients with TRS utilization in age, sex, race, insurance, smoking history, or employment status, TRS patients sustained more high-energy mechanisms (81% versus 56%) and had more associated psychiatric illness (33% versus 17%), both P < 0.01. Multivariable regression indicated general exposure to TRS to be an independent predictor of higher overall care ratings (B = 1.31; P = 0.03). DISCUSSION Utilization of TRS was the greatest predictor of better overall care ratings. This study builds on existing evidence demonstrating the positive impact of Trauma Survivor Network programming. We conclude that a hospital-wide program supporting patient education and engagement can effectively increase patient satisfaction after traumatic injury. LEVEL OF EVIDENCE Prognostic Level II.
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Affiliation(s)
- Natasha M Simske
- From the Department of Orthopaedic Surgery, MetroHealth Medical Center, Affiliated With Case Western Reserve University, Cleveland, OH
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Kavalukas SL, Baucom RB, Geiger TM, Ford MM, Muldoon RL, Cavin NA, Killion BE, Hopkins MB, Rothman RL, Penson DF, Hawkins AT. Benchmarking patient satisfaction scores in a colorectal patient population. Surg Endosc 2020; 35:309-316. [PMID: 32040633 DOI: 10.1007/s00464-020-07401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Healthcare reimbursement is rapidly moving away from a fee-for-service model toward value-based purchasing. An integral component of this new focus on quality is patient-centered outcomes. One metric used to define patient satisfaction is the Press Ganey Patient Satisfaction Survey. Data are lacking to accurately benchmark these scores based on diagnosis. We sought to identify if different colorectal disease processes affected a patient's perception of their healthcare experience. METHODS Adult colorectal patients seen between July 2015 and September 2016 in a tertiary hospital colorectal clinic were mailed a Press Ganey survey. Patients were stratified based on diagnosis: neoplasia, IBD, anorectal and benign colorectal disease. Survey scores were compared across the groups with adjustment for confounding variables. RESULTS 312 patients responded and formed the cohort. The mean age was 61 (range 18-93) and 56% were women. The cohort breakdown was 38% neoplasia, 32% anorectal, 21% benign, and 9% IBD. In a multivariable model, there was a difference in PG scores by diagnosis; patients with neoplasia had higher Overall scores (β 10.2; Std Error 4.0; p = 0.01), Care Provider scores (β 8.5; Std Error 4.2; p = 0.04), Nurse Assistant scores (β 15.0; Std Error 5.7; p = 0.01), and Personal Issues scores (β 11.8; Std Error 5/0; p = 0.01). CONCLUSION Press Ganey scores were found to vary significantly. Patients with a neoplasia diagnosis reported higher overall satisfaction, Care Provider, Nurse Assistant, and Personal Issues scores. Adjustment for disease condition is important when assessing patient satisfaction as an indicator of quality and as a metric for reimbursement. This study adds to increasing evidence about bias in these scores.
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Affiliation(s)
- Sandra L Kavalukas
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, USA
| | - Rebeccah B Baucom
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, USA
| | - Timothy M Geiger
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, USA
| | - Molly M Ford
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, USA
| | - Roberta L Muldoon
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, USA
| | - Nicholas A Cavin
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, USA
| | - Benjamin E Killion
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, USA
| | - M Benjamin Hopkins
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, USA
| | - Russell L Rothman
- Center for Health Services Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander T Hawkins
- Division of General Surgery, Colon and Rectal Surgery, Vanderbilt University Medical Center, 1161 21st Ave South, Room D5248 MCN, Nashville, TN, 37232, USA.
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Abstract
INTRODUCTION Hospital Value-Based Purchasing (HVBP) is an initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide. A hospital's trauma certification has the potential to influence HVBP scores as attaining the certification provides indication of the service quality offered by the hospital. As such, this study focuses on hospitals' level of trauma certification attainment through the American College of Surgeons and whether this certification is associated with greater HVBP. METHODS A retrospective review of the 2015 HVBP database, 2015 Area Health Resources Files (AHRF) database, and the 2015 American Hospital Association (AHA) database is utilized, and propensity score matching was employed to determine the association between level of trauma certification and scores on HVBP dimensions. RESULTS Results reveal trauma certification is associated with lower HVBP domain scores when compared to hospitals without trauma certification. In addition, hospitals with a greater degree of trauma specialization were associated with lower total performance score and efficiency domain scores. CONCLUSIONS Although payers attempt to connect hospital reimbursements with quality and outcomes, unintended consequences may occur. In response to these results, HVBP risk adjustment and scoring methods should receive further scrutiny.
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Rane AA, Tyser AR, Kazmers NH. Evaluating the Impact of Wait Time on Orthopaedic Outpatient Satisfaction Using the Press Ganey Survey. JB JS Open Access 2019; 4:e0014. [PMID: 32043054 PMCID: PMC6959917 DOI: 10.2106/jbjs.oa.19.00014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Press Ganey Outpatient Medical Practice Survey is a commonly utilized questionnaire that attempts to measure satisfaction with outpatient health care. A wide variety of factors have been associated with lower satisfaction scores among orthopaedic patients, including age, sex, presence of psychological disorders, and driving distance to the point of care. The impact of clinic workflows is less clear. In this study, we hypothesized that an increased clinic wait time was an independent predictor of lower patient satisfaction as measured by the Press Ganey survey.
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Affiliation(s)
- Ajinkya A Rane
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Andrew R Tyser
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
| | - Nikolas H Kazmers
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah
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20
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Hopkins BS, Patel MR, Yamaguchi JT, Cloney MB, Dahdaleh NS. Predictors of patient satisfaction and survey participation after spine surgery: a retrospective review of 17,853 consecutive spinal patients from a single academic institution. Part 1: Press Ganey. J Neurosurg Spine 2019; 30:382-388. [PMID: 30611140 DOI: 10.3171/2018.8.spine18594] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 08/29/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEPress Ganey surveys are common modalities used to assess patient satisfaction scores in an outpatient setting. Despite the existence of data, neurosurgical and orthopedic literature on patient satisfaction following spinal surgery is scarce.METHODSA total of 17,853 patients who underwent spinal procedures at the authors' institution were analyzed retrospectively for Press Ganey survey participation. Appropriate demographic, surgical, comorbidity, and complication data were collected; 1936 patients had patient satisfaction survey data, and further survey metrics were collected for this subset of patients.RESULTSMale patients, patients with urgent/emergency procedures, and patients with longer length of stay (LOS) were less likely to fill out Press Ganey surveys (OR 0.822, p < 0.001; OR 0.781, p = 0.010; and OR 0.983, p < 0.001, respectively). Posterior approach was negatively associated with Press Ganey participation (OR 0.907, p = 0.055). Patients undergoing fusion procedures were more likely to participate in Press Ganey surveys (OR 1.419, p < 0.001). Of the patients who filled out surveys, there were no positive predictors associated with receiving perfect scores on Press Ganey surveys. High Charlson Comorbidity Index (OR 0.959, p = 0.02), increasing elapsed time since surgery or discharge (OR 0.996, p = 0.03), and increasing LOS (OR 0.965, p = 0.009) were all negatively associated with receiving a perfect score. Patients who underwent a posterior-approach procedure compared with other approaches were less likely to report a low Press Ganey score (OR 0.297, p = 0.046). Patient sex and race did not influence the likelihood of receiving perfect or low Press Ganey scores. Finally, the perceived skill of the surgeon was not a significant predictor for perfect (p > 0.99) or low (p = 0.828) Press Ganey scores.CONCLUSIONSPatient participation in Press Ganey surveys strongly correlated with preoperative factors such as procedure approach and type, as well as postoperative factors such as LOS and complications. No factors were associated with an increased likelihood of receiving a perfect Press Ganey score. Similarly, LOS and time elapsed since surgery to survey completion were significant negative predictors of perfect Press Ganey scores. Skill of surgeon, sex, and race did not correlate with a predictive value for Press Ganey outcomes. In addition, overall comorbid disease burden was found to be a significant negative predictor for high patient satisfaction scores. Further study on predictors of patient satisfaction within spine surgery is needed to better assist physicians in improving the surgical experience for patients.
