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Miyawaki A, Jena AB, Rotenstein LS, Tsugawa Y. Comparison of Hospital Mortality and Readmission Rates by Physician and Patient Sex. Ann Intern Med 2024; 177:598-608. [PMID: 38648639 DOI: 10.7326/m23-3163] [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: 04/25/2024] Open
Abstract
BACKGROUND Little is known as to whether the effects of physician sex on patients' clinical outcomes vary by patient sex. OBJECTIVE To examine whether the association between physician sex and hospital outcomes varied between female and male patients hospitalized with medical conditions. DESIGN Retrospective observational study. SETTING Medicare claims data. PATIENTS 20% random sample of Medicare fee-for-service beneficiaries hospitalized with medical conditions during 2016 to 2019 and treated by hospitalists. MEASUREMENTS The primary outcomes were patients' 30-day mortality and readmission rates, adjusted for patient and physician characteristics and hospital-level averages of exposures (effectively comparing physicians within the same hospital). RESULTS Of 458 108 female and 318 819 male patients, 142 465 (31.1%) and 97 500 (30.6%) were treated by female physicians, respectively. Both female and male patients had a lower patient mortality when treated by female physicians; however, the benefit of receiving care from female physicians was larger for female patients than for male patients (difference-in-differences, -0.16 percentage points [pp] [95% CI, -0.42 to 0.10 pp]). For female patients, the difference between female and male physicians was large and clinically meaningful (adjusted mortality rates, 8.15% vs. 8.38%; average marginal effect [AME], -0.24 pp [CI, -0.41 to -0.07 pp]). For male patients, an important difference between female and male physicians could be ruled out (10.15% vs. 10.23%; AME, -0.08 pp [CI, -0.29 to 0.14 pp]). The pattern was similar for patients' readmission rates. LIMITATION The findings may not be generalizable to younger populations. CONCLUSION The findings indicate that patients have lower mortality and readmission rates when treated by female physicians, and the benefit of receiving treatments from female physicians is larger for female patients than for male patients. PRIMARY FUNDING SOURCE Gregory Annenberg Weingarten, GRoW @ Annenberg.
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Affiliation(s)
- Atsushi Miyawaki
- Department of Health Services Research and Department of Public Health, Graduate School of Medicine, and Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan (A.M.)
| | - Anupam B Jena
- Department of Health Care Policy, Harvard Medical School, Boston, Department of Medicine, Massachusetts General Hospital, Boston, and National Bureau of Economic Research, Cambridge, Massachusetts (A.B.J.)
| | - Lisa S Rotenstein
- Divisions of General Internal Medicine and Clinical Informatics, University of California at San Francisco, San Francisco, California, and Center for Physician Experience and Practice Excellence, Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts (L.S.R.)
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, and Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California (Y.T.)
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Cucuzzella C, Rasoulivalajoozi M, Farzamfar G. Spatial experience of cancer inpatients in the oncology wards: A qualitative study in visual design aspects. Eur J Oncol Nurs 2024; 70:102552. [PMID: 38518630 DOI: 10.1016/j.ejon.2024.102552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/14/2024] [Accepted: 03/03/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE This paper aims to explore how the visual characteristics of cancer wards' interior spaces can be improved based on the combined visual design themes to help cancer inpatients' spatial experience and relieved state of mind. Accordingly, we present a visual design framework that can be applied in oncology wards. METHOD This study adopts the Ulrich-supportive design theory as a theoretical framework using two main methodological phases: observation of cancer wards and interviews with professional caregivers. The first phase critically explores hospital cancer wards' interactive aesthetical and visual interior characteristics. Next, we adjusted the visual criteria based on the Post Occupation Evaluation (POE) method to develop the interview questions. Interviews were conducted with experienced nurses, oncologists, and a general physician, all from a cancer ward at McGill University Health Center (MUHC) in Montreal, Canada. RESULTS We presented 11 main themes in the categories of color and light, natural/artistic images, way-finding, and visual clutter. To present and justify our visual design framework, these main themes were then classified based on the common goals, resulting in four combined themes: applying simplicity and usability; developing naturality; creating homeyness and respecting patients' agency; and promoting trustworthiness. CONCLUSION Our findings suggest that-apart from the last theme, promoting trustworthiness, the rest are in line with Ulrich's supportive design theory. Therefore, further research is needed to investigate "promoting trustworthiness" in the context of cancer wards. In addition, each aspect of the visual design framework can offer practical design recommendations for future studies.
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Affiliation(s)
- Carmela Cucuzzella
- Faculty of Environmental Design, University of Montreal, Montreal, Canada.
| | | | - Golriz Farzamfar
- Department of Design and Computation Arts, Concordia University. Montreal, Canada.
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Sivarajkumar S, Huang Y, Wang Y. Fair patient model: Mitigating bias in the patient representation learned from the electronic health records. J Biomed Inform 2023; 148:104544. [PMID: 37995843 PMCID: PMC10850918 DOI: 10.1016/j.jbi.2023.104544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/02/2023] [Accepted: 11/10/2023] [Indexed: 11/25/2023]
Abstract
OBJECTIVE To pre-train fair and unbiased patient representations from Electronic Health Records (EHRs) using a novel weighted loss function that reduces bias and improves fairness in deep representation learning models. METHODS We defined a new loss function, called weighted loss function, in the deep representation learning model to balance the importance of different groups of patients and features. We applied the proposed model, called Fair Patient Model (FPM), to a sample of 34,739 patients from the MIMIC-III dataset and learned patient representations for four clinical outcome prediction tasks. RESULTS FPM outperformed the baseline models in terms of three fairness metrics: demographic parity, equality of opportunity difference, and equalized odds ratio. FPM also achieved comparable predictive performance with the baselines, with an average accuracy of 0.7912. Feature analysis revealed that FPM captured more information from clinical features than the baselines. CONCLUSION FPM is a novel method to pre-train fair and unbiased patient representations from the EHR data using a weighted loss function. The learned representations can be used for various downstream tasks in healthcare and can be extended to other domains where fairness is important.
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Affiliation(s)
- Sonish Sivarajkumar
- Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States
| | - Yufei Huang
- Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States; Department of Medicine, University of Pittsburgh, Pittsburgh, PA, United States; Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, United States; University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, United States
| | - Yanshan Wang
- Intelligent Systems Program, School of Computing and Information, University of Pittsburgh, Pittsburgh, PA, United States; Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States; Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, PA, United States; Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA, United States; University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, United States.
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Lai LY, Lopez AD, Copp HL, Baradaran N, Breyer BN, Elaine Allen I, Hampson LA. Access and Utilization of Health Care by Adults with Spina Bifida. Urology 2023; 181:174-181. [PMID: 37690544 PMCID: PMC10842464 DOI: 10.1016/j.urology.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/15/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE To contextualize the challenges that persons with congenital genitourinary conditions (CGC) may encounter in adulthood, we examined health care access, readiness for self-management, and health care utilization of adults with spina bifida (SB). METHODS Through surveys distributed via social media, persons with SB were asked about access and barriers to care, readiness for self-management, and health care utilization (ie, medical visits, missed visits, emergency room [ER] visits, hospital admissions) within the past year. Multivariable models were fitted to examine determinants of utilization. RESULTS Of the 270 eligible respondents (mean age 39), 24.5% had not received care from a urologist in the past year. The odds of missing any medical visits were increased among those with more prior urologic surgeries (odds ratio (OR) 1.35, 95%confidence interval (CI) 1.05-1.78) and those with ER visits for urologic condition within the past year (OR 2.65, 95%CI 1.22-6.01). Those with private insurance had lower odds of having ER visits for urologic condition (OR 0.46, 95%CI 0.22-0.84). The odds of hospital admission related to urologic condition were increased among female (OR 2.35, 95%CI 1.01-6.64), those with more prior urologic surgeries (OR 1.18, 95%CI 1.09-1.51), and those with a urologist (OR 2.98, 95%CI 1.15-14.47). CONCLUSION A substantial proportion of adults with CGC lack routine urologic care. Considering the significant barriers to care and lapses in care, efforts to improve access and optimize health care services utilization for this population with high medical complexity are warranted.
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Affiliation(s)
- Lillian Y Lai
- Department of Urology, University of Michigan, Ann Arbor, MI
| | - Alejandro D Lopez
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Hillary L Copp
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nima Baradaran
- Department of Urology, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - I Elaine Allen
- Department of Epidemiology and Biostatistics, School of Medicine, University of California San Francisco, San Francisco, CA
| | - Lindsay A Hampson
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Surgery, San Francisco Veterans Affairs Medical Center, San Francisco, CA.
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Burke OC, Gibbons JAB, Do HT, Y. Lai E, Bradford L, Bass AR, Amen TB, Russell LA, Mehta B, Parks M, Figgie M, Goodman S. Racial Differences in Patient Satisfaction With the Hospital Experience Undergoing Primary Unilateral Hip and Knee Arthroplasty: A Retrospective Study. Arthroplast Today 2023; 23:101212. [PMID: 37745963 PMCID: PMC10511336 DOI: 10.1016/j.artd.2023.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023] Open
Abstract
Background Press Ganey (PG) inpatient survey is widely used to track patient satisfaction with the hospital experience. Our aim was to use the PG survey to determine if there are racial differences in overall hospital experience and perception of nurses and surgeons following hip and knee arthroplasty. Methods We retrospectively analyzed Black and White patients from hip and knee arthroplasty registries from a single institution between July 2010 and February 2012. The overall assessment score for the hospital experience and perception of the nurse and surgeon questions from the PG inpatient survey were dichotomized as "not completely satisfied" or "completely satisfied". Multivariable logistic regression models were developed to determine the impact of race on the likelihood of being 'completely satisfied' in the hip and knee cohorts. Results There were 2517 hip and 2114 knee patients who underwent surgery and completed the PG survey, of whom 3.9% were Black and 96.0% were White. Black patients were less likely to be completely satisfied with their hospital experience compared to White patients in the hip (odds ratio 0.62, confidence interval 0.39-1.00, P = .049) and knee (odds ratio 0.52, confidence interval 0.33-0.82, P = .005) cohorts. Black patients were also less likely to be completely satisfied with multiple aspects of care they received from the nurse and surgeon in both cohorts. Conclusions We found that the PG Survey shows Black patients were less likely to be completely satisfied than White patients with the hospital experience, including their interactions with nurses and surgeons. More work is needed to understand this difference.
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Affiliation(s)
- Orett C. Burke
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - J. Alex B. Gibbons
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Huong T. Do
- Division of Research Administration, Hospital for Special Surgery, New York, NY, USA
| | - Emily Y. Lai
- Division of Research Administration, Hospital for Special Surgery, New York, NY, USA
| | - Letitia Bradford
- Department of Orthopedics, University of Nevada, Reno, Reno, NV, USA
| | - Anne R. Bass
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Troy B. Amen
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Linda A. Russell
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Bella Mehta
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael Parks
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Mark Figgie
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Susan Goodman
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Robertson TW, Manganello JA, Wu M, Miller LS, Yucel RM, Schettine AM. Organizational Health Literacy and Health Among New York State Medicaid Members. Health Lit Res Pract 2023; 7:e154-e164. [PMID: 37698848 PMCID: PMC10495121 DOI: 10.3928/24748307-20230822-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 01/21/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The definition of health literacy has recently expanded beyond the idea of individual skills to include the system and environment the individual interacts with to receive care, known as organizational health literacy (OHL). However, neither the prevalence of OHL nor the impact of OHL on individuals' perceptions of their health and healthcare have been examined in New York's Medicaid managed care population. OBJECTIVE This study aimed to estimate the prevalence of organizational health literacy in the New York State (NYS) Medicaid Managed Care (MMC) program. METHODS A brief measure to assess organizational health literacy was developed from responses to two questions in the 2018 NYS Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. Generalized Estimating Equation models were developed to analyze the association between organizational health literacy and three aspects of perceptions of health and health care, controlling for demographic differences and clustering effects from health insurance plans. Missing data were handled using multiple imputation. KEY RESULTS Among 3,598 members included in the study, 20% of the MMC members reported inadequate organizational health literacy. These members were more likely to be older, less educated, from racial and ethnic minority groups, and less fluent with English. They are more likely to have poorer self-reported health (odds ratio [OR] 1.49), lower perceived access to health care (OR 6.97), and lower satisfaction with their health care (OR 6.49) than members who did not report inadequate organizational health literacy. CONCLUSIONS Our results suggest that a proportion of the NYS MMC population faces inadequate organizational health literacy, which can present a barrier to health care access and result in patients having a significantly poorer health care experience. Using an existing data source that is part of existing data collection allows for routine assessment of organizational health literacy, which can help inform health plans about areas for potential improvement. [HLRP: Health Literacy Research and Practice. 2023;7(3):e154-e164.].
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Affiliation(s)
- Thomas W. Robertson
- Address correspondence to Thomas W. Robertson, MS, Office of Quality and Patient Safety, New York State Department of Health, Empire State Plaza, Corning Tower Room 1963, Albany, NY 12237;
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Takruri A, Radwan M, El Jabari C, Nawajah I, Hassan S. Experiences of Palestinian patients with hospital services: a mixed-methods study. BMJ Open Qual 2023; 12:bmjoq-2022-002118. [PMID: 37072148 PMCID: PMC10124303 DOI: 10.1136/bmjoq-2022-002118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 04/02/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND This study aimed at assessing patient experiences with hospital services and key factors associated with better experiences. METHODS The study design is cross-sectional supported by qualitative interviews. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was used as data collection instrument. A convenience sample of 391 volunteers aged ≥18 years participated in this study. Qualitative interviews were conducted with patients and healthcare providers to further enrich and explain the quantitative results. RESULTS The average age of the sample was 41.34, SD (16.4), range (18-87). Females represented 61.9% of the whole sample. Almost 75% were from the West Bank and 25% from the Gaza Strip. The majority of respondents reported that doctors and nurses were respectful, listened to them and explained clearly to them always or most of the time. Only 29.4% of respondents were given written information about the symptoms they may have after discharge from the hospital. Factors that were independently associated with higher scores on the HCAHPS scale were; being females (coef: 0.87, 95% CI: 0.157 to 1.587, p=0.017), being healthy (coef: -1.58, 95% CI: -2.458 to -0.706, p=0.000), being with high financial status (coef: 1.51, 95% CI: 0.437 to 2.582, p=0.006), being from Gaza (coef: 1.45, 95% CI: 0.484 to 2.408, p=0.003) and who visited hospitals outside of Palestine (coef: 3.37, 95% CI: 1.812 to 4.934, p=0.000). Overcrowding, weak organisational and management processes, and inadequate supply of goods, medicines, and equipment were reported factors impeding quality services via in-depth interviews. CONCLUSIONS The overall hospital experiences of Palestinian patients were moderate but varied significantly based on patients' factors such as sex, health status, financial status and residency as well as by hospital type. Hospitals in Palestine should invest more in improving their services including communications with patients, the hospital environment and communication with patients.
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Affiliation(s)
- Adel Takruri
- Quality Improvement Department, Hebron University, Hebron, West Bank, State of Palestine
| | - Mahmoud Radwan
- International Cooperation Department, Palestinian Ministry of Health, Gaza, State of Palestine
| | - Carol El Jabari
- Quality Improvement Department, Hebron University, Hebron, West Bank, State of Palestine
| | - Inad Nawajah
- Quality Improvement Department, Hebron University, Hebron, West Bank, State of Palestine
| | - Sahar Hassan
- Department of Nursing, Faculty of Pharmacy, Nursing, and Health Professions, Birzeit University, West Bank, State of Palestine
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Spezia N, Barello S, Torri C, Celano A, Graffigna G. Patient Experience of Integrated Care: Findings from a Cross-Sectional Study Involving People with Rheumatic and Musculoskeletal Diseases. Int J Integr Care 2023; 23:14. [PMID: 37188055 PMCID: PMC10178639 DOI: 10.5334/ijic.6616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/06/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Although the patient experience of integrated care has been documented for several chronic conditions, little is known in the context of rheumatic and musculoskeletal diseases (RMDs). This study provides a first overview of the patient experience of integrated care according to the perspective of people living with RMDs in Italy. Methods A cross-sectional survey was administered to 433 participants who reported their experiences together with the importance assigned to different attributes of integrated care. Explorative factor analysis (EFA) and non-parametric ANOVA and ANCOVA statistical tests were employed to account for the differences in the answers provided by sample subgroups. Results Two factors (namely, "Person-centred care" and "Health service delivery") were extracted in the EFA. Participants attributed high importance to both of them. Overall positive experiences were reported only for Person-centred care. The delivery of health services instead received a poor evaluation. Significantly worse experiences were observed for women and people that were either older, unemployed, with comorbidities or lower self-reported health, or less engaged in their healthcare management. Conclusions Italians with RMDs described integrated care as an important approach to care. However, further effort is needed to allow them to perceive an actual benefit from integrated care practices. Specific attention should be paid to disadvantaged and/or frail population groups.
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Affiliation(s)
- Nicola Spezia
- EngageMinds HUB –Consumer, Food & Health Engagement Research Center, Department of Psychology, UniversitàCattolica del Sacro Cuore, Milan, Italy
| | - Serena Barello
- EngageMinds HUB –Consumer, Food & Health Engagement Research Center, Department of Psychology, UniversitàCattolica del Sacro Cuore, Milan, Italy
| | - Chiara Torri
- EngageMinds HUB –Consumer, Food & Health Engagement Research Center, Department of Psychology, UniversitàCattolica del Sacro Cuore, Milan, Italy
| | - Antonella Celano
- Apmarr APS (Italian Association of People with Rheumatological and Rare Diseases), Lecce, Italy
| | - Guendalina Graffigna
- EngageMinds HUB –Consumer, Food & Health Engagement Research Center, Department of Psychology, UniversitàCattolica del Sacro Cuore, Milan, Italy
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Sekandi JN, Castellanos ME, Woldu H, Kakaire R, Mutembo S, Mutanga JN. Patient satisfaction among persons living with HIV/AIDS and receiving antiretroviral therapy in urban Uganda: A factor analysis. PLoS One 2023; 18:e0280732. [PMID: 36730252 PMCID: PMC9894454 DOI: 10.1371/journal.pone.0280732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/08/2023] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Patient satisfaction is an important predictor of health outcomes among patients in HIV/AIDS treatment and care, yet it is rarely measured in routine clinic settings in most of Africa. The aims of our study were to evaluate the internal validity and reliability of the Consumer Assessment of Healthcare Providers and Systems instrument for measuring satisfaction, assess the general level of patient satisfaction, and identify the factors associated with the level of satisfaction among patients receiving antiretroviral therapy in Uganda. MATERIALS AND METHODS We conducted a cross-sectional study of 475 HIV/AIDS-infected patients from July to August 2015 in Kampala, Uganda. Eligible participants were 18 years or older, consented to the study and receiving antiretroviral therapy and outpatient care at the selected public health clinic. This study used a modified version of the validated Consumer Assessment of Healthcare Providers and Systems (CAHPS) instrument to assess the level of satisfaction among HIV/AIDS patients receiving outpatient care. We collected data on socio-demographics, clinical variables and 18-items adapted from the CAHPS instrument rating satisfaction with aspects of health services. We conducted an exploratory factor analysis to assess the internal validity of the 18 items and multiple linear regression analysis of factors associated with patient satisfaction with care. RESULTS Majority of the respondents were females (76.8%), and the mean age was 37 years (SD = 10). The modified CAHPS instrument had high internal consistency (Cronbach's α = 0.94) for measuring satisfaction with HIV/AIDS care. Female sex (p = 0.016), perceived providers' technical and interpersonal skills (p = 0.022), emotional health (p = 0.032), and quality of reception services (p<0.001) were significantly associated with satisfaction in this urban HIV/AIDS public clinic. CONCLUSION The reliability of the CAHPS instrument was high for measuring satisfaction. Providers' technical and interpersonal skills, and the quality of reception services are key to achieving patient satisfaction. Health system interventions to address the gaps identified will enhance the quality of patient-centered HIV/AIDS care in the Ugandan setting.
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Affiliation(s)
- Juliet Nabbuye Sekandi
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, United States of America
- Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, United States of America
- * E-mail:
| | - Maria Eugenia Castellanos
- Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Henok Woldu
- The Center for Health Analytics for National and Global Equity (C.H.A.N.G.E.), Columbia, Missouri, United States of America
| | - Robert Kakaire
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, United States of America
| | - Simon Mutembo
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jane Namangolwa Mutanga
- Global Health Institute, College of Public Health, University of Georgia, Athens, Georgia, United States of America
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Silvestre JH, Spector N. Nursing Student Errors and Near Misses: Three Years of Data. J Nurs Educ 2023; 62:12-19. [PMID: 36652577 DOI: 10.3928/01484834-20221109-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Understanding the magnitude of errors and near misses in all health care situations is crucial to preventing them from occurring in the future. However, little research is available on the type or extent of nursing student errors in the United States. METHOD Nursing student error and near miss data were submitted by more than 200 participating prelicensure nursing programs via a secured online repository. RESULTS Medication errors represented more than half (58.8%, n = 613) of the total error and near-miss data (n = 1,042) submitted. Errors and near misses were attributed to students not adhering to three major patient safety procedures: checking the patient's identification, checking the patient's allergy status, and following the rights of medication administration. CONCLUSION Results indicate collecting data on nursing students' errors and near misses can help nursing programs identify system issues, promote transparency, and make quality improvements. [J Nurs Educ. 2023;62(1):12-19.].
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Alkhaled T, Rohde G, Lie B, Johannessen B. Beyond challenges and enrichment: a qualitative account of cross-cultural experiences of nursing patients with an ethnic minority background in Norway. BMC Nurs 2022; 21:322. [PMID: 36419037 PMCID: PMC9685157 DOI: 10.1186/s12912-022-01102-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 11/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Substantial mass migrations to the Scandinavian countries have made them heterogeneous and multicultural societies. Migration has also influenced the workforce, especially the healthcare system that has had to accommodate a culturally diverse population. This qualitative study aimed to explore nurses' experiences in caring for patients with an ethnic minority background. METHODS Focus group interviews with a total of 21 nurses were conducted. Thematic analysis was performed on the transcribed and translated interviews. RESULTS The findings of this study revealed three major themes: various experiences concerning language barriers and the use of interpreters, the impact of religious and cultural values, and caring for patients with an ethnic minority background is professionally interesting but demanding. CONCLUSIONS Caring for culturally diverse patients offers both challenges and opportunities to enhance cultural competence and cultural sensitivity among nurses. Various culturally divergent needs of patients such as family visits, food preferences, expression of pain, and gender sensitivity are interlinked and depend on effective communication during encounters with nurses and the healthcare system at large.