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Rane AA, Tyser AR, Presson AP, Zhang C, Kazmers NH. Patient Satisfaction in the Hand Surgery Clinic: An Analysis of Factors That Impact the Press Ganey Survey. J Hand Surg Am 2019; 44:539-547.e1. [PMID: 31103247 PMCID: PMC6637964 DOI: 10.1016/j.jhsa.2019.03.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 02/06/2019] [Accepted: 03/26/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Our purpose was to test the null hypothesis that no patient or clinic visit characteristics affect satisfaction of hand surgery outpatients, as measured by the Press Ganey Outpatient Medical Practice Survey (PGOMPS). METHODS Adult patients (≥ 18 years) evaluated by 5 fellowship-trained hand surgeons between January 2014 and December 2016 for a new patient clinic visit at a single tertiary academic medical center, were included. Prospectively collected PGOMPS data were reviewed retrospectively for each visit. Chart review was performed to collect demographic and visit characteristics data. Satisfaction was defined a priori as achieving a PGOMPS score above the 33rd percentile. Both the PGOMPS Total Score (primary outcome) and Provider Subscore (secondary outcome) were analyzed using univariate and multivariable logistic regression. RESULTS Of 748 included patients, the mean age was 51.7 ± 15.5 years, and 64% were women. Leading diagnoses included tendinitis (19%), neuropathy (19%), arthritis (16%), and fracture-dislocation (13%). Multivariable modelling of the PGOMPS Total Score revealed that older age, shorter wait times, and scheduling surgery were significantly associated with greater satisfaction. The PGOMPS Provider Sub-Score multivariable modelling revealed that older age, shorter wait times, scheduling surgery, and administering injections were significantly associated with greater satisfaction. Diagnostic category and insurance status did not affect satisfaction. CONCLUSIONS Increasing patient age, decreased wait time, and receiving an intervention (scheduling of surgery or receiving an injection) are associated with increased satisfaction among newly presenting hand surgery clinic patients as measured by the Press Ganey Outpatient Medical Practice Survey. Diagnosis and access to health care (insurance status and distance to clinic) did not influence patient satisfaction. TYPE OF STUDY/LEVEL OF EVIDENCE Diagnostic III.
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Affiliation(s)
| | | | - Angela P Presson
- Division of Public Health, University of Utah, Salt Lake City, UT
| | - Chong Zhang
- Division of Public Health, University of Utah, Salt Lake City, UT
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Abstract
STUDY DESIGN Retrospective survey review. OBJECTIVE We seek to evaluate satisfaction scores in patients seen in neurosurgical spine versus neurosurgical nonspine clinics. SUMMARY OF BACKGROUND DATA The Press Ganey survey is a well-established metric for measuring hospital performance and patient satisfaction. These measures have important implications in setting hospital policy and guiding interventions to improve patient perceptions of care. METHODS Retrospective Press Ganey survey review was performed to identify patient demographics and patient visit characteristics from January 1st, 2012 to October 10th, 2017 at Stanford Medical Center. A total of 40 questions from the Press Ganey survey were investigated and grouped in categories addressing physician and nursing care, personal concerns, admission, room, meal, operating room, treatment and discharge conditions, visitor accommodations and overall clinic assessment. Raw ordinal scores were converted to continuous scores of 100 for unpaired student t test analysis. We identified 578 neurosurgical spine clinic patients and 1048 neurosurgical nonspine clinic patients. RESULTS Spine clinic patients reported lower satisfaction scores in aggregate (88.2 vs. 90.1; P=0.0014), physician (89.5 vs. 92.6; P=0.0002) and nurse care (91.3 vs. 93.4; P=0.0038), personal concerns (88.2 vs. 90.9; P=0.0009), room (81.0 vs. 83.1; P=0.0164), admission (90.8 vs. 92.6; P=0.0154) and visitor conditions (87.0 vs. 89.2; P=0.0148), and overall clinic assessment (92.9 vs. 95.5; P=0.005). CONCLUSIONS This study is the first to evaluate the relationship between neurosurgical spine versus nonspine clinic with regards to patient satisfaction. The spine clinic cohort reported less satisfaction than the nonspine cohort in all significant questions on the Press Ganey survey. Our findings suggest that efforts should be made to further study and improve patient satisfaction in spine clinics. LEVEL OF EVIDENCE Level III.
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Self-Reported Recovery Likelihood Predicts Higher Physician Ratings: A Survey of Patients After Orthopaedic Surgery. J Orthop Trauma 2019; 33:e19-e23. [PMID: 30277983 DOI: 10.1097/bot.0000000000001333] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES What are the differences between elective and trauma patient satisfaction and do patient and diagnosis factors predict physician scores? DESIGN Prospective cohort study. SETTING Urban Level 1 Trauma center. PATIENTS/PARTICIPANTS Three hundred twenty-three trauma patients and 433 elective orthopaedic patients treated at our center by the same surgeons. INTERVENTION Trauma patients treated surgery for one or more fractures; elective patients treated with hip, knee, or shoulder arthroplasty, or rotator cuff repair. MAIN OUTCOME MEASUREMENTS Telephone survey regarding patient experience and satisfaction with their care. The survey included questions from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, and responses were rated on a 1-5 point Likert scale (5 best). RESULTS Elective surgery patients had mean age of 56.4 years, and trauma patients were mean 50.3 years of age. Trauma patients rated their likelihood to make a full recovery lower than elective patients (median, interquartile range), 5.0 (1.0) versus 4.0 (2.0) (P < 0.001). After multivariate binary logistic regression, patients who rated the hospital higher (≥4 vs. ≤3) were more likely (odds ratio = 10.0, 95% confidence interval, 6.4-15.8) to score physicians better. Similarly, patients who scored their overall likelihood of recovering ≥4 compared with ≤3 were more likely (odds ratio = 3.6, 95% confidence interval, 2.9-5.6) to rate their physicians more positively. CONCLUSIONS Patient perceptions including their likelihood to make a full recovery and their overall impression of the hospital predicted higher physician scores. We conclude that these physician scores are subject to patient perception biases and are not independent of the overall care experience. We recommend HCAHPS and physician ratings' web sites include internal controls, such as the patient perception of overall likelihood to recover, to aid in interpreting survey results.
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Tyser AR, Gaffney CJ, Zhang C, Presson AP. The Association of Patient Satisfaction with Pain, Anxiety, and Self-Reported Physical Function. J Bone Joint Surg Am 2018; 100:1811-1818. [PMID: 30399075 PMCID: PMC6636800 DOI: 10.2106/jbjs.17.00372] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND A complete understanding of the variables that influence patient satisfaction has yet to be reached. The purpose of this study was to determine whether patient-reported physical function, pain, and/or anxiety are associated with patient satisfaction in a hand and upper-extremity outpatient setting. METHODS This is a cohort study of 1,160 adult patients presenting to an upper-extremity (non-shoulder) clinic from January 1, 2014, to December 31, 2016, who completed functional patient-reported outcome measures (PROMIS [Patient-Reported Outcomes Measurement Information System] Physical Function, PROMIS Upper Extremity, and abbreviated Disabilities of the Arm, Shoulder and Hand scale [QuickDASH]) and psychological patient-reported outcome measures (PROMIS Anxiety and PROMIS Pain Interference) immediately prior to their physician encounter. After the clinic visit, included patients filled out the Press Ganey Medical Practice satisfaction survey online. Logistic regression models were used to predict overall patient satisfaction and satisfaction with the care provider among all, new, and return clinic visit types from the patient-reported functional and psychological measures, controlling for age and provider. RESULTS Among all visit types, there was a significant negative association of both pain and anxiety with patient satisfaction, whereby a 10-point increase in PROMIS Pain Interference (higher self-reported pain symptomatology) was associated with a 17% decrease in the odds of overall satisfaction (odds ratio [OR], 0.83 [95% confidence interval (CI), 0.71 to 0.98]; p = 0.03), and a 10-point increase in PROMIS Anxiety (higher self-reported anxiety) was associated with a 16% decrease in the odds of satisfaction with the care provider (OR, 0.84 [95% CI, 0.72 to 0.97]; p = 0.02). A significant positive association was found between higher levels of self-reported physical function and new-patient satisfaction with their care provider (OR, 1.22 [95% CI, 1.02 to 1.47]; p = 0.03). Among return patient visits, there was a negative association with overall patient satisfaction between both pain interference (OR, 0.76 [95% CI, 0.58 to 0.98]; p = 0.04) and anxiety (OR, 0.69 [95% CI, 0.53 to 0.89]; p < 0.01). CONCLUSIONS In hand and upper-extremity (non-shoulder) clinic visits, pre-encounter levels of patient-reported physical function, anxiety, and pain were significantly associated with patient satisfaction with the care provided. As the U.S. health-care system increasingly utilizes satisfaction scores in payment models and in quality assessment, these associations may influence how such metrics are interpreted and are utilized.