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Affiliation(s)
- Tariq Alkhaled
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Gudrun Rohde
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway ,grid.417290.90000 0004 0627 3712Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Birgit Lie
- grid.417290.90000 0004 0627 3712Department of Clinical Research, Sorlandet Hospital, Kristiansand, Norway
| | - Berit Johannessen
- grid.23048.3d0000 0004 0417 6230Department of Health and Nursing, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Gender differences in experiences and expectations of haemodialysis in a frail and seriously unwell patient population. Kidney Int Rep 2022; 7:2421-2430. [DOI: 10.1016/j.ekir.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
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Pascual-Ramos V, Contreras-Yáñez I, Ortiz-Haro AB, Molewijk AC, Obrador GT, Agazzi E. Factors Associated With the Quality of the Patient-Doctor Relationship: A Cross-Sectional Study of Ambulatory Mexican Patients With Rheumatic Diseases. J Clin Rheumatol 2022; 28:183-189. [PMID: 35616508 PMCID: PMC9169750 DOI: 10.1097/rhu.0000000000001816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The patient-doctor relationship (PDR) is a complex phenomenon with strong cultural determinants, which impacts health-related outcomes and, accordingly, does have ethical implications. The study objective was to describe the PDR from medical encounters between 600 Mexican outpatients with rheumatic diseases and their attending rheumatologists, and to identify factors associated with a good PDR. METHODS A cross-sectional study was performed. Patients completed the PDRQ-9 (Patient-Doctor Relationship Questionnaire, 9 items), the HAQ-DI (Health Assessment Questionnaire Disability Index), the Short-Form 36 items (SF-36), a pain-visual analog scale, and the Ideal Patient Autonomy Scale. Relevant sociodemographic, disease-related, and treatment-related variables were obtained. Patients assigned a PDRQ-9 score to each patient-doctor encounter. Regression analysis was used to identify factors associated with a good PDR, which was defined based on a cutoff point established using the borderline performance method. RESULTS Patients were primarily middle-aged female subjects (86%), with substantial disease duration (median, 11.1 years), without disability (HAQ-DI within reference range, 55.3%), and with deteriorated quality of life (SF-36 out of reference range, 73.7%-78.6%). Among them, 36.5% had systemic lupus erythematosus and 31.8% had rheumatoid arthritis. There were 422 patients (70.3%) with a good PDR and 523 medical encounters (87.2%) involved certified rheumatologists.Patient paternalistic ideal of autonomy (odds ratio [OR], 3.029; 95% confidence interval [CI], 1.793-5.113), SF-36 score (OR, 1.014; 95% CI, 1.003-1.025), female sex (OR, 0.460; 95% CI, 0.233-0.010), and being certified rheumatologist (OR, 1.526; 95% CI, 1.059-2.200) were associated with a good PDR. CONCLUSIONS Patient-related factors and the degree of experience of the attending physician impact the quality of the PDR, in Mexican outpatients with rheumatic diseases.
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Affiliation(s)
- Virginia Pascual-Ramos
- From the Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Irazú Contreras-Yáñez
- From the Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Ana Belén Ortiz-Haro
- From the Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Gregorio T. Obrador
- Interdisciplinary Center of Bioethics
- School of Medicine, Universidad Panamericana, Mexico City, Mexico
| | - Evandro Agazzi
- School of Medicine, Universidad Panamericana, Mexico City, Mexico
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Rapp KS, Volpe VV, Hale TL, Quartararo DF. State-Level Sexism and Gender Disparities in Health Care Access and Quality in the United States. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:2-18. [PMID: 34794351 DOI: 10.1177/00221465211058153] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In this investigation, we examined the associations between state-level structural sexism-a multidimensional index of gender inequities across economic, political, and cultural domains of the gender system-and health care access and quality among women and men in the United States. We linked administrative data gauging state-level gender gaps in pay, employment, poverty, political representation, and policy protections to individual-level data on health care availability, affordability, and quality from the national Consumer Survey of Health Care Access (2014-2019; N = 24,250). Results show that higher state-level sexism is associated with greater inability to access needed health care and more barriers to affording care for women but not for men. Furthermore, contrary to our hypothesis, women residing in states with higher state-level sexism report better quality of care than women in states with lower levels of sexism. These findings implicate state-level sexism in perpetuating gender disparities in health care.
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Chen PG, Tolpadi A, Elliott MN, Hays RD, Lehrman WG, Stark DS, Parast L. Gender Differences in Patients' Experience of Care in the Emergency Department. J Gen Intern Med 2022; 37:676-679. [PMID: 33963502 PMCID: PMC8858357 DOI: 10.1007/s11606-021-06862-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/26/2021] [Indexed: 02/03/2023]
Affiliation(s)
| | | | | | - Ron D. Hays
- University of California Los Angeles, Los Angeles, CA USA
| | | | - Debra S. Stark
- Centers for Medicare and Medicaid Services, Baltimore, MD USA
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Al-Jabri FYM, Turunen H, Kvist T. Patients' Perceptions of Healthcare Quality at Hospitals Measured by the Revised Humane Caring Scale. J Patient Exp 2021; 8:23743735211065265. [PMID: 34926803 PMCID: PMC8674720 DOI: 10.1177/23743735211065265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The patients’ perceptions are central to quality improvement of the healthcare
system worldwide. This study aimed to examine patients’ perceptions of quality
care and investigate the demographic factors related to the overall patients’
perceptions. The Revised Humane Caring Scale was distributed to 367 adult
patients who were admitted at medical, surgical, and obstetrics and gynecology
departments in 2 tertiary hospitals in Oman. Overall patients’ perceptions of
quality of care were high, with professionalism being rated the highest, and
cognition of physical needs and human resources rated the lowest. Significant
differences in patients’ perceptions between hospitals as well as in the
subscales of interdisciplinary collaboration and outcome variables, between
planned- and emergency-admitted patients were found. The linear regression
analysis indicated a relationship between gender and overall quality care where
male patients reported higher satisfaction compared to counterparts. This study
suggested the need to improve the cognition of physical needs (food quality and
environmental sanitation) and human resources (staff to patient ratio) as well
as pay attention to the individual patients’ needs especially for
emergency-admitted patients.
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Affiliation(s)
| | - Hannele Turunen
- Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Tarja Kvist
- University of Eastern Finland, Kuopio, Finland
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Kemp KA, Norris CM, Steele B, Fairie P, Santana MJ. Sex Differences in the Care Experiences of Patients Hospitalized Due to Ischemic Heart Disease in Alberta, Canada. CJC Open 2021; 3:S36-S43. [PMID: 34993432 PMCID: PMC8712602 DOI: 10.1016/j.cjco.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Women with heart disease experience disparities in the diagnosis, treatment, and management of their condition. However, it is unknown whether these sex differences exist with respect to in-hospital patient experience. We examined the comprehensive experience of patients hospitalized due to ischemic heart disease (IHD) across Alberta, Canada, according to sex. METHODS Patients completed a modified version of the Canadian Patient Experiences Survey-Inpatient Care (CPES-IC) within 6 weeks of discharge. We examined 37 questions, including 33 regarding specific care processes and 4 global rating scales. Survey responses were reported as raw "top-box" percentages, that is, the most-positive answer choice to each question. Odds and corresponding 95% confidence intervals of women reporting a top-box response were then calculated for each question, while controlling for demographic and clinical factors. RESULTS From April 2014 to March 2020, a total of 5795 surveys (1612 women, 4183 men) were completed. Taking the survey margin of error into account, women had lower top-box percentages on 26 of 37 questions. Similar results were obtained for the adjusted odds of reporting a top-box response. Women did not have a higher percentage of top-box responses on any of the questions studied. CONCLUSIONS This study is a Canadian first, which stratified the experiences of hospitalized patients living with ischemic heart disease according to sex. Our results highlighted important sex differences. Future research to understand the mechanisms associated with these observed sex differences in patient-reported experiences is warranted.
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Affiliation(s)
- Kyle A. Kemp
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research (SPOR), Calgary, Alberta, Canada
| | - Colleen M. Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Cardiovascular Health and Stroke Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Brian Steele
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Paul Fairie
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research (SPOR), Calgary, Alberta, Canada
| | - Maria J. Santana
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Patient Engagement Platform, Alberta Strategy for Patient-Oriented Research (SPOR), Calgary, Alberta, Canada
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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Goudarzi F, Pour FJ, Hasanvand S, Ebrahimzadeh F, Kvist T. Patients' Satisfaction with Humane Care in Critical Care Units. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:455-461. [PMID: 34703786 PMCID: PMC8491824 DOI: 10.4103/ijnmr.ijnmr_88_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/20/2020] [Accepted: 05/11/2021] [Indexed: 11/15/2022]
Abstract
Background: It is important to assess the provision of care in a humane framework to achieve patients' holistic needs in Critical Care Units (CCUs) and to promote health outcomes. The aim of the current study was to determine patients' satisfaction with humane care in CCUs. Materials and Methods: In the current descriptive–analytical study, data were collected from 225 patients admitted to the CCUs of seven teaching hospitals in Lorestan Province, Iran, in 2017. The Persian version of the Revised Humane Caring Scale (P-RHCS) was used in this study. Data were analyzed using descriptive statistics and inferential statistics (independent t-test and one-way ANOVA). Results: The mean (SD) overall score of the P-RHCS was 4.61 (0.53), which indicated that patients were highly satisfied with humane care. The patients were most satisfied with “professional performance” [mean (SD) 4.72 (0.60)] and “interdisciplinary collaboration” [mean (SD) 4.72 (0.65)], and the least satisfied with “awareness of and contribution to self-care” [mean (SD) 4.23 (0.78)]. The findings revealed that patients' satisfaction with humane care depends on their demographic and clinical characteristics. Conclusions: Generally, patients were satisfied with humane care provided in CCUs; however, it is recommended that nurses' skills be reinforced, especially regarding information provision and effective communication with patients to improve health outcomes.
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Affiliation(s)
- Fateme Goudarzi
- Department of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Fatemeh Jafari Pour
- Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran.,Department of Nursing, Behbahan Faculty of Medical Sciences, Behbahan, Iran
| | - Shirin Hasanvand
- Department of Nursing, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Farzad Ebrahimzadeh
- Department of Biostatistics, Nutritional Health Research Center, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Tarja Kvist
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
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Handayani PW, Dartanto T, Moeis FR, Pinem AA, Azzahro F, Hidayanto AN, Denny, Ayuningtyas D. The regional and referral compliance of online healthcare systems by Indonesia National Health Insurance agency and health-seeking behavior in Indonesia. Heliyon 2021; 7:e08068. [PMID: 34632140 PMCID: PMC8487026 DOI: 10.1016/j.heliyon.2021.e08068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 07/27/2021] [Accepted: 09/22/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Whether the provision of online health care referral systems by the Indonesia National Health Insurance Agency has ensured healthcare referral compliance raises much concern due to the continuing deficit. This study examines the pattern of healthcare referral process, regional and referral compliance from 2015 to 2016. To provide comprehensive analysis on how people seek treatment, this study also aims to understand health-seeking behavior in Indonesia, the utilization of alternative treatment, and health information-seeking behavior on social media. METHOD The data come from three data files, namely the National Health Insurance membership master data, the First Level Health Facilities transaction data and the Advanced Referral Health Facilities transaction data of 1,697,452 individuals. The regional compliance applies a logit regression model, while referral compliance applies descriptive statistics of the referral pathway. This study also follows a quantitative approach using an online questionnaire, with 463 respondents who have National Health Insurance which applies an ordered logit model. RESULT We found that several demographic variables and regional health facility availability affect regional compliance. Moreover, we found 19.3% of the transactions did not comply with the prescribed referral sequence. The prescribed referral sequence was mostly followed for patients with malignant diseases. We also found men who perceive that their health condition is healthy will less likely seek health services compared to women. Further, the tendency of alternative treatment increases health-seeking behavior, and the tendency of seeking health information on social media increases the frequency seeking health services. CONCLUSION We recommend the prescribed referral sequence to be re-evaluated especially for patients with malignant disease; the referral process should not be based on hospital classes but on the competency of the healthcare facility which may indirectly address the deficit issue. It is imperative that the government evaluate health promotion approaches to men and women, both direct and indirect through their significant others.
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Affiliation(s)
| | - Teguh Dartanto
- Faculty of Economic and Business, Universitas Indonesia, Indonesia
| | | | | | - Fatimah Azzahro
- Faculty of Computer Science, Universitas Indonesia, Indonesia
| | | | - Denny
- Faculty of Computer Science, Universitas Indonesia, Indonesia
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Abstract
OBJECTIVES To explore gender and racial differences in heart failure (HF) self-care processes and examine whether gender and race predict HF self-care. METHODS A secondary analysis of baseline data (n = 107) from a longitudinal HF study (54.2% males; 56% non-Caucasians) was conducted. The self-care of heart failure index was used to measure self-care maintenance, management, and confidence. Descriptive statistics and univariate analyses examined gender and racial differences in HF self-care outcomes. Multiple linear regression examined whether gender and race predicted HF self-care maintenance, management, and confidence. RESULTS Univariate analyses indicated that Caucasians reported significantly better self-care maintenance (p = 0.042), while non-Caucasians reported significantly better self-care management (p = 0.003). Males had significantly higher self-care confidence scores versus women (p = 0.017). Multiple regression analysis indicated Caucasian race predicted significantly worse self-care management (β = -11.188; p = 0.006) versus non-Caucasian, while male gender predicted significantly higher self-care confidence scores (β = 7.592; p = 0.010) versus female gender. Gender nor race significantly predicted self-care maintenance. DISCUSSION Although gender and race may influence HF self-care, other factors may be more important. More research is needed to identify individual factors that contribute to HF self-care to improve education and intervention.
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Affiliation(s)
- Lucinda J Graven
- Florida State University College of Nursing, Tallahassee, FL, USA
| | - Laurie Abbott
- Florida State University College of Nursing, Tallahassee, FL, USA
| | - Sabrina L Dickey
- Florida State University College of Nursing, Tallahassee, FL, USA
| | - Glenna Schluck
- Florida State University College of Nursing, Tallahassee, FL, USA
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Clinton-McHarg T, Paul C, Sanson-Fisher R, Turon H, Butler M, Lindeman R. Are the Physical Environments of Treatment Centres Meeting Recommendations for Patient-Centred Care? Perceptions of Haematological Cancer Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094892. [PMID: 34064433 PMCID: PMC8125011 DOI: 10.3390/ijerph18094892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 11/16/2022]
Abstract
The physical environment of a treatment centre may impact the well-being of patients and their perceptions of care. Outpatients with haematological cancer may be in contact with the treatment centre over long periods and could be particularly affected. This study aimed to identify haematological cancer patients' perceptions of supportive design elements in the hospital they attended and associations with self-reported mood or well-being. Outpatients from three large metropolitan hospitals in Australia were mailed a self-report questionnaire and responded to statements about the treatment centre concerning their sense of control over the physical surroundings; access to social support; and access to positive distractions. Participants also reported whether they felt the overall environment affected their mood or wellbeing. Of the outpatients who returned the questionnaire (n = 165), almost one-quarter (24%) agreed that the physical environment of the hospital affected their mood or well-being. Patients who disagreed that the hospital was a comfortable temperature or agreed that waiting rooms were crowded had significantly higher odds of reporting that the treatment environment affected their mood or wellbeing. Implementing systems to reduce overcrowding in waiting rooms and increasing patient control over personal temperature in clinics may be the most effective strategies to improve patient wellbeing.
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Affiliation(s)
- Tara Clinton-McHarg
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
- School of Psychology, The University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence:
| | - Christine Paul
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Rob Sanson-Fisher
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Heidi Turon
- School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW 2308, Australia; (C.P.); (R.S.-F.); (H.T.)
- Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia
| | - Michelle Butler
- Hunter New England Population Health, Wallsend, NSW 2287, Australia;
| | - Robert Lindeman
- Department of Haematology, Prince of Wales Hospital, Randwick, NSW 2031, Australia;
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Matar RN, Shah NS, Vincent JC, Rayos Del Sol S, Grawe BM. Factors that influence inpatient satisfaction after shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:e165-e172. [PMID: 32750529 DOI: 10.1016/j.jse.2020.07.022] [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: 02/07/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is important to distinguish satisfaction regarding the outcome of care and satisfaction with the delivery of care. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are modern assessments of hospitals and providers of delivery of care. The purpose of this study was to report inpatient satisfaction according to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) scores after shoulder arthroplasty and to determine factors that influence them, as well as their correlation with surgical expectations, pain perception, quality of life, surgical setting, and functional outcomes. METHODS All patients scheduled for a shoulder arthroplasty were prospectively asked to complete a demographic and initial shoulder assessment form, a shoulder surgery expectations survey, a pain catastrophizing scale, the SF-12 (12-item Short Form) survey, and a resiliency form (Resilience Scale 11). Patient satisfaction was measured with the CG-CAHPS and HCAHPS surveys. Legacy forms, patient-specific factors, type of surgery performed, location of surgery, length of hospital stay, and discharge disposition were evaluated on their ability to predict these survey scores. Linear regression was used to calculate correlations and predictions of continuous variables, and logistic regression was used to compared the satisfied vs. unsatisfied cohorts. RESULTS The average HCAHPS and CG-CAHPS satisfaction scores for the population were 74.7 ± 20.7 and 82.1 ± 19.4, respectively. Nonsmokers had a mean HCAHPS score of 77.7 ± 22.0, whereas current smokers reported a mean of 59.6 ± 5.2 (P = .03). Patients who were discharged home had a mean HCAHPS score of 77.3 ± 21.9, whereas those discharged to a skilled nursing facility reported a mean of 59.3 ± 6.6 (P = .05). These same groups also had significantly higher odds of being satisfied with the hospital. No significant differences or higher odds were seen for comparisons between overall CG-CAHPS satisfaction and any of the patient-specific factors tested. There was no significant correlation between age, length of stay, pain (pain catastrophizing scale), resiliency (Resilience Scale 11), expectations (shoulder surgery expectations survey), or function (SF-12) and both the HCAHPS and CG-CAHPS satisfaction scores. CONCLUSION Overall, 37 patients (74%) had CG-CAHPS scores that indicated satisfaction and 34 patients (68%) had HCAHPS scores that indicated satisfaction. Nonsmokers and patients discharged home after surgery report higher levels of inpatient hospital (HCAHPS) satisfaction after shoulder arthroplasty. Patients with high preoperative surgical expectations, pain perception, and resiliency are not generally more satisfied with the hospital or clinician. Preoperative diagnosis, location of surgery, and length of stay do not reliably impact satisfaction with the hospital or clinician. Inpatient HCAHPS and CG-CAHPS satisfaction does not correlate with legacy functional outcome measures and, therefore, may not be predictive of long-term functional outcomes.
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Affiliation(s)
- Robert N Matar
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - Nihar S Shah
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jonathan C Vincent
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Shane Rayos Del Sol
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Brian M Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Donaldson CD, Bharadwaj A, Giafaglione B, Patton P, Fortier MA, Kain ZN. Ethnicity and Language Differences in Patient Experience: an Analysis of the HCAHPS Survey. J Racial Ethn Health Disparities 2021; 9:899-908. [PMID: 33770386 DOI: 10.1007/s40615-021-01029-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although there has been a rising emphasis on patient-centered care, limited research has assessed differences in patient experience based on ethnicity and language. METHODS This study examined differences in quality of care (N = 6945) using the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Data were collected between January 2014 and April 2019. Bivariate and multivariate analyses assessed relationships between ethnicity/language with individual items capturing specific components of care and global hospital evaluations using regression modeling. RESULTS Compared to English-speaking non-Hispanic White patients, Spanish-speaking Hispanic/Latinx patients reported more positive interactions with nurses, physicians, and the hospital environment and reported a better understanding of care after discharge. Findings also indicated that Spanish-speaking Hispanic/Latinx patients were more satisfied with their experience compared to non-Hispanic White patients. DISCUSSION Spanish-speaking Hispanic/Latinx patients were more satisfied with specific components of care and also scored higher in a measure of the global patient experience. Findings suggest the need for setting clear expectations for health care encounters and adapting health system responses to better capture factors driving Hispanic/Latinx patient satisfaction.
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Affiliation(s)
- Candice D Donaldson
- Department of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA, USA
- Center on Stress & Health, University of California School of Medicine, Irvine, CA, USA
| | - Archana Bharadwaj
- Center on Stress & Health, University of California School of Medicine, Irvine, CA, USA
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA
| | | | | | - Michelle A Fortier
- Center on Stress & Health, University of California School of Medicine, Irvine, CA, USA
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA, USA
- Department of Pediatric Psychology, CHOC Children's, Orange, CA, USA
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, CA, USA
- Health Policy Research Institution, University of California, Irvine, CA, USA
| | - Zeev N Kain
- Center on Stress & Health, University of California School of Medicine, Irvine, CA, USA.
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, CA, USA.
- Department of Psychological Science, University of California, Irvine, CA, USA.
- Yale Child Study Center, Yale University, New Haven, CT, USA.
- Department of Pediatrics, CHOC Children's, Orange, CA, USA.
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Kranjac AW, Kranjac D, Fortier MA, Patton P, Giafaglione B, Kain ZN. Surgical Patients' Hospital Experience Scores: Neighborhood Context Conceptual Framework. ANNALS OF SURGERY OPEN 2021; 2:e037. [PMID: 37638237 PMCID: PMC10455165 DOI: 10.1097/as9.0000000000000037] [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: 11/06/2020] [Accepted: 01/04/2021] [Indexed: 11/25/2022] Open
Abstract
Objective Through geocoding the physical residential address included in the electronic medical record to the census tract level, we present a novel model for concomitant examination of individual patient-related and residential context-related factors that are associated with patient-reported experience scores. Summary Background Data When assessing patient experience in the surgical setting, researchers need to examine the potential influence of neighborhood-level characteristics on patient experience-of-care ratings. Methods We geocoded the residential address included in the electronic medical record (EMR) from a tertiary care facility to the census tract level of Orange County, CA. We then linked each individual record to the matching census tract and use hierarchical regression analyses to test the impact of distinct neighborhood conditions on patient experience. This approach allows us to estimate how each neighborhood characteristic uniquely influences Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Results Individuals residing in communities characterized by high levels of socioeconomic disadvantage have the highest experience ratings. Accounting for individual patient's characteristics such as age, gender, race/ethnicity, primary language spoken at home, length of stay, and average pain levels during their hospital stay, neighborhood-level characteristics such as proportions of people receiving public assistance influence the ratings of hospital experience (0.01, P < 0.05) independent of, and beyond, these individual-level factors. Conclusions This manuscript is an example of how geocoding could be used to analyze surgical patient experience scores. In this analysis, we have shown that neighborhood-level characteristics influence the ratings of hospital experience independent of, and beyond, individual-level factors.
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Affiliation(s)
| | - Dinko Kranjac
- Department of Psychology, University of La Verne, La Verne, CA
| | - Michelle A. Fortier
- Center on Stress & Health, University of California School of Medicine, Irvine, CA
- Sue & Bill Gross School of Nursing, University of California, Irvine, CA
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, CA
| | | | | | - Zeev N. Kain
- Center on Stress & Health, University of California School of Medicine, Irvine, CA
- Department of Anesthesiology and Perioperative Care, University of California, Irvine, CA
- Yale Child Study Center, Yale University, New Haven, CT
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Waldron MK, Wathen K, Houston S, Coleman L, Mason JJ, Wang Y, Hinds PS. The Impact of Demographics on Child and Parent Ratings of Satisfaction with Hospital Care. Pediatr Qual Saf 2021; 6:e382. [PMID: 38571519 PMCID: PMC10990349 DOI: 10.1097/pq9.0000000000000382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/14/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Patient satisfaction ratings differ between minority and nonminority respondents in studies of hospitalized adults, but little is known about such differences in pediatrics. Our goal was to determine if patient satisfaction ratings completed by hospitalized children and their parents at the point of discharge differed by race/ethnicity, language, child gender, and age. Methods We used a mixed-methods design. English and Spanish-speaking families from 5 inpatient units at 1 pediatric hospital completed ratings, face-to-face, before scheduled hospital discharge (T1), and again by telephone after discharge (T2). Participating children and their parents completed an 8-item satisfaction survey, and parents additionally completed 7 discharge readiness items. Results The refusal rate was 10.7%, with 600 families enrolled; non-white families represented 66% of both study refusals and completions. The proportion of racial/ethnic groups in our study exceeded those in our standard survey sample. There were no significant differences in satisfaction ratings between non-white and white families or by child gender, age, or language. Conclusions The lack of rating differences by demographic characteristics, the low refusal and attrition rates, and a more racially/ethnically representative sample of both child and parent perspectives indicate this approach to measuring satisfaction is acceptable and feasible to demographically diverse families.