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Affiliation(s)
- Andrew R. Tyser
- Department of Orthopaedics (A.R.T. and C.J.G.) and Division of Epidemiology, Department of Internal Medicine (C.Z. and A.P.P.), University of Utah, Salt Lake City, Utah
| | - Christian J. Gaffney
- Department of Orthopaedics (A.R.T. and C.J.G.) and Division of Epidemiology, Department of Internal Medicine (C.Z. and A.P.P.), University of Utah, Salt Lake City, Utah
| | - Chong Zhang
- Department of Orthopaedics (A.R.T. and C.J.G.) and Division of Epidemiology, Department of Internal Medicine (C.Z. and A.P.P.), University of Utah, Salt Lake City, Utah
| | - Angela P. Presson
- Department of Orthopaedics (A.R.T. and C.J.G.) and Division of Epidemiology, Department of Internal Medicine (C.Z. and A.P.P.), University of Utah, Salt Lake City, Utah
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Etcheson JI, Gwam CU, George NE, Caughran AT, Mont MA, Delanois RE. Does the Amount of Opioid Consumed Influence How Patients Rate Their Experience of Care After Total Knee Arthroplasty? J Arthroplasty 2018; 33:3407-3411. [PMID: 30029929 DOI: 10.1016/j.arth.2018.06.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 06/15/2018] [Accepted: 06/25/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND With legislative efforts aimed at optimizing value of care, surgeons performing total knee arthroplasty (TKA) are faced with increased responsibility of optimizing patient perception of care. However, pain after TKA may negatively influence patient perception of care, as measured by Press Ganey (PG) patient satisfaction surveys. While opioid-based medications are best suited for acute pain alleviation, awareness of a growing opioid epidemic has spurred efforts to reduce its administration. Therefore, this study assessed the correlation between postoperative opioid consumption and 7 PG question domains: (1) overall hospital rating; (2) communication with nurses; (3) response time of hospital staff; (4) communication with doctors; (5) hospital environment; (6) pain management and; (7) communication about medication. METHODS We reviewed our institutional PG database for TKA patients from 2011 to 2014. A total of 406 patients were analyzed (mean age = 66, 73.4%). Opioid consumption was measured using a morphine milliequivalent conversion algorithm. Bivariate correlation analysis assessed the association between opioid consumption and PG domains. Spearman's r was utilized to assess the strength of the association. RESULTS No association between total opioid consumption and overall hospital rating (r = 0.044), communication with doctors (r = 0.080), communication with nurses (r = 0.072), responsiveness of hospital staff (r = 0.084), pain management (r = 0.100), communication about medicines (r = 0.083), or hospital environment (r = 0.155) were found. DISCUSSION Our findings demonstrate that PG scores are not influenced by immediate postoperative opioid use. These results suggest opioid-based pain medications should be administered exclusively on the basis of clinical guidelines and patient needs without concern regarding satisfactions scores and reimbursement penalties.
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Affiliation(s)
- Jennifer I Etcheson
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Chukwuweike U Gwam
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Nicole E George
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Alexander T Caughran
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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Opioids Consumed in the Immediate Post-Operative Period Do Not Influence How Patients Rate Their Experience of Care After Total Hip Arthroplasty. J Arthroplasty 2018; 33:1008-1011. [PMID: 29153633 DOI: 10.1016/j.arth.2017.10.033] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient perception of care, commonly measured with Press Ganey (PG) surveys, is an important metric used to determine hospital and provider reimbursement. However, post-operative pain following total hip arthroplasty (THA) may negatively affect patient satisfaction. As a result, over-administration of opioids may occur, even without marked evidence of pain. Therefore, this study evaluated whether opioid consumption in the immediate postoperative period bears any influence on satisfaction scores after THA. Specifically, this study assessed the correlation between post-operative opioid consumption and 7 PG domains: (1) Overall hospital rating; (2) Communication with nurses; (3) Responsiveness of hospital staff; (4) Communication with doctors; (5) Hospital environment; (6) Pain Management; and (7) Communication about medicines. METHODS Our institutional PG database was reviewed for patients who received THA from 2011 to 2014. A total of 322 patients (mean age = 65 years; 61% female) were analyzed. Patient's opioid consumption was measured using a morphine milli-equivalent conversion algorithm. Bivariate correlation analysis assessed the association between opioid consumption and Press-Ganey survey elements. Pearson's r assessed the strength of the association. RESULTS No correlation was found between total opioid consumption and Overall hospital rating (r = 0.004; P = .710), Communication with nurses (r = 0.093; P = .425), Responsiveness of hospital staff (r = 0.104; P = .381), Communication with doctors (r = 0.009; P = .940), Hospital environment (r = 0.081; P = .485), and Pain management (r = 0.075; P = .536). However, there was a positive correlation between total opioid consumption and "Communication about medicines" (r = 0.262; P = .043). CONCLUSIONS Our report demonstrates that PG patient satisfaction scores are not influenced by post-operative opioid use, with the exception of PG domain, "Communication about medications." These results suggest that opioid medications should be administered based solely on patient requirements without concern about patient satisfaction survey results.
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Day MA, Anthony CA, Bedard NA, Glass NA, Clark CR, Callaghan JJ, Noiseux NO. Increasing Perioperative Communication With Automated Mobile Phone Messaging in Total Joint Arthroplasty. J Arthroplasty 2018; 33:19-24. [PMID: 29017803 DOI: 10.1016/j.arth.2017.08.046] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/26/2017] [Accepted: 08/31/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Automated mobile phone messaging has not been reported in total joint arthroplasty (TJA). Our purpose was to compare Press Ganey (PG) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores between TJA patients who did and did not receive perioperative automated mobile phone messages. METHODS Patients were prospectively enrolled and received messages for 1 week prior until 2 weeks after TJA. Message content included reminders, activity, and pain control. Patients answered select PG/HCAHPS and questions regarding their experience with the automated communication platform. Average PG/HCAHPS scores were compared to historical TJA patients in the 3-year window prior (control group) with significance P < .05. RESULTS Thirty-seven consecutive patients were approached and 92% (n = 34) were enrolled. The experimental group was 47% male, with 80% patients between 51 and 75 years. The experimental (n = 30) and control groups (n = 26) were similar. Patients receiving messages were more likely to have a good understanding of health responsibilities (P = .024) and feel that the care team demonstrated shared decision-making (P = .024). Of patients enrolled, 87% felt messages helped them be more prepared for surgery, 100% felt messages kept them better informed, and 97% would participate again. CONCLUSION TJA patients who received perioperative communication via automated mobile phone messaging had improved patient satisfaction scores postoperatively. Patients perceived this form of communication was useful and kept them better informed. Automated mobile phone messaging can be an easily integrated, helpful adjunct to surgeons, healthcare systems, and case managers to more effectively communicate with patients undergoing TJA in this era of value-based care.
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Affiliation(s)
- Molly A Day
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Christopher A Anthony
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Nicholas A Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Natalie A Glass
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Charles R Clark
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - John J Callaghan
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Nicolas O Noiseux
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Abstract
BACKGROUND Physician care influences patient satisfaction. Inherent physician attributes may also affect scores. OBJECTIVE To determine the relationship between physician characteristics and patient satisfaction regarding physician care and communication. METHOD Observational retrospective study. We examined patient satisfaction surveys from inpatient adults across 9 questions (HCAHPS: Courtesy, Listen, and Explain; Press Ganey: Time, Concern, Informed, Friendliness, Skill, Rating) in relation to physician gender, age, ethnicity, race, and specialty. RESULTS We analyzed 51 896 surveys on 914 physicians. In univariate analysis, males were rated significantly more often in the highest category (top box) compared to females on Informed and Skill, and whites were rated in the top box more often than nonwhites on all questions. In multivariate analysis, there were no significant associations between ratings and physician gender, ethnicity, and race. On all questions, the odds of being rated in the top box were highest for obstetricians, second highest for surgeons, and lowest for medicine providers. On the question of Skill, the odds of being rated in the top box were higher with increasing age. CONCLUSION Patient satisfaction regarding physicians is associated with physician specialty and age.