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Affiliation(s)
- Mia K. Waldron
- From the Department of Nursing Science Professional Practice and Quality (NSPPQ) at Children’s National Hospital and the George Washington University, Department of Pediatrics in Washington, D.C
| | - Kourtney Wathen
- Department of Speech-language Pathology, Loyola University Maryland
| | - Sasha Houston
- Departments of Revenue Cycle and Clinical Resource Management at Children’s National Hospital in Washington, D.C
| | - Lael Coleman
- DC Mental Health Access in Pediatrics (MAP) program in the Community Health and Advocacy Institute at Children’s National Hospital in Washington, D.C
| | - Janice J. Mason
- From the Department of Nursing Science Professional Practice and Quality (NSPPQ) at Children’s National Hospital and the George Washington University, Department of Pediatrics in Washington, D.C
| | - Yunfei Wang
- Division of Biostatistics & Study Methodology, Children’s National Hospital in Washington, D.C
| | - Pamela S. Hinds
- From the Department of Nursing Science Professional Practice and Quality (NSPPQ) at Children’s National Hospital and the George Washington University, Department of Pediatrics in Washington, D.C
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Damen A, Murphy P, Fullam F, Mylod D, Shah RC, Fitchett G. Examining the Association Between Chaplain Care and Patient Experience. J Patient Exp 2021; 7:1174-1180. [PMID: 33457562 PMCID: PMC7786773 DOI: 10.1177/2374373520918723] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
A developing body of evidence indicates that chaplain care is associated with higher levels of patient/family satisfaction with their hospital care. We examined the association between chaplain care and patient experience among patients at Rush University Medical Center in Chicago who responded to Hospital Consumer Assessment of Healthcare Providers and Systems and Press Ganey survey items between 2011 and 2017. Information about chaplain care was taken from the inpatients’ electronic medical record. Our analyses included 11 741 patients, 26.5% of whom had received any chaplain care. Patients with lower self-rated health were more likely to have received chaplain care (P < .001). In bivariate analyses, chaplain care was associated with lower likelihood of reporting the highest score for 4 patient experience items (P < .001). In multi-variable models that adjusted for patient self-rated health and other factors, the association between chaplain care and the 4 patient experience items was nonsignificant. There was no effect modification for patient religious affiliation, self-rated health, or other demographic factors. The chaplain care-patient experience association may be more complex than has initially appeared, and further research is needed to help us better understand it.
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Affiliation(s)
- Annelieke Damen
- PhD student Outcomes of Chaplaincy, University of Humanistic Studies, Utrecht, the Netherlands
| | - Patricia Murphy
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, IL, USA
| | - Francis Fullam
- Health Systems Management, Rush University Medical Center, Chicago, IL, USA
| | - Deirdre Mylod
- Institute for Innovation, SVP Research & Analytics, Press Ganey Associates, South Bend, IN, USA
| | - Raj C Shah
- Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - George Fitchett
- Department of Religion, Health, and Human Values, Rush University Medical Center, Chicago, IL, USA
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Bender JL. The Internet as a Route to Health Information, Support, and Healthcare for Cancer Survivors. J Natl Compr Canc Netw 2020; 18:1586-1588. [PMID: 33152699 DOI: 10.6004/jnccn.2020.7672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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28
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Gender Differences in Patient Experience Across Medicare Advantage Plans. Womens Health Issues 2020; 30:477-483. [DOI: 10.1016/j.whi.2020.08.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 11/24/2022]
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Chekijian S, Kinsman J, Taylor RA, Ravi S, Parwani V, Ulrich A, Venkatesh A, Agrawal P. Association between patient-physician gender concordance and patient experience scores. Is there gender bias? Am J Emerg Med 2020; 45:476-482. [PMID: 33069544 DOI: 10.1016/j.ajem.2020.09.090] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patient satisfaction, a commonly measured indicator of quality of care and patient experience, is often used in physician performance reviews and promotion decisions. Patient satisfaction surveys may introduce gender-related bias. OBJECTIVE Examine the effect of patient and physician gender concordance on patient satisfaction with emergency care. METHODS We performed a cross-sectional analysis of electronic health record and Press Ganey patient satisfaction survey data of adult patients discharged from the emergency department (2015-2018). Logistic regression models were used to examine relationships between physician gender, patient gender, and physician-patient gender dyads. Binary outcomes included: perfect care provider score and perfect overall assessment score. RESULTS Female patients returned surveys more often (n=7 612; 61.55%) and accounted for more visits (n=232 024; 55.26%). Female patients had lower odds of perfect scores for provider score and overall assessment score (OR: 0.852, 95% CI: 0.790, 0.918; OR: 0.782, 95% CI: 0.723, 0.846). Female physicians had 1.102 (95% CI: 1.001, 1.213) times the odds of receiving a perfect provider score. Physician gender did not influence male patients' odds of reporting a perfect care provider score (95% CI: 0.916, 1.158) whereas female patients treated by female physicians had 1.146 times the odds (95% CI: 1.019, 1.289) of a perfect provider score. CONCLUSION Female patients prefer female emergency physicians but were less satisfied with their physician and emergency department visit overall. Over-representation of female patients on patient satisfaction surveys introduces bias. Patient satisfaction surveys should be deemphasized from physician compensation and promotion decisions.
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Affiliation(s)
- Sharon Chekijian
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
| | - Jeremiah Kinsman
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - R Andrew Taylor
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Shashank Ravi
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Stanford University School of Medicine, USA
| | - Vivek Parwani
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Andrew Ulrich
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Arjun Venkatesh
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA; Center for Outcomes Research and Evaluation, Yale University School of Medicine, New Haven, CT, USA
| | - Pooja Agrawal
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Tandon V, Stringer B, Conner C, Gabriel A, Tripathi B, Balakumaran K, Chen K. An Observation of Racial and Gender Disparities in Congestive Heart Failure Admissions Using the National Inpatient Sample. Cureus 2020; 12:e10914. [PMID: 33194481 PMCID: PMC7657376 DOI: 10.7759/cureus.10914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Suhail P, Srinivasulu Y. Impact of communication dyads on health-care service experience in Ayurveda. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2020. [DOI: 10.1108/ijphm-06-2019-0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to understand whether the perceptions of the patient’s in the health-care service experience differs in the Ayurveda, and to examine the impact of three critical communication dyads on the patient service experiences in Ayurveda health-care sector.
Design/methodology/approach
The study consists of 436 participants, recruited directly from the inpatients of Ayurveda establishments/hospitals/clinics in Northern Kerala, India. Data was collected through a structured questionnaire. An independent sample t-test was used to find out the differences in the perceptions of Ayurveda health-care consumers towards their health-care service experience. Multiple regression analysis is used to explain the dyadic relationship of patient–firm (PFR), patient–employee (PER) and employee–firm relation (EFR) on the health-care service experience (SE) in the Ayurveda sector.
Findings
The study highlights that the perception of patients on Ayurveda health-care service experience varies according to their socio-economic statuses such as age, gender, annual income and the number of inpatient days. Among the service communication dyads, PFR is the most effective dyadic phase that contributes significantly more towards an improved Ayurveda health-care SE, followed by the PER and EFR.
Research limitations/implications
The findings of the study will be more applicable to the Ayurveda health-care sector, where the doctors and the management have more role in the servicescape.
Practical implications
Health managers have to consider three stakeholders (customers, employees and firm) and the relationship between them. It is valued the PFR more, followed by the PER and EFR.
Social implications
Proper implementation of the suggestions given by the study can improve overall service communications of the different service providers of Ayurveda with good interpersonal manner to achieve better relationships among the three mentioned parties.
Originality/value
The empirical evidence from the study is relevant and timely to the health-care service providers of the country to aid them in providing a better health-care service experience. The study adds value given the increasing trend of lifestyle diseases and subsequent demand in health-care services, especially in the Ayurveda sector.
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Hoffstädt H, Stouthard J, Meijers MC, Westendorp J, Henselmans I, Spreeuwenberg P, de Jong P, van Dulmen S, van Vliet LM. Patients' and Clinicians' Perceptions of Clinician-Expressed Empathy in Advanced Cancer Consultations and Associations with Patient Outcomes. Palliat Med Rep 2020; 1:76-83. [PMID: 34223461 PMCID: PMC8241346 DOI: 10.1089/pmr.2020.0052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Empathy is a cornerstone of effective communication. However, clinicians' and patients' perceptions of clinician-expressed empathy might differ. The independent perceptions of patients and clinicians on clinician-expressed empathy in advanced cancer consultations and the associations of these perceptions with patient outcomes are unknown. Objective: We assessed (1) patients' and clinicians' independent perceptions of clinician-(self-)expressed empathy in advanced cancer consultations and (2) the associations between these perceptions and affective patient outcomes. Methods: This observational study included data from 41 consultations in the advanced breast cancer setting. Postconsultation, patients' and clinicians' perceptions of clinician-expressed empathy were assessed, as well as patients' (1) pre-post anxiety, (2) post-anxiety, (3) emotional well-being, and (4) satisfaction. Multilevel regression analyses were run to draw conclusions. Results: Patients perceived higher levels of empathy than clinicians, without a significant relationship between the two (mean [M] = 85.47, standard deviation [SD] = 14.00 vs. M = 61.88, SD = 15.30, 0-100 scale; β = 0.14, p < 0.138, 95% confidence interval [CI] = -0.04 to 0.32). Higher patient-perceived empathy was associated with decreased anxiety [(1) β = -0.67, p = 0.039, 95% CI = -1.30 to -0.03; (2) β = -0.15, p = 0.042, 95% CI = -0.30 to -0.01], higher satisfaction (β = 0.05, p < 0.001, 95% CI = 0.03 to 0.08), and lower emotional distress (β = -0.32, p < 0.001, 95% CI = -0.48 to -0.16). There were no associations with clinicians' perceptions [(1) β = -0.34, p = 0.307, 95% CI = -1.00 to 0.31; (2) β = -0.02, p = 0.824, 95% CI = -0.17 to 0.14; (3) β < 0.01, p = 0.918, 95% CI = -0.03 to 0.02; (4) β = 0.08, p = 0.335, 95% CI = -0.08 to 0.25]. Conclusions: Patients' and clinicians' empathy perceptions differed. In improving patient outcomes, the focus should be on patients' perceptions of clinician-expressed empathy. Future research could focus on ways to elicit patients' perceptions of empathy with the higher aim of improving patient outcomes.
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Affiliation(s)
- Hinke Hoffstädt
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Communication, Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Jacqueline Stouthard
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maartje C Meijers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Janine Westendorp
- Department of Communication, Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Inge Henselmans
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.,Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - Peter Spreeuwenberg
- Department of Communication, Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Paul de Jong
- Department of Medical Oncology, St Antonius Hospital, Utrecht, The Netherlands
| | - Sandra van Dulmen
- Department of Communication, Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Liesbeth M van Vliet
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands.,Department of Communication, Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Leiden Institute for Brain and Cognition (LIBC), Leiden University, Leiden, The Netherlands
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Upton E, Sangal RB, Blutinger E, Khachatryan M, Aysola J, Mamtani M. Female millennial patient perspectives in the emergency department: A qualitative analysis. Am J Emerg Med 2020; 38:2462-2464. [PMID: 32224040 DOI: 10.1016/j.ajem.2020.02.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/16/2020] [Accepted: 02/16/2020] [Indexed: 12/20/2022] Open
Affiliation(s)
- Elizabeth Upton
- Perelman School of Medicine at the University of Pennsylvania Department of Emergency Medicine, 3400 Spruce Street, Ground Floor, Ravdin, Philadelphia, PA 19104.
| | - Rohit B Sangal
- Perelman School of Medicine at the University of Pennsylvania Department of Emergency Medicine, 3400 Spruce Street, Ground Floor, Ravdin, Philadelphia, PA 19104; Yale New Haven Health System, Department of Emergency Medicine, 20 York St, New Haven, CT 06510.
| | - Erik Blutinger
- Perelman School of Medicine at the University of Pennsylvania Department of Emergency Medicine, 3400 Spruce Street, Ground Floor, Ravdin, Philadelphia, PA 19104; Mount Sinai Health System, Department of Emergency Medicine, 555 W 57(th) St, New York, NY 10019.
| | - Mary Khachatryan
- Perelman School of Medicine at the University of Pennsylvania Department of Emergency Medicine, 3400 Spruce Street, Ground Floor, Ravdin, Philadelphia, PA 19104.
| | - Jaya Aysola
- Perelman School of Medicine at the University of Pennsylvania, Division of General Internal Medicine, Department of Medicine, 3400 Spruce Street, Philadelphia, PA 19104.
| | - Mira Mamtani
- Perelman School of Medicine at the University of Pennsylvania Department of Emergency Medicine, 3400 Spruce Street, Ground Floor, Ravdin, Philadelphia, PA 19104.
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Williams B, Hibberd C, Baldie D, Duncan EAS, Elders A, Maxwell M, Rattray JE, Cowie J, Strachan H, Jones MC. Evaluation of the impact of an augmented model of The Productive Ward: Releasing Time to Care on staff and patient outcomes: a naturalistic stepped-wedge trial. BMJ Qual Saf 2020; 30:27-37. [PMID: 32217699 PMCID: PMC7788216 DOI: 10.1136/bmjqs-2019-009821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/20/2019] [Accepted: 02/27/2020] [Indexed: 11/24/2022]
Abstract
Background Improving the quality and efficiency of healthcare is an international priority. A range of complex ward based quality initiatives have been developed over recent years, perhaps the most influential programme has been Productive Ward: Releasing Time to Care. The programme aims to improve work processes and team efficiency with the aim of ‘releasing time’, which would be used to increase time with patients ultimately improving patient care, although this does not form a specific part of the programme. This study aimed to address this and evaluate the impact using recent methodological advances in complex intervention evaluation design. Method The objective of this study was to assess the impact of an augmented version of The Productive Ward: Releasing Time to Care on staff and patient outcomes. The design was a naturalistic stepped-wedge trial. The setting included fifteen wards in two acute hospitals in a Scottish health board region. The intervention was the Productive Ward: Releasing Time to Care augmented with practice development transformational change methods that focused on staff caring behaviours, teamwork and patient feedback. The primary outcomes included nurses’ shared philosophy of care, nurse emotional exhaustion, and patient experience of nurse communication. Secondary outcomes covered additional key dimensions of staff and patient experience and outcomes and frequency of emergency admissions for same diagnosis within 6 months of discharge. Results We recruited 691 patients, 177 nurses and 14 senior charge nurses. We found statistically significant improvements in two of the study’s three primary outcomes: patients’ experiences of nurse communication (Effect size=0.15, 95% CI; 0.05 to 0.24), and nurses’ shared philosophy of care (Effect size =0.42, 95% CI; 0.14 to 0.70). There were also significant improvements in secondary outcomes: patients’ overall rating of ward quality; nurses’ positive affect; and items relating to nursing team climate. We found no change in frequency of emergency admissions within six months of discharge. Conclusions We found evidence that the augmented version of The Productive Ward: Releasing Time to Care Intervention was successful in improving a number of dimensions of nurse experience and ward culture, in addition to improved patient experience and evaluations of the quality of care received. Despite these positive summary findings across all wards, intervention implementation appeared to vary between wards. By addressing the contextual factors, which may influence these variations, and tailoring some elements of the intervention, it is likely that greater improvements could be achieved. Trial registration number UKCRN 14195.
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Affiliation(s)
- Brian Williams
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Carina Hibberd
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Deborah Baldie
- Division of Nursing, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Edward A S Duncan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Andrew Elders
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Janice E Rattray
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
| | - Julie Cowie
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Glasgow, UK
| | - Heather Strachan
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK
| | - Martyn C Jones
- School of Nursing and Health Sciences, University of Dundee, Dundee, UK
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Uhelski ACR, Sheikh MM, Panda M, Qayyum R. Spirituality and satisfaction with physicians among hospitalized patients. J Health Care Chaplain 2020; 28:21-28. [PMID: 32075543 DOI: 10.1080/08854726.2020.1727601] [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: 10/25/2022]
Abstract
We examined the relationship between a patient's spirituality and satisfaction with physicians during hospitalization. Data were collected using the Daily Spiritual Experience Scale (DSES), the Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH) and a five-question, internally-developed, patient satisfaction questionnaire (5QS). Scores were rescaled from 0 to 100 for easy comparison. Results showed a statistically significant increase in patient satisfaction with increasing spirituality. In the unadjusted model, each 1% increase in DSES score (or 1% decrease in spirituality) was associated with 0.21% (p < 0.001) and 0.14% (p = 0.002) decrease in patient satisfaction with physicians as measured by 5QS and TAISCH respectively. The results were consistent after adjustment for the patient's age, gender, and race. With the increasing influence, patient satisfaction scores have on the health care system, the results from this study help us better understand how these scores are influenced.
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Affiliation(s)
- Anna-Carson Rimer Uhelski
- Department of Medicine, University of Tennessee Health Science Center - College of Medicine, Memphis, TN, USA.,Department of Medicine, Osler Internal Medicine Residency Program, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Muhammad Mubbashir Sheikh
- Department of Medicine and Medical Education, University of Tennessee - College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Mukta Panda
- Department of Medicine and Medical Education, University of Tennessee - College of Medicine Chattanooga, Chattanooga, TN, USA.,College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Rehan Qayyum
- Division of Hospital Medicine, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
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Zawisza K, Galas A, Tobiasz-Adamczyk B. Factors associated with patient satisfaction with health care among Polish older people: results from the polish part of the COURAGE in Europe. Public Health 2020; 179:169-177. [DOI: 10.1016/j.puhe.2019.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/12/2019] [Accepted: 10/17/2019] [Indexed: 11/29/2022]
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Valaker I, Fridlund B, Wentzel-Larsen T, Nordrehaug JE, Rotevatn S, Råholm MB, Norekvål TM. Continuity of care and its associations with self-reported health, clinical characteristics and follow-up services after percutaneous coronary intervention. BMC Health Serv Res 2020; 20:71. [PMID: 32005235 PMCID: PMC6993348 DOI: 10.1186/s12913-020-4908-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
AIMS Complexity of care in patients with coronary artery disease is increasing, due to ageing, improved treatment, and more specialised care. Patients receive care from various healthcare providers in many settings. Still, few studies have evaluated continuity of care across primary and secondary care levels for patients after percutaneous coronary intervention (PCI). This study aimed to determine multifaceted aspects of continuity of care and associations with socio-demographic characteristics, self-reported health, clinical characteristics and follow-up services for patients after PCI. METHODS This multi-centre prospective cohort study collected data at baseline and two-month follow-up from medical records, national registries and patient self-reports. Univariable and hierarchical regressions were performed using the Heart Continuity of Care Questionnaire total score as the dependent variable. RESULTS In total, 1695 patients were included at baseline, and 1318 (78%) completed the two-month follow-up. Patients stated not being adequately informed about lifestyle changes, medication and follow-up care. Those experiencing poorer health status after PCI scored significantly worse on continuity of care. Patients with ST-segment elevation myocardial infarction scored significantly better on informational and management continuity than those with other cardiac diagnoses. The regression analyses showed significantly better continuity (P ≤ 0.034) in patients who were male, received written information from hospital, were transferred to another hospital before discharge, received follow-up from their general practitioner or had sufficient consultation time after discharge from hospital. CONCLUSION Risk factors for sub-optimal continuity were identified. These factors are important to patients, healthcare providers and policy makers. Action should be taken to educate patients, reconcile discharge plans and organise post-discharge services. Designing pathways with an interdisciplinary approach and shared responsibility between healthcare settings is recommended.
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Affiliation(s)
- Irene Valaker
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Svanehaugvegen 1, 6812 Førde, Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
- Centre for Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, 351 95 Växjö, Sweden
| | - Tore Wentzel-Larsen
- Centre for Clinical Research, Haukeland University Hospital, Haukelandsveien 28, 5009 Bergen, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, 0484 Oslo, Norway
- Norwegian Centre for Violence and Traumatic Stress Studies, Gullhaugveien 1, 0484 Oslo, Norway
| | - Jan Erik Nordrehaug
- Department of Clinical Science, Faculty of Medicine, University of Bergen, P.O box 7804, 5020 Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, 4011 Stavanger, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
- Norwegian Registry for Invasive Cardiology, 5021 Bergen, Norway
| | - Maj-Britt Råholm
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Svanehaugvegen 1, 6812 Førde, Norway
| | - Tone M. Norekvål
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Svanehaugvegen 1, 6812 Førde, Norway
- Department of Heart Disease, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
- Department of Clinical Science, Faculty of Medicine, University of Bergen, P.O box 7804, 5020 Bergen, Norway
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Vogel R, McGraw C, Orlando A, Bourg P, Dreiman C, Peck L, Tanner A, Lynch N, Bar-Or D. Examining satisfaction of older adult patients and their caregivers following traumatic injury: a cross-sectional study of three level I trauma centres. BMJ Open 2019; 9:e032374. [PMID: 31719090 PMCID: PMC6858218 DOI: 10.1136/bmjopen-2019-032374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To explore satisfaction of care received by older adult patients and their primary caregivers following traumatic injury. DESIGN Prospective, cross-sectional study using the FAMCARE (Family Satisfaction with Advanced Cancer Care Scale) satisfaction surveys prior to discharge. SETTING Three level I trauma centres in Colorado from November 2016 to December 2017. PARTICIPANTS Trauma patients ≥55 years old and their primary caregivers. OUTCOME MEASURES Overall mean (SD) satisfaction, satisfaction <80% vs ≥80%, and mean satisfaction by survey conceptual structures. RESULTS Of the 319 patients and 336 caregivers included, the overall mean (SD) patient satisfaction was 81.7% (15.0%) and for caregivers was 83.6% (13.4%). The area with the highest mean for patient and caregiver satisfaction was psychosocial care (85.4% and 86.9%, respectively). Information giving was the lowest for patients (80.4%) and caregivers (80.9%). When individual items were examined, patients were significantly more satisfied with 'availability of nurses to answer questions' (84.5 (15.3) vs 87.4 (14.8), p=0.02) and significantly less satisfied with 'speed with which symptoms were treated' (80.6 (17.9) vs 84.0 (17.0), p=0.03) compared with caregivers. Patients with a history of smoking (least squares mean difference: -0.096 (-0.18 to -0.07), p<0.001) and hospital discharge destination to an outside facility of care (adjusted OR: 1.6 (1.0 to 2.4), p=0.048) were identified as independent predictors of lower overall satisfaction in generalised linear and logistic models, respectively. CONCLUSIONS Our data suggest that patients' medical history was driving both patient and caregiver satisfaction. Patient characteristics and expectations need to be considered when tailoring healthcare interventions.