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Affiliation(s)
- J Gene Chen
- Department of Pediatrics, University of Florida College of Medicine, Orlando, FL, USA
- Arnold Palmer Hospital for Children, Orlando Health, Orlando, FL, USA
| | - Baiming Zou
- Department of Biostatistics, Colleges of Medicine and Public Health, University of Florida, Gainesville, FL, USA
| | - Jonathan Shuster
- Department of Health Outcomes and Policy, University of Florida College of Medicine, Gainesville, FL, USA
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What Demographic and Clinical Characteristics Correlate With Expectations With Trapeziometacarpal Arthritis? Clin Orthop Relat Res 2017; 475:2704-2711. [PMID: 28425053 PMCID: PMC5638728 DOI: 10.1007/s11999-017-5359-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/13/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pretreatment variables have been shown to be associated with the fulfillment of patient expectations, yet in treating thumb trapeziometacarpal osteoarthritis (OA) it remains unclear how patient expectations correlate with the effectiveness of treatment. An increased understanding of the variables that affect patient expectations enables tailored patient education and patient-provider communication. QUESTIONS/PURPOSES (1) Is there a correlation between patient demographics and clinical characteristics, and the expectations the patients have when seeking treatment for trapeziometacarpal OA? (2) What factors are independently associated with the total expectations score and frequency of expecting "back to normal" among patients treated for trapeziometacarpal OA? METHODS Between March 2011 and October 2013, 89 patients of all 96 eligible patients seeking treatment for trapeziometacarpal OA were approached and agreed to participate in this study. Participants completed a validated expectations survey measuring the number of expectations and the degree of improvement expected. Comparative analysis of demographic and clinical characteristics and multivariate regression analysis against patients' expectations were performed to assess and identify factors that correlate with the number and degree of expectations. Sample size was determined with an a priori power analysis (with 80% power and statistical significance set at p < 0.05), which showed that 88 patients were needed to detect the minimal clinical difference of 12 points in the Michigan Hand Questionnaire; we then increased this by 10% to allow for potential dropouts. RESULTS After controlling for potential confounding variables such as age, hand dominance, and work status, the following factors were associated with a higher expectations score: choice of surgery (β = 11.5; 95% CI, 0.7-23.8; p = 0.044), female gender (β = 19.0; 95% CI, 5.3-32.7; p = 0.007), and dominant side affected (β = -41.6; 95% CI, -63.7 to -19.5; p < 0.001). For the frequency of "back to normal" responses, surgical treatment (β = 7.4; 95% CI, 2.3-12.4; p = 0.005) and history of previous injury (β = 8.2; 95% CI, 0.1-16.3; p = 0.047) were independently associated factors after controlling for confounding variables. There were no independent associations with age, marital status, work status, depression or anxiety, or prior contralateral surgery. CONCLUSIONS Patients whose dominant side was affected, were female, and chose surgical treatment, had higher total expectations. Patients who reported an antecedent injury and chose surgical treatment more frequently expected a return to normal. With identification of these factors, orthopaedic surgeons can recognize patients who are prone to higher expectations, and, thus, have the opportunity to implement efficient pretreatment education. In addition, identification of specific factors enables a focused measure of the effect of these factors on the fulfillment of expectations. LEVEL OF EVIDENCE Level II, prognostic study.
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Mistry JB, Gwam CU, Chughtai M, Khlopas A, Ramkumar P, Piuzzi NS, Muschler G, Harwin SF, Mont MA, Delanois RE. Factors Influencing Patients' Hospital Rating After Total Joint Arthroplasty. Orthopedics 2017; 40:377-380. [PMID: 29116323 DOI: 10.3928/01477447-20171019-03] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 09/08/2017] [Indexed: 02/03/2023]
Abstract
Patient satisfaction assessments, such as the Press Ganey surveys, have been adopted by the Centers for Medicare & Medicaid Services to help determine reimbursements. It is uncertain what facets most affect survey scores among patients who have received total joint arthroplasty (TJA). This study explored which factors guide scores for TJA patients. Specifically, the authors assessed (1) which Press Ganey survey features affected the patients' overall hospital rating and (2) whether survey scores were disparate between patients who did and patient who did not have complications. The authors' institutional Press Ganey database was queried for lower-extremity TJAs that occurred between November 2009 and January 2015. This yielded 1454 patients with a mean age of 63 years (range, 15-92 years; 60% women and 40% men). The database contains information related to American Society of Anesthesiologists scores, Press Ganey question responses, and demographics. Multiple regression analysis was performed to assess the association (beta weight) between Press Ganey domains and overall hospital rating. The weighted mean for each domain was calculated. The authors' analysis revealed that overall hospital rating was significantly influenced by communication with nurses (beta weight=0.434, P<.001), responsiveness of hospital staff (beta weight=0.181, P=.001), communication with doctors (beta weight=0.115, P=.014), and hospital environment (beta weight=0.100, P=.039). No significant differences were found when comparing the Press Ganey scores of patients with and without complications. By recognizing these elements, physicians can direct measures appropriately, which may help avoid financial penalties and possibly increase patient satisfaction after TJA. [Orthopedics. 2017; 40(6):377-380.].
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American College of Surgeons Level I trauma centers outcomes do not correlate with patients' perception of hospital experience. J Trauma Acute Care Surg 2017; 82:722-727. [PMID: 28099378 DOI: 10.1097/ta.0000000000001385] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a data collection methodology for measuring a patient's perception of his/her hospital experience, and it has been selected by the Centers of Medicare and Medicaid Services as the validated and transparent national survey tool with publicly available results. Since 2012, hospital reimbursements rates have been linked to HCAHPS data based on patient satisfaction scores. The aim of this study was, therefore, to assess whether HCAHPS scores of Level I trauma centers correlate with actual hospital performance. METHODS Retrospective analysis of the latest publicly available HCAHPS data (2014-2015) was performed. American College of Surgeons (ACS) verified Level I trauma centers for each state were identified from the ACS registry and then the following data points were collected for each hospital: HCAHPS linear mean scores regarding cleanliness of the hospital, doctor and nurse communication with the patient, staff responsiveness, pain management, overall hospital rating, and patient willingness to recommend the hospital. Our outcome measure were serious complication scores, failure-to-rescue (FTR) scores and readmission-after-discharge scores. Spearman correlation analysis was performed. RESULTS A total of 119 ACS verified Level I trauma centers across 46 states were included. The median [IQR] overall hospital rating score for Level I trauma centers was 89 (87-90). The mean ± SD score for serious complication was 0.96 ± 0.266, FTR was 123.06 ± 22.5, and readmission after discharge was 15.71 ± 1.07. The Spearman correlation analysis showed that overall HCAHP-based hospital rating scores did not correlate with serious complications (correlation coefficient = 0.14 p = 0.125), FTR (correlation coefficient = -0.15 p = 0.073), or readmission after discharge (correlation coefficient = -0.18 p = 0.053). CONCLUSION The findings of our study suggest that no correlation exists between HCAHPS patient satisfaction scores and hospital performance for Level I trauma centers. Consequently, the Centers of Medicare and Medicaid Services should reconsider hospital reimbursement decisions based on HCAHP patient satisfaction scores. LEVEL OF EVIDENCE Prognostic/epidemiologic study, level III; therapeutic study, level IV.
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Nagarajan N, Rahman S, Boss EF. Are There Racial Disparities in Family-Reported Experiences of Care in Inpatient Pediatrics? Clin Pediatr (Phila) 2017; 56:619-626. [PMID: 27621079 DOI: 10.1177/0009922816668497] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite increased emphasis on patient satisfaction as a quality measure in health care, little is known about the influence of race in parent-reported experience of care in pediatrics. This study evaluates the association of race with patient satisfaction scores in an inpatient pediatric tertiary care hospital in one year. Risk-adjusted multivariable logistic regression was performed to evaluate the association of minority race with the likelihood to provide a top-box (=5) satisfaction score for 38 individual questions across 8 domains. Of the 904 participants, 269 (29.8%) identified as belonging to a minority race. Parents of minority children reported 30% to 50% lower satisfaction across questions related to well-established themes of interpersonal communication and cultural competency. Overall, minorities also reported lower satisfaction for the domain of nursing care (odds ratio 0.7, P = .016). These findings suggest a need for training and interventions to improve communication and mitigate disparities in how minority patients and their families perceive pediatric care.