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Affiliation(s)
- Rebecca Vogel
- Trauma Services Department, St. Anthony's Hospital, Lakewood, Colorado, USA
| | - Constance McGraw
- Trauma Research Department, St Anthony Hospital, Lakewood, Colorado, USA
- Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
- Trauma Research Department, Penrose Hospital, Colorado Springs, Colorado, USA
| | - Alessandro Orlando
- Trauma Research Department, St Anthony Hospital, Lakewood, Colorado, USA
- Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
- Trauma Research Department, Penrose Hospital, Colorado Springs, Colorado, USA
| | - Pamela Bourg
- Trauma Services Department, St. Anthony's Hospital, Lakewood, Colorado, USA
| | - Chester Dreiman
- Trauma Services Department, St. Anthony's Hospital, Lakewood, Colorado, USA
| | - Laura Peck
- Trauma Services Department, Swedish Medical Center, Englewood, Colorado, USA
| | - Allen Tanner
- Trauma Services Department, Penrose Hospital, Colorado Springs, Colorado, USA
| | - Neal Lynch
- Trauma Services Department, Penrose Hospital, Colorado Springs, Colorado, USA
| | - David Bar-Or
- Trauma Research Department, St Anthony Hospital, Lakewood, Colorado, USA
- Trauma Research Department, Swedish Medical Center, Englewood, Colorado, USA
- Trauma Research Department, Penrose Hospital, Colorado Springs, Colorado, USA
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Eftekhary N, Feng JE, Anoushiravani AA, Schwarzkopf R, Vigdorchik JM, Long WJ. Hospital Consumer Assessment of Healthcare Providers and Systems: Do Patient Demographics Affect Outcomes in Total Hip Arthroplasty? J Arthroplasty 2019; 34:2580-2585. [PMID: 31266690 DOI: 10.1016/j.arth.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/08/2019] [Accepted: 06/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score is a nationally standardized measure of a patient's hospital experience. This study aims to assess whether HCAHPS scores vary by demographic or surgical factors in patients undergoing primary total hip arthroplasty. METHODS Patients who completed an HCAHPS survey after a primary total hip arthroplasty between October 2011 and November 2016 were included in this study. Patient demographics and surgical factors were evaluated for correlations with individual HCAHPS questions. RESULTS One thousand three hundred eighty-three HCAHPS questionnaires were reviewed for this study. Patients with a submitted HCAHPS response had an average age of 63.83 ± 10.17 years. Gender distribution was biased toward females at 57.27% (792 females) versus 42.73% (591 males). The average body mass index (BMI) was 28.68 ± 5.86 kg/m2. Race distribution was predominantly Caucasian at 81.49% (1127 patients), followed by "unknown" at 8.60% (119 patients) and African-American at 8.46% (117 patients). Home discharge occurred for 93.06% (1287 patients) versus 6.94% for facility discharge (96 patients). Mean length of stay was 2.41 ± 1.17 days. Each 1-year increase in age was positively correlated with a 0.16% increase in top-box response rate (β = 0.0016 ± 0.0008; P < .05). Male gender was correlated with a 4.61% increase in top-box response rate when compared to female gender (β = 0.0461 ± 0.0118; P < .01). BMI was found to be correlated with a 0.20% increase in HCAHPS response rates for each 1 kg/m2 increase (β = 0.0020 ± 0.0010; P < .05). For each day increase in length of stay, HCAHPS top-box response rates decrease by 3.41% (β = -0.0341 ± 0.0051; P < .0001). Race, marital status, smoking status, insurance type, and discharge disposition were not found to be significantly correlated with HCAHPS top-box response rate (P > .05). CONCLUSION The HCAHPS quality measurement metric affects physician reimbursement and may be biased by a number of variables including sex, length of stay, and BMI, rather than a true reflection of the quality of their hospital experience. Further research is warranted to determine whether HCAHPS scores are an appropriate measure of the quality of care received.
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Affiliation(s)
- Nima Eftekhary
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - James E Feng
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Insall Scott Kelly Institute, New York, NY
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Koskenniemi J, Leino‐Kilpi H, Puukka P, Suhonen R. Respect and its associated factors as perceived by older patients. J Clin Nurs 2019; 28:3848-3857. [DOI: 10.1111/jocn.15013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/09/2019] [Accepted: 06/30/2019] [Indexed: 02/03/2023]
Affiliation(s)
| | - Helena Leino‐Kilpi
- Department of Nursing Science, Turku University Hospital University of Turku Turku Finland
| | - Pauli Puukka
- National Institute for Health and Welfare Turku Finland
| | - Riitta Suhonen
- Department of Nursing Science, Turku University Hospital and City of Turku, Welfare Division University of Turku Turku Finland
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Eftekhary N, Feng JE, Anoushiravani AA, Schwarzkopf R, Vigdorchik JM, Long WJ. Hospital Consumer Assessment of Healthcare Providers and Systems: Do Patient Demographics Affect Outcomes in Total Knee Arthroplasty? J Arthroplasty 2019; 34:1570-1574. [PMID: 31053469 DOI: 10.1016/j.arth.2019.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/03/2019] [Accepted: 04/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a nationally standardized tool to assess patient experience between hospitals. The HCAHPS survey can affect hospital reimbursement. This study aims to determine if HCAHPS scores vary by a number of demographic variables in patients undergoing primary total knee arthroplasty (TKA). METHODS Patients who underwent primary TKA and returned a completed HCAHPS survey were included in this study. HCAHPS surveys were collected from our institution's Center for Quality and Patient Safety department, which was cross-referenced with our hospital's electronic data warehouse. Patient demographics, surgical factors, and quality outcomes were queried, and multivariable linear regression was performed. RESULTS In total, 1028 HCAHPS questionnaires after primary TKA were evaluated. The average age of patients was 65.9 ± 9.0 years and 67.9% (698 patients) were female. Average body mass index was 32.5 ± 6.9 kg/m2. Sixty-nine percent of the patients (1287 patients) were discharged home versus 10.3% (106 patients) to another facility. Mean length of stay was 2.9 ± 1.4 days. Age was correlated with a 0.3% decrease in top-box response rate (P < .01) for each 1-year increase in age. Compared to Caucasian race, African American race was correlated with a 5.6% increased rate for top-box response (P < .01), while Asian race (P = .42) and unknown race (P = 1.00) demonstrated no significant difference. Marital status demonstrated that divorced/separated status resulted in a significant 5.4% decrease in top-box response rates (P < .05). Similarly, single (P = .12) and widowed (P = .09) statuses also demonstrated a trend toward lower top-box response rates when compared to married or partnered patients. For each day increase in length of stay, HCAHPS top-box response rates decrease by 1.6% (P < .01). Gender, body mass index, smoking status, insurance type, and discharge disposition were not found to be significantly correlated with HCHAPS top-box response rate (P > .05). CONCLUSION HCAHPS scores in patients undergoing primary TKA are influenced not just by hospital and surgeon factors such as length of stay but by demographic variables such as age, race, and marital status. As surgeons become more involved with the burden of improving patient experience, they should be aware that static demographic variables can have a significant effect on HCAHPS scores.
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Affiliation(s)
- Nima Eftekhary
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - James E Feng
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Insall Scott Kelly Institute for Orthopaedics and Sports Medicines, New York, NY
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Eftekhary N, Feng JE, Anoushiravani AA, Schwarzkopf R, Vigdorchik JM, Long WJ. Revision Versus Primary Hospital Consumer Assessment of Healthcare Providers and Systems Scores in Total Joint Arthroplasty. J Arthroplasty 2019; 34:S84-S90. [PMID: 30545652 DOI: 10.1016/j.arth.2018.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/23/2018] [Accepted: 11/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score is a nationally standardized measure of a patient's inpatient experience. This study aims to assess whether HCAHPS scores differ between patients undergoing primary total joint arthroplasty (TJA) and patients undergoing revision TJA. METHODS Patients who underwent primary or revision total hip or total knee arthroplasty (THA or TKA) and returned a completed HCAHPS survey were included in this study. HCAHPS scores were collected from our institution's Center for Quality and Patient Safety department, which was cross-referenced with our hospital's electronic data warehouse. Patient demographics, surgical factors, and quality outcomes were queried. Appropriate statistical analyses were performed using MatLab 2017a and P-values less than .05 were deemed significant. RESULTS In total, 523 primary and 59 revision THA recipients completed HCAHPS surveys at our institution between October 2011 and November 2016. During this same period, 507 primary TKA recipients and 40 revision TKA recipients completed HCAHPS surveys. Compared to revision THA, primary THA patients had a significantly higher top box for overall hospital ratings (58.46% vs 41.38%), felt that nurses listened to them carefully (84.3% vs 72.88%), and felt that they clearly understood the role of each medication (69.48% vs 56.90%). Moreover, 18 of 20 HCAHPS question responses favored primary THA despite not reaching significance for the majority of HCAHPS questions. Patients with revision TKA demonstrated a significantly higher incidence of "top box" choices for quieter rooms and a trend favoring better HCAHPS scores in revision TKA in a further 12 of 20 HCAHPS responses. CONCLUSION Patients undergoing primary THA report higher HCAHPS scores than those undergoing revision THA, while revision TKA demonstrated a general trend toward higher scores when compared to primary TKA patients. This publicly reported quality measurement metric which factors into physician reimbursement may be biased by the patient's health status, the complexity of the surgical procedure, and length of stay in hospital rather than a true reflection of the quality of their hospital experience.
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Affiliation(s)
- Nima Eftekhary
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - James E Feng
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Department of Orthopedic Surgery, Albany Medical Center, Albany Medical College, Albany, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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Predicting Inpatient Dissatisfaction Following Total Joint Arthroplasty: An Analysis of 3,593 Hospital Consumer Assessment of Healthcare Providers and Systems Survey Responses. J Arthroplasty 2019; 34:824-833. [PMID: 30777630 DOI: 10.1016/j.arth.2019.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/14/2018] [Accepted: 01/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, created by the Centers for Medicare and Medicaid, is directly tied to hospital reimbursement. The purpose of this study is to identify factors that are predictive HCAHPS survey responses following primary hip and knee arthroplasty. METHODS Prospectively collected HCAHPS responses from patients undergoing elective hip and knee arthroplasty between January 2013 and October 2017 at our institution were analyzed. Patient age, gender, race, marital status, body mass index, American Society of Anesthesiologists score, preoperative pain score, smoking status, alcohol use, illegal drug use, socioeconomic quartile, insurance type, procedure type, hospital type (academic vs community), distance to medical center, length of stay (LOS), and discharge disposition were obtained and correlated with HCAHPS inpatient satisfaction scores. RESULTS Responses from 3593 patients were obtained: 1546 total hip arthroplasties, 1899 total knee arthroplasties, and 148 unicompartmental knee arthroplasties. Mean overall HCAHPS score was 79.2. Women had lower inpatient satisfaction than men (77.6 vs 81.6, P < .001). Alcohol consumers had lower inpatient satisfaction than abstainers (77.7 vs 81.6, P < .001). Inpatient satisfaction varied by socioeconomic quartile (P < .001) with patients in the highest quartile having lower satisfaction than patients in all other quartiles (P < .001). Patients discharged to a facility had lower inpatient satisfaction than those discharged home (71.2 vs 80.2, P < .001). An inverse correlation between inpatient satisfaction and LOS (r = -0.19, P < .001) and a direct correlation between satisfaction and distance to medical center (r = 0.06, P < .001) were seen. CONCLUSION Patients more likely to report lower levels of inpatient satisfaction after total joint arthroplasty are female, affluent, and alcohol consumers, who are discharged to postacute care facilities. Inpatient satisfaction was inversely correlated with LOS and positively correlated with distance from patient home to medical center. These findings provide targets for improvements in TJA inpatient care.