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Affiliation(s)
- Neeraja Nagarajan
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA.,2 Brigham and Women's Hospital, Boston, MA, USA
| | - Sydur Rahman
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily F Boss
- 1 Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Abstract
BACKGROUND Patient satisfaction surveys are an important tool in measuring physician performance. We hypothesized that nonmodifiable factors would be associated with surgical outpatient satisfaction scores. METHODS Press Ganey Consumer Assessment of Health Providers and Systems outpatient satisfaction scores from completed surveys (18,373) at an academic department of surgery were reviewed. Data were collected on patient factors, provider specialty, practice setting, and first visit status. Patients were divided into groups based on satisfaction scores-completely satisfied (score = 100) or less satisfied (score ≤99). Generalized estimating equation logistic regression analysis was performed to identify factors predictive of patient satisfaction. RESULTS Patients less likely to be completely satisfied were younger (odds ratio [OR] 0.54; confidence interval [CI] 0.43-0.69, P < 0.001 for 18-29 y versus >80 y) and were more likely to be seeing their surgeon for the first time (OR 0.84; CI 0.78-0.89, P < 0.001 for first versus return patients). Compared with patients seen at hospital subspecialty clinics, patients were more likely to be satisfied if seen at a cancer center clinic (OR 1.22; CI 1.13-1.32, P < 0.001) or a community ambulatory clinic (OR 1.30; CI 1.18-1.43, P < 0.001). There was no difference in satisfaction among patients seen in General Surgery, Plastic Surgery, or Otolaryngology Clinics. Patients were less likely to be satisfied when seen in Urology (OR 0.82; CI 0.75-0.91, P < 0.001) and Vascular Surgery (OR 0.75; CI 0.62-0.92, P = 0.006) clinics compared with General Surgery Clinics. CONCLUSIONS Using satisfaction scores to evaluate providers should take into account nonmodifiable factors of the underlying patient population, the specialty of the provider, and the practice setting of the visit.
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Robins RJ, Anderson MB, Zhang Y, Presson AP, Burks RT, Greis PE. Convergent Validity of the Patient-Reported Outcomes Measurement Information System's Physical Function Computerized Adaptive Test for the Knee and Shoulder Injury Sports Medicine Patient Population. Arthroscopy 2017; 33:608-616. [PMID: 27964968 DOI: 10.1016/j.arthro.2016.08.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate the convergent validity, precision, and completion times for the Physical Function Computerized Adaptive Test (PF-CAT) in a sports medicine patient population relative to standard measures of knee and shoulder function. METHODS We reviewed all patient visits from April through September 2014 with either knee or shoulder complaints from a university-based sports medicine clinic, during which PF-CAT, Single Assessment Numerical Evaluation (SANE), Simple Shoulder Test (SST), and American Shoulder and Elbow Surgeons (ASES) outcome scores for shoulder patients and PF-CAT, SANE, and International Knee Documentation Committee (IKDC) scores for knee patients were obtained, with an initial visit or one follow-up visit included in the study. Spearman correlation was used to evaluate pairwise agreement among scores. The McNemar χ2 test was used to evaluate a difference in the number of times floor and ceiling values occurred. Wilcoxon signed rank tests were used to compare differences in completion times. RESULTS In total, 415 shoulder and 450 knee clinical evaluations qualified for inclusion in the study. A high correlation was found between IKDC and PF-CAT scores (r = 0.75, P < .0001), and a moderately high correlation was found between PF-CAT and both SST (r = 0.68, P < .0001) and ASES (r = 0.63, P < .0001) scores. Maximum differences in the sum of floor-ceiling values versus the PF-CAT were 15% for the SST (P < .0001), 2.5% for the ASES (ceiling only, P = .0133), and 5.8% for the shoulder SANE (floor P = .0012, ceiling P = .0269). The PF-CAT had values of 0.4% for the shoulder and 0.6% for the knee. Zero percent of IKDC scores but 6.9% of knee SANE scores hit floor or ceiling values (floor P = .0019, ceiling P = .0007). The PF-CAT median completion time was lower at 55 seconds versus 268 seconds for the IKDC assessment (P < .0001), whereas shoulder patients' times were 61, 139, and 116 seconds for the PF-CAT, SST, and ASES evaluation, respectively (P < .0001). CONCLUSIONS The PF-CAT showed a high correlation with IKDC scores and a moderately high correlation with ASES and SST outcomes. The PF-CAT takes significantly less time to complete and exhibits improved or similar floor and ceiling effects in comparison to IKDC, SST, and ASES scores. The PF-CAT can be used in evaluating sports medicine knee and shoulder patients. LEVEL OF EVIDENCE Level III, cross-sectional study.
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Affiliation(s)
| | - Mike B Anderson
- Department of Orthopaedics, University of Utah, Salt Lake City, Utah, U.S.A
| | - Yingying Zhang
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, U.S.A
| | - Angela P Presson
- Division of Epidemiology, University of Utah, Salt Lake City, Utah, U.S.A
| | - Robert T Burks
- University of Utah Orthopaedic Center, Salt Lake City, Utah, U.S.A
| | - Patrick E Greis
- University of Utah Orthopaedic Center, Salt Lake City, Utah, U.S.A
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Patterson BM, Eskildsen SM, Clement RC, Lin FC, Olcott CW, Del Gaizo DJ, Tennant JN. Patient Satisfaction Is Associated With Time With Provider But Not Clinic Wait Time Among Orthopedic Patients. Orthopedics 2017; 40:43-48. [PMID: 27755644 DOI: 10.3928/01477447-20161013-05] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 08/30/2016] [Indexed: 02/03/2023]
Abstract
Clinic wait time is considered an important predictor of patient satisfaction. The goal of this study was to determine whether patient satisfaction among orthopedic patients is associated with clinic wait time and time with the provider. The authors prospectively enrolled 182 patients at their outpatient orthopedic clinic. Clinic wait time was defined as the time between patient check-in and being seen by the surgeon. Time spent with the provider was defined as the total time the patient spent in the examination room with the surgeon. The Consumer Assessment of Healthcare Providers and Systems survey was used to measure patient satisfaction. Factors associated with increased patient satisfaction included patient age and increased time with the surgeon (P=.024 and P=.037, respectively), but not clinic wait time (P=.625). Perceived wait time was subject to a high level of error, and most patients did not accurately report whether they had been waiting longer than 15 minutes to see a provider until they had waited at least 60 minutes (P=.007). If the results of the current study are generalizable, time with the surgeon is associated with patient satisfaction in orthopedic clinics, but wait time is not. Further, the study findings showed that patients in this setting did not have an accurate perception of actual wait time, with many patients underestimating the time they waited to see a provider. Thus, a potential strategy for improving patient satisfaction is to spend more time with each patient, even at the expense of increased wait time. [Orthopedics. 2017; 40(1):43-48.].
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Etier BE, Orr SP, Antonetti J, Thomas SB, Theiss SM. Factors impacting Press Ganey patient satisfaction scores in orthopedic surgery spine clinic. Spine J 2016; 16:1285-1289. [PMID: 27084192 DOI: 10.1016/j.spinee.2016.04.007] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/15/2016] [Accepted: 04/07/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Patient satisfaction is and will continue to become an important metric in the American health care system. To our knowledge, there is no current literature exploring the factors that impact patient satisfaction in outpatient orthopedic spine surgery clinic. PURPOSE The purpose of this study was to determine which factors impact patient satisfaction in an outpatient orthopedic spine clinic. STUDY DESIGN This is a case series, level of evidence IV. PATIENT SAMPLE We reviewed the Press Ganey Associates database to identify patients seen in an orthopedic spine surgery clinic from 2013 to 2015. OUTCOME MEASURES Outcome measures were self-reported, which included visual analog pain scores and Press Ganey satisfaction scores. METHODS Retrospective computerized Press Ganey survey review was performed to identify patient demographics and patient visit characteristics. Bivariate analysis was used by splitting the patient response into the following: 0-3 (not satisfied), 4-7 (somewhat satisfied), and 8-11 (satisfied). Kruskal-Wallis test and Fisher exact test were used to evaluate the significance of patient and visit characteristics. Any variable that had a p-value less than .20 was subjected to the Poisson regression model. RESULTS Overall, 353 patients were seen in an orthopedic spine surgery clinic and completed the Press Ganey survey. Three hundred and thirty-two patients were satisfied with their visit. Patients who were satisfied had a mean pain score of 4.02; patients who were somewhat satisfied or not satisfied had a pain score of 7 and 6, respectively (p=.009). Of 21 patients who felt the provider did not spend enough time with him or her, five (24%) patients were not satisfied with their visit. Poisson regression model confirmed significance of pain score and "provider time spent with you." Most impactful was "provider spent enough time with you" where a "yes, definitely" answer predicted a nearly 60% increase in Press Ganey overall satisfaction score. CONCLUSIONS Two patient variables that have a statistical significance on Press Ganey patient satisfaction scores were pain score and "provider spent enough time with you."
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Affiliation(s)
- Brian E Etier
- University of Alabama at Birmingham, 1313 13th St South, Birmingham, AL 35205, USA.
| | - Scott P Orr
- University of Alabama at Birmingham, 1313 13th St South, Birmingham, AL 35205, USA
| | - Jonathan Antonetti
- University of Alabama at Birmingham, 1313 13th St South, Birmingham, AL 35205, USA
| | - Scott B Thomas
- University of Alabama at Birmingham, 1313 13th St South, Birmingham, AL 35205, USA
| | - Steven M Theiss
- University of Alabama at Birmingham, 1960 6th Ave South, Faculty Office Tower 960, Birmingham, AL 35233, USA
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Mistry JB, Chughtai M, Elmallah RK, Le S, Bonutti PM, Delanois RE, Mont MA. What Influences How Patients Rate Their Hospital After Total Hip Arthroplasty? J Arthroplasty 2016; 31:2422-2425. [PMID: 27155998 DOI: 10.1016/j.arth.2016.03.060] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 03/25/2016] [Accepted: 03/30/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Centers for Medicare and Medicaid Services are now using results from patient satisfaction surveys, such as Press Ganey, for reimbursement. It is unknown what factors influence scores on satisfaction surveys in post-total hip arthroplasty (THA) patients. The purpose of this study was to evaluate what influences these scores in THA patients. Specifically, we aimed to evaluate: (1) how pain control affects the patients' perception of their orthopedist, nursing staff, and overall hospital satisfaction; (2) the individual impact of these factors on overall hospital satisfaction after THA; and (3) the impact of lengths of stay, age, body mass index (BMI), and American Society of Anesthesiology (ASA) scores on overall satisfaction. METHODS To assess whether pain management influences patients' perception of the orthopedist, a correlation analysis was performed between pain control and perception of their doctor. Similar analyses were performed to determine the relationship between pain management and patients' perception of their treating nurse, as well as overall satisfaction. A multiple regression analysis was performed to determine which of the aforementioned factors have the greatest impact on overall satisfaction. To determine the impact of length of stay on overall hospital satisfaction, a correlation analysis was performed between these 2 variables. Similar analyses were performed for age, BMI, and ASA scores. RESULTS Patients' perception of pain control was significantly positively correlated with the perception of their orthopedist, nurse, and overall hospital satisfaction. Multiple regression analysis demonstrated that patients' perception of nurses and orthopedists yielded a significantly positive influence on overall hospital satisfaction. A significant negative correlation existed between lengths of stay and hospital satisfaction. There were no significant correlations between age, BMI, and ASA scores and overall hospital rating. CONCLUSION Post-THA patients associate pain management with hospital satisfaction, as well as their perception of their treating nurses and orthopedists. Overall satisfaction was most impacted by patients' perception of their nurse, followed by their orthopedist. In addition, there was an association between shorter length of stay and higher overall satisfaction. These results are of paramount importance because by recognizing factors that affect scores on satisfaction surveys, orthopedic surgeons can direct efforts to improve post-THA satisfaction and optimize reimbursements.
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Affiliation(s)
- Jaydev B Mistry
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Morad Chughtai
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Randa K Elmallah
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sidney Le
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | | | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland
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Alluri RK, Leland H, Heckmann N. Surgical research using national databases. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:393. [PMID: 27867945 DOI: 10.21037/atm.2016.10.49] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Recent changes in healthcare and advances in technology have increased the use of large-volume national databases in surgical research. These databases have been used to develop perioperative risk stratification tools, assess postoperative complications, calculate costs, and investigate numerous other topics across multiple surgical specialties. The results of these studies contain variable information but are subject to unique limitations. The use of large-volume national databases is increasing in popularity, and thorough understanding of these databases will allow for a more sophisticated and better educated interpretation of studies that utilize such databases. This review will highlight the composition, strengths, and weaknesses of commonly used national databases in surgical research.
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Affiliation(s)
- Ram K Alluri
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA 90033, USA
| | - Hyuma Leland
- Department of Plastic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA 90033, USA
| | - Nathanael Heckmann
- Department of Orthopaedic Surgery, Keck Medical Center of University of Southern California, Los Angeles, CA 90033, USA
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Admission Through the Emergency Department Is an Independent Risk Factor for Lower Satisfaction With Physician Performance Among Orthopaedic Surgery Patients: A Multicenter Study. J Am Acad Orthop Surg 2016; 24:735-42. [PMID: 27579815 DOI: 10.5435/jaaos-d-16-00084] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient experience data are increasingly used to guide performance improvement and to determine physician and hospital reimbursement. We studied the relationship between emergency department (ED) admission and patient satisfaction with physicians' performance, and identified other associated predictors. METHODS We evaluated 6,524 inpatient Press Ganey patient experience surveys from two academic level I trauma centers over 5 years. We stratified patients by ED admission or other admission and compared the proportions of patients in each group who were satisfied with physician performance. We used logistic regression to control for demographic differences and characteristics of hospitalizations. RESULTS Among patients admitted through the ED, 85.18% were satisfied, compared with 89.44% of patients admitted through other pathways (P < 0.001). Admission through the ED predicted decreased satisfaction, with an odds ratio of 0.67 (P = 0.032) after controls were applied through logistic regression. CONCLUSIONS Admission through the ED is an independent risk factor for lower satisfaction with physician performance. Understanding the determinants of patient satisfaction will help improve physician-patient interactions and guide quality improvement and value-based reimbursement initiatives. LEVEL OF EVIDENCE This retrospective survey-based analysis of satisfaction does not fall clearly under any of the Journal's established categories of level of evidence. The most closely aligned choice would be Level III Prognostic.
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Tyser AR, Abtahi AM, McFadden M, Presson AP. Evidence of non-response bias in the Press-Ganey patient satisfaction survey. BMC Health Serv Res 2016; 16:350. [PMID: 27488567 PMCID: PMC4972948 DOI: 10.1186/s12913-016-1595-z] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/28/2016] [Indexed: 12/30/2022] Open
Abstract
Background Measures of patient satisfaction have gained prominence in recent years as changes to the American health care system have led to the incorporation of such metrics into reimbursement models. The response rate for widely-used outpatient satisfaction metrics and variables influencing the probability of survey nonresponse remain largely unknown. Methods We reviewed all unique adult patients (16,779) who completed an outpatient encounter in the Department of Orthopaedic surgery at our academic institution from 1/1/13 to 10/24/13. Survey data was linked to each clinic visit, and patient factors including age, sex, insurance type, zip code, and orthopaedic subspecialty visited were recorded. The overall survey response rate was calculated. Logistic regression was performed, and unadjusted and adjusted odds ratios of patients’ probability of responding to the Press-Ganey survey were calculated. Results Two thousand seven hundred sixty two (16.5 %) of individuals completed a Press-Ganey patient satisfaction survey and 14017 patients did not respond. For those patients considered responders, 906 patients (32.8 %) did not complete all the survey items. Among these 906 patients, the mean number of missing items was 2.24 (Standard Deviation SD: 2.19). Age, sex, insurance type, and orthopaedic subspecialty were all found to be associated with the odds of responding to our patient satisfaction survey. Advancing age increased the odds of responding to the survey (Adjusted Odds Ratio (OR) = 3.396 for ≥65 vs. 18–29, p < 0.001). Several variables were associated with a decreased odds of survey response, and included male sex (Adjusted OR = 0.782 for Males vs. Females, p < 0.001), insurance type (Adjusted OR = 0.311 for Medicaid/Self-Pay vs. Private), and subspecialty type (Adjusted OR = 0.623 for Trauma vs. Adult Reconstruction). Conclusions The response rate to the Press-Ganey Medical Practice Survey of outpatient satisfaction is low in an orthopaedic outpatient population, and furthermore, is impacted by patient characteristics such as age, sex, insurance type, and type of orthopaedic subspecialist encountered. The findings of the present study should inform future non-response weighting procedures in this area. More research is needed to assess non-response bias—including follow-up studies of non-respondents—in order to more accurately measure of patient satisfaction.