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Nketiah-Amponsah E, Alhassan RK, Ampaw S, Abuosi A. Subscribers' perception of quality of services provided by Ghana's National Health Insurance Scheme - what are the correlates? BMC Health Serv Res 2019; 19:196. [PMID: 30922298 PMCID: PMC6437960 DOI: 10.1186/s12913-019-4023-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 03/18/2019] [Indexed: 11/21/2022] Open
Abstract
Background Ghana’s National Health Insurance Scheme (NHIS) has witnessed an upsurge in enrollment since its inception in 2003, with over 40% of the Ghanaian population actively enrolled in the scheme. While the scheme strives to achieve universal health coverage, this quest is derailed by negative perceptions of the quality of services rendered to NHIS subscribers. This paper presents an analysis on perceptions of service quality provided to subscribers of Ghana’s NHIS with emphasis on rural and urban scheme policy holders, using a nationally representative data. Methods The study used data from the 2014 Ghana Demographic and Health Survey. Ordered logistic regressions were estimated to identify the correlates of perceived quality of care of services rendered by the NHIS. Also, chi-square statistics were performed to test for significant differences in the proportions of subscribers in the two subsamples (rural and urban). Results Rural subscribers of the NHIS were found to identify more with better perception of quality of services provided by the NHIS than urban subscribers. Results from the chi-square statistics further indicated that rural subscribers are significantly different from urban subscribers in terms of the selected socioeconomic and demographic characteristics. In the full sample; age, out-of-pocket payment for healthcare and region of residence proved significant in explaining perceived quality of services rendered by the NHIS. Age, out-of-pocket payment for healthcare, region of residence, wealth status, and access to media were found to be significant predictors of perceived quality of services provided to both rural and urban subscribers of the NHIS. The significance of these variables varied among men and women in rural and urban areas. Conclusion Different factors affect the perception of quality of services provided to rural and urban subscribers of Ghana’s NHIS. Health financing policies geared toward improving the NHIS-related services in rural and urban areas should be varied.
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Affiliation(s)
| | - Robert Kaba Alhassan
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Samuel Ampaw
- Department of Economics, University of Ghana, Legon, Accra, Ghana
| | - Aaron Abuosi
- Department of Public Administration and Health Services Management, University of Ghana, University of Ghana Business School, Legon, Accra, Ghana
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Jørgensen TSH, Allore H, MacNeil Vroomen JL, Wyk BV, Agogo GO. Sociodemographic Factors and Characteristics of Caregivers as Determinants of Skilled Nursing Facility Admissions When Modeled Jointly With Functional Limitations. J Am Med Dir Assoc 2019; 20:1599-1604.e4. [PMID: 30902676 DOI: 10.1016/j.jamda.2019.01.154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/25/2019] [Accepted: 01/29/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We examined whether previously identified relationships between sociodemographic factors and caregivers for skilled nursing facility (SNF) admissions are replicated when jointly accounting for longitudinal change in functional limitations. We further explored the impact of caregivers by investigating the relationship between caregiver's characteristics and SNF admissions. DESIGN Longitudinal follow-up study. SETTING The United States of America. PARTICIPANTS In total, 3875 older Americans from the 2011-2015 rounds of the National Health and Aging Trends Study linked with Centers for Medicare and Medicaid Services. MEASURES Sociodemographic factors and caregiver's characteristics were used to predict change in functional limitations from baseline and time to first SNF admission using a joint modeling approach. RESULTS In total, 11.3% of the study population had a SNF admission during follow-up. For sociodemographic factors, non-Hispanic white, <9th grade education, and having at least 1 caregiver were associated with higher hazards of SNF admission than other race/ethnicity, college or higher education, and no caregiver, respectively. In contrast, living with a partner or living with others was associated with lower hazard of SNF admissions. For characteristics of caregivers, medical-supportive caregiver was associated with increased hazard of SNF admissions, whereas partner caregiver was protective of SNF admissions. Jointly modeling SNF admissions and change in functional limitations resulted in greater precision of effect estimates than modeling these outcomes separately. CONCLUSIONS AND IMPLICATIONS The study provides insight that can help identify high-risk populations for future interventions to prevent or delay SNF admissions. The relation between caregivers and SNF admissions depended on caregiver's characteristics. Future work should focus on providing help to those without a partner caregiver or needing help managing their health to ensure independent living and improve the well-being of older adults. Precision increased when jointly modeling the SNF admission with change in functional limitations.
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Affiliation(s)
- Terese Sara Høj Jørgensen
- Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark; Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
| | - Heather Allore
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT; Department of Biostatistics, Yale School of Public Health, New Haven, CT
| | - Janet L MacNeil Vroomen
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - Brent Vander Wyk
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
| | - George O Agogo
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, CT
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Improving the Patient Experience and Decreasing Patient Anxiety With Nursing Bedside Report. CLIN NURSE SPEC 2019; 33:82-89. [DOI: 10.1097/nur.0000000000000428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Menendez ME, Shaker J, Lawler SM, Ring D, Jawa A. Negative Patient-Experience Comments After Total Shoulder Arthroplasty. J Bone Joint Surg Am 2019; 101:330-337. [PMID: 30801372 DOI: 10.2106/jbjs.18.00695] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is growing interest in enhancing the patient experience after discretionary orthopaedic surgery. Patient narratives are a potentially valuable but largely unscrutinized source of information. Using machine learning to understand sentiment within patient-experience comments, we explored the content of negative comments after total shoulder arthroplasty (TSA), their associated factors, and their relationship with traditional measures of patient satisfaction and with perioperative outcomes. METHODS An institutional registry was used to link the records of 186 patients who had undergone elective primary TSA between 2016 and 2017 with vendor-supplied patient satisfaction data, which included patient comments and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Using a machine-learning-based natural language processing approach, all patient comments were mined for sentiment and classified as positive, negative, mixed, or neutral. Negative comments were further classified into themes. Multivariable logistic regression was employed to determine characteristics associated with providing a negative comment. RESULTS Most patients (71%) provided at least 1 comment; 32% of the comments were negative, 62% were positive, 5% were mixed, and 1% were neutral. The themes of the negative comments were room condition (27%), time management (17%), inefficient communication (13%), lack of compassion (12%), difficult intravenous (IV) insertion (10%), food (10%), medication side effects (6%), discharge instructions (4%), and pain management (2%). Women and sicker patients were more likely to provide negative comments. Patients who made negative comments were more likely to be dissatisfied with overall hospital care and with pain management (2 HCAHPS core items), but there were no differences in any of the studied outcomes (peak pain intensity, opioid intake, operative time, hospital length of stay, discharge disposition, or 1-year American Shoulder and Elbow Surgeons [ASES] score) between those who provided negative comments and those who did not. CONCLUSIONS Patient-narrative analysis can shed light on the aspects of the process of care that are most critiqued by patients. While patient satisfaction may not be a surrogate for effectiveness of care or functional outcomes, efforts to improve the hospital environment, enhance nontechnical skills, and reduce unnecessary delays are important in providing high-quality, patient-centered care after TSA.
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Affiliation(s)
- Mariano E Menendez
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts
| | - Jonathan Shaker
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts
| | - Sarah M Lawler
- Boston Sports and Shoulder Center, Waltham, Massachusetts
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts.,Boston Sports and Shoulder Center, Waltham, Massachusetts
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Factors Driving Patient Perception of Quality Care After Primary Total Hip and Total Knee Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e061. [PMID: 30656258 PMCID: PMC6324905 DOI: 10.5435/jaaosglobal-d-18-00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Differences in female and male patient perception of care and satisfaction following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) were assessed via Hospital Consumer Assessment of Healthcare Providers and Systems survey, demographic, and clinical data. Methods: After institutional review board approval, a retrospective review of the Hospital Consumer Assessment of Healthcare Providers and Systems survey responses at a private, academic, level-I trauma center was performed from January 2011 to December 2013. Inclusion criteria were primary THA and TKA patients who were 18 years or older and returned the survey. Results: Overall, 1,166 THA and 1,411 TKA were included, with 55.0% of female THA patients and 64.5% of male THA patients highly satisfied (P = 0.002). The mean overall hospital rating was 7.2 for female THA and 7.8 for male THA (P = 0.003) patients. No significant differences was found in the TKA cohort. For all cohorts, the Nurse Communication with Nurses domain reported the greatest correlation with overall hospital rating (range, ρ = 0.418 to ρ = 0.502; P < 0.0001). Discussion: This series indicated that initiatives to improve patient care and patient perception of care should focus on nurse-patient communication, hospital staff responsiveness, the care transition process, and hospital environment. Patient sex was a significant factor in the overall satisfaction for THA, with female patients reporting significantly lower ratings than male patients.
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Schmocker RK, Cherney Stafford LM, Winslow ER. Satisfaction with surgeon care as measured by the Surgery-CAHPS survey is not related to NSQIP outcomes. Surgery 2018; 165:510-515. [PMID: 30322662 DOI: 10.1016/j.surg.2018.08.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/10/2018] [Accepted: 08/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patient satisfaction is a patient-centered outcome of particular interest. Previous work has suggested that global measures of satisfaction may not adequately evaluate surgical care, therefore the surgery-specific Consumer Assessment of Healthcare Providers and Systems survey was developed. It remains unclear how traditional outcome measures, such as morbidity, impact patient satisfaction. Our aim was to determine whether National Surgical Quality Improvement Program-defined complications impacted satisfaction with the surgeon as measured by a surgery-specific survey, the surgery-specific Consumer Assessment of Healthcare Providers and Systems survey. METHODS All patients undergoing a general surgical operation from June 2013-November 2013 were sent the surgery-specific Consumer Assessment of Healthcare Providers and Systems survey after discharge. Retrospective chart review was conducted using the National Surgical Quality Improvement Program variable definitions, and major complications were defined. Data were analyzed as a function of response to the overall surgeon-rating item, and those surgeons rated as the "best possible" or "topbox" were compared with those rated lower. Univariate and logistic regression were used to determine variable importance. RESULTS A total of 529 patients responded, and 71.5% (378/529) rated the surgeon as topbox. The overall National Surgical Quality Improvement Program complication rate was 14.2% (75/529), with 26.7% of those (20/75) being major complications. On univariate analysis, patients who rated their surgeon more highly were somewhat older (59 vs 54 years: P < .001), more often underwent elective surgery (81% vs 57%: P < .001), and had an increased rate of operation for malignancy (31% vs 17%). Neither the complication rate (total or major) nor the number of complications were associated with satisfaction scores. CONCLUSIONS When examined on a patient level with surgery-specific measures and outcomes, the presence of complications after an operation does not appear to be associated with overall patient satisfaction with surgeon care. This finding suggests that satisfaction may be an outcome distinct from traditional measures.
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Affiliation(s)
- Ryan K Schmocker
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
| | | | - Emily R Winslow
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison.
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Nottingham Q, Johnson DM, Russell R. A multi-year SEM model predicting the impact of behavior attributes on overall patient satisfaction. INTERNATIONAL JOURNAL OF QUALITY & RELIABILITY MANAGEMENT 2018. [DOI: 10.1108/ijqrm-02-2018-0031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Pressure from competition; inflexible third-party reimbursements; greater demand from government, regulatory and certifying agencies; discerning patients; and the quest of healthcare entities for greater profitably place demands and high expectations for service quality impacting overall patient experience. Extending a prior multivariate, single-period model of varied medical practices predicting patient experience to a three-year time period to understand whether there was a change in overall assessment using data analytics. The paper aims to discuss these issues.
Design/methodology/approach
SEM was employed on a per year and aggregated, three-year basis to gain insights into qualitative psychometric constructs predicting overall patient experience and strength of the relationships.
Findings
Statistically significant differences were uncovered between years indicating the strength of the relationships of latent variables on overall performance.
Research limitations/implications
Study focused on data gathered from a questionnaire mailed to patients who visited various outpatient medical clinics in a rural community with over 4,000 responses during the three-year study period. A higher percentage of female respondents over the age of 45 may limit the generalizability of the findings.
Practical implications
Practitioners can gain a broader understanding of different factors influencing overall patient experience. Administrative processes associated with the primary care provider are inconsequential. Patients are not as concerned with patient flow as they are with patient safety and health.
Originality/value
This research informs healthcare quality management of psychometrics and analytics to improve the overall patient experience in outpatient medical clinics.
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