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Affiliation(s)
- A R Tyser
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA.
| | - A M Abtahi
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT, 84108, USA
| | - M McFadden
- Department of Internal Medicine, Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - A P Presson
- Department of Internal Medicine, Division of Epidemiology, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
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Ryan T, Specht J, Smith S, DelGaudio JM. Does the Press Ganey Survey Correlate to Online Health Grades for a Major Academic Otolaryngology Department? Otolaryngol Head Neck Surg 2016; 155:411-5. [DOI: 10.1177/0194599816652386] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 05/10/2016] [Indexed: 11/16/2022]
Abstract
Objectives Analyze the correlation between online-based review websites and the Press Ganey Patient Satisfaction Survey (PGPSS) in an academic otolaryngology department. Study Design Retrospective cross sectional. Setting Tertiary academic institution. Methods All available data were collected for Vitals.com and Healthgrades.com , along with PGPSS data for 16 otolaryngology attending physicians from 2012 to 2014. A mean rating was calculated for each topic category for online websites and compared with 7 PGPSS content questions using zero-order correlations. A paired t test was used to analyze the difference between the PGPSS and online scores. Results There were no statistically significant correlations between time spent with the patient ( r = 0.391, P = .208) and overall provider scores ( r = 0.193, P = .508) when compared between Vitals.com and the PGPSS. The correlations were not statistically significant when Healthgrades.com was compared with the PGPSS in the items “probability of recommending the provider” ( r = −0.122, P = .666) and “trust in provider” ( r = −0.025, P = .929). The most important factors in a patient recommending the provider were as follows, per resource: time spent with the patient for Vitals.com ( r = 0.685, P = .014), listening for Healthgrades.com ( r = 0.981, P ≤ .001), and trust in the provider for the PGPSS ( r = 0.971, P ≤ .001). Conclusion This study suggests that online-based reviews do not have statistically significant correlations with the widely used PGPSS and may not be an accurate source of information for patients. Patients should have access to the most reliable and least biased surveys available to the public to allow for better-informed decisions regarding their health care.
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Affiliation(s)
- Timothy Ryan
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jessica Specht
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sarah Smith
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - John M. DelGaudio
- Department of Otolaryngology–Head and Neck Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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Factors Associated with Patient Press Ganey Satisfaction Scores for Ophthalmology Patients. Ophthalmology 2016; 123:242-247. [DOI: 10.1016/j.ophtha.2015.09.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 08/29/2015] [Accepted: 09/29/2015] [Indexed: 11/21/2022] Open
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Kedia R, Dargan C, Hassan O, Dasa V. Pain, Functional Scores, and Radiographic Severity of Illness Influence the Perception of Time Spent With the Physician by Patients Presenting for Initial Evaluation of Knee Osteoarthritis. Ochsner J 2016; 16:457-463. [PMID: 27999502 PMCID: PMC5158150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Patient satisfaction has become a significant factor in reimbursement schedules for physicians. A matter of debate is whether the patient's perception of time spent with the physician improves patient satisfaction. We sought to determine whether patient-physican time correlates with patient satisfaction and which factors are associated with patient perception of time. METHODS A total of 73 patients who presented for an initial evaluation of knee osteoarthritis were evaluated by the same orthopedic surgeon at an outpatient clinic in New Orleans, LA. Each encounter was timed with a stopwatch. After the physician encounter, patients were asked to fill out a questionnaire assessing their perception of time spent with the physician, subjective pain, satisfaction with the visit, and understanding of the diagnosis and treatment plan. Patients were also asked to complete 4 functionality surveys. Radiographs of the patients' knees were taken and quantified using Kellgren-Lawrence and Ahlbäck grading scales. RESULTS We noted no relationship between patient satisfaction and patients' perception of time spent with the physician. Patients perceived their time with the physician to be an average of 6.5 minutes more than the actual time. However, patients who reported higher subjective pain scores (>7 on a 10-point scale) misestimated their time with the physician by nearly 96%, while patients with lower subjective pain scores (<7 on a 10-point scale) misestimated their time with the physician by only 54% (P<0.007). We discovered similar findings in patients with worse Kellgren-Lawrence radiographic scores as well as worse Oxford Knee Scores and Knee injury and Osteoarthritis Outcome Scores. The actual time spent was not different among patients. CONCLUSION Patients with greater subjective pain and worse functional status and patients with worse radiographic severity of knee osteoarthritis perceived greater time spent with the physician. However, no relationship between these variables and patient satisfaction scores was seen.
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Affiliation(s)
- Ronak Kedia
- Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Chandni Dargan
- Department of Pediatrics, Palmetto Health Children's Hospital, Columbia, SC
| | - Omar Hassan
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, Chicago, IL
| | - Vinod Dasa
- Department of Orthopedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
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Beckmann JT, Hung M, Bounsanga J, Wylie JD, Granger EK, Tashjian RZ. Psychometric evaluation of the PROMIS Physical Function Computerized Adaptive Test in comparison to the American Shoulder and Elbow Surgeons score and Simple Shoulder Test in patients with rotator cuff disease. J Shoulder Elbow Surg 2015; 24:1961-7. [PMID: 26321484 DOI: 10.1016/j.jse.2015.06.025] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Revised: 06/15/2015] [Accepted: 06/22/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computerized Adaptive Test (PF CAT) is a newly developed patient-reported outcome instrument designed by the National Institutes of Health to measure generalized physical function. However, the measurement properties of the PF CAT have not been compared with established shoulder-specific patient-reported outcomes. METHODS Patients with clinical diagnosis of rotator cuff disease completed the American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST), and PF CAT. Responses to each of the 3 instruments were statistically analyzed with a Rasch partial credit model. Associations between instruments, convergent validity, item and person reliability, ceiling and floor effects, dimensionality, and survey length were determined. RESULTS Responses from 187 patients were analyzed. The PF CAT required fewer questions than the ASES or SST (PF CAT, 4.3; ASES, 11; SST, 12). Correlation between all instruments was moderately high. Item reliability was excellent for all instruments, but person reliability of the PF CAT was superior (0.93, excellent) to the SST (0.71, moderate) and ASES (0.48, fair). Ceiling effects were similar among all instruments (PF CAT, 0.53%; SST, 6.1%; ASES, 2.3%). Floor effects were found in 21% of respondents to the SST but in only 3.2% of PF CAT and 2.3% of ASES respondents. CONCLUSION The measurement properties of the PROMIS PF CAT compared favorably with the ASES and SST despite requiring fewer questions to complete. The PROMIS PF CAT had improved person reliability compared with the ASES score and fewer floor effects compared with the SST.
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Affiliation(s)
- James T Beckmann
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Man Hung
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jerry Bounsanga
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - James D Wylie
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Erin K Granger
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Robert Z Tashjian
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA.
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Abtahi AM, Presson AP, Zhang C, Saltzman CL, Tyser AR. Association Between Orthopaedic Outpatient Satisfaction and Non-Modifiable Patient Factors. J Bone Joint Surg Am 2015; 97:1041-8. [PMID: 26135070 PMCID: PMC4574907 DOI: 10.2106/jbjs.n.00950] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Increasingly, patient satisfaction surveys are being utilized to evaluate hospital and physician performance. Despite this, little is known about factors associated with patient satisfaction. The objective of this study was to determine whether selected non-modifiable patient characteristics are associated with outpatient satisfaction scores. METHODS We reviewed patient satisfaction scores from 12,177 outpatient clinical encounters at an academic orthopaedic outpatient clinic between December 2010 and October 2013. Any adult patient who completed at least one patient satisfaction survey at any point during the study period was included in this study. Factors including age, sex, employment status, type of health insurance, zip code, and orthopaedic subspecialty were recorded. Patients were divided into more satisfied and less satisfied groups, and generalized estimating equation logistic regression analysis was performed to identify factors predictive of lower patient satisfaction. RESULTS Age was found to be strongly associated with patient satisfaction, with younger patients reporting less satisfaction; the adjusted odds ratio for the patient age of eighteen to twenty-nine years compared with the patient age of eighty years or older was 2.78 (95% confidence interval, 1.74 to 3.82) (p < 0.001). This relationship was maintained in a predictive model across all age groups, both sexes, all travel distances, and all orthopaedic subspecialties. Travel distance was also associated with patient satisfaction, with patients who live closer reporting less satisfaction compared with patients who live farther away; the adjusted odds ratio for a distance of less than fifty miles compared with a distance of fifty miles or more was 1.18 (95% confidence interval, 1.03 to 1.33) (p = 0.016). CONCLUSIONS The finding that non-modifiable patient factors such as age and geographic location affect patient satisfaction challenges the utility of comparing patient satisfaction between populations that differ significantly with regard to such characteristics. CLINICAL RELEVANCE A more complete knowledge of the factors that influence patient satisfaction may enable better insight into the interpretation of current patient satisfaction metrics and may allow physicians and hospitals to improve their delivery of care.
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Affiliation(s)
- Amir M. Abtahi
- Department of Orthopaedics, University of Utah, 590
Wakara Way, Salt Lake City, UT 84108. E-mail address for A.R. Tyser:
| | - Angela P. Presson
- Division of Epidemiology, Department of Internal
Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108
| | - Chong Zhang
- Division of Epidemiology, Department of Internal
Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108
| | - Charles L. Saltzman
- Department of Orthopaedics, University of Utah, 590
Wakara Way, Salt Lake City, UT 84108. E-mail address for A.R. Tyser:
| | - Andrew R. Tyser
- Department of Orthopaedics, University of Utah, 590
Wakara Way, Salt Lake City, UT 84108. E-mail address for A.R. Tyser:
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Nieman CL, Benke JR, Boss EF. Does Race/Ethnicity or Socioeconomic Status Influence Patient Satisfaction in Pediatric Surgical Care? Otolaryngol Head Neck Surg 2015; 153:620-8. [PMID: 26124264 DOI: 10.1177/0194599815590592] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 05/19/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate patient satisfaction in outpatient pediatric surgical care and assess differences in scores by race/ethnicity and socioeconomic status (SES). STUDY DESIGN Observational, cross-sectional analysis. SETTING Outpatient pediatric surgical specialty clinics at a tertiary academic center. SUBJECT AND METHODS Families of patients received a patient satisfaction survey following their initial care visit in 2012. Mean scores were calculated and compared by child race/ethnicity and insurance type, where insurance with medical assistance (MA) served as a proxy for low SES. Kruskal-Wallis tests were used to compare scores between groups. Surveys were dichotomized to low and high scorers, and multivariate logistic regression was used to calculate the likelihood of high satisfaction. RESULTS Of 527 surveys completed, 132 (25%) were for children with MA and 143 (27%) were for racial/ethnic minority children. The overall satisfaction score for all specialties was 84.8, which did not significantly differ by SES (P = .98) or minority status (P = .52). The survey item with the highest score in both SES groups was "degree to which provider talked with you using words you could understand" (overall mean 91.94, P = .23). Multivariate analysis showed that patient age, sex, race/ethnicity, insurance type, neighborhood SES, neighborhood diversity, or surgical department did not significantly influence satisfaction. CONCLUSION This is the first study to evaluate the relationship between SES and race/ethnicity with patient satisfaction in outpatient pediatric surgical specialty care. In this analysis, no disparities were identified in the patient experience by individual- or community-level factors. Although the survey methodologies may be limited, these findings suggest that provision of care in pediatric surgical specialties can be simultaneously equitable, culturally competent, and family centered.
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Affiliation(s)
- Carrie L Nieman
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - James R Benke
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily F Boss
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Abtahi AM, Brodke DS, Lawrence BD, Zhang C, Spiker WR. Association between patient-reported measures of psychological distress and patient satisfaction scores after spine surgery. J Bone Joint Surg Am 2015; 97:824-8. [PMID: 25995493 PMCID: PMC4430100 DOI: 10.2106/jbjs.n.00916] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Patient satisfaction has become an important component of the delivery of health care in the United States. Previous studies have shown that patient satisfaction is influenced by patient-specific characteristics. The goal of this study was to determine whether psychological distress influences outpatient satisfaction scores following spine surgery. METHODS We retrospectively reviewed the records from all outpatient clinical encounters at a single academic spine surgery center between February 2011 and January 2013. Any patient who completed both a patient satisfaction survey and a Distress and Risk Assessment Method (DRAM) questionnaire for the same clinical encounter was included in the study. Statistical analysis was performed to determine whether patient satisfaction scores were influenced by psychological distress. RESULTS During the study period, 103 patients who met the inclusion criteria were identified. On the basis of their responses to the DRAM questionnaire, fifty-six were classified as normal (no evidence of distress), twenty-two as at risk, thirteen as distressed depressive, and twelve as distressed somatic. The mean overall patient satisfaction scores (and standard deviation) were 90.2 ± 10.9 in the normal group, 94.7 ± 8.2 in the at-risk group, 87.5 ± 16.2 in the distressed-depressive group, and 75.7 ± 22.4 in the distressed-somatic group (p = 0.003). The mean score for the patients' satisfaction with their provider was 94.2 ± 12.0 in the normal group, 94.2 ± 9.5 in the at-risk group, 90.6 ± 24.0 in the distressed-depressive group, and 74.9 ± 26.2 in the distressed-somatic group (p = 0.011). CONCLUSIONS These results indicate a significant association between patient satisfaction and psychological distress as measured with the DRAM questionnaire. "Distressed" patients gave significantly lower scores for overall satisfaction and satisfaction with their provider compared with patients categorized as "normal." These results suggest that psychological factors may influence patients' perception of the medical care provided to them.
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Affiliation(s)
- A M Abtahi
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for W.R. Spiker:
| | - D S Brodke
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for W.R. Spiker:
| | - B D Lawrence
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for W.R. Spiker:
| | - C Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108
| | - W R Spiker
- Department of Orthopaedics, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108. E-mail address for W.R. Spiker:
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Abstract
BACKGROUND The purpose of this study was to assess satisfaction and pain intensity in patients undergoing minor hand surgery under local anesthesia (LA) with or without sedation. METHODS Seventy-three adult patients presenting to two hand surgeons were enrolled in this prospective observational study in 2012. They completed questionnaires prior to surgery (current pain intensity, Patient Health Questionnaire-2 (PHQ-2) to measure symptoms of depression, Pain Self-Efficacy Questionnaire (PSEQ) to assess the effective coping strategy of pain self-efficacy) and within 48 h after surgery (satisfaction with surgery, satisfaction with anesthesia, pain during the injection, and pain during the procedure). Thirty-seven patients had carpal tunnel release (bilateral in 3), 22 had release of one or more trigger digits, and 12 had excision of a benign tumor, gouty tophus (1 patient), or foreign body (1 patient). Forty-six patients chose LA and 27 chose LA with sedation. RESULTS There was no difference in satisfaction with surgery or anesthesia by the type of anesthesia. Satisfaction with surgery was associated with older age alone. Satisfaction with anesthesia was associated with no prior surgery for the same condition. Pain during injection and during the procedure were significantly higher without sedation. Pain during injection was associated with younger age and LA. No factors were associated with pain during the procedure. CONCLUSIONS Patients that had local anesthesia immediately prior to incision with tourniquet use during surgery had more pain during the procedure but were equally satisfied on average with surgery and with anesthesia compared to patients that had sedation.
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