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Riddle DL, Dumenci L. Using Two Predictive Models to Capture Two Types of Poor Outcomes in Knee Arthroplasty: A Multisite Longitudinal Cohort Study. Arthritis Rheumatol 2024; 76:1036-1046. [PMID: 38327016 PMCID: PMC11213671 DOI: 10.1002/art.42819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Poor outcome after knee arthroplasty (KA), a common major surgery worldwide, reportedly occurs in approximately 20% of patients. These patients demonstrate minimal improvement, at least moderate knee pain, and difficulty performing many routine daily activities. The purposes of our study were to comprehensively determine poor outcome risk after KA and to identify predictors of poor outcome. METHODS Data from 565 participants with KA in the Osteoarthritis Initiative and the Multicenter Osteoarthritis studies were used. Previously validated latent class analyses (LCAs) of good versus poor outcome trajectories of Western Ontario and McMaster Universities Arthritis Index (WOMAC) Pain and Disability were generated to describe minimal improvement and poor final outcome. The modified Escobar RAND appropriateness system was used to generate classifications of appropriate, inconclusive, and rarely appropriate. Multivariable prediction models included LCA-based good versus poor outcome, modified Escobar classifications, and evidence-driven preoperative prognostic variables. RESULTS Modified Escobar appropriateness classifications were nonsignificant predictors of WOMAC Pain good versus poor outcomes, indicating the methods provide independent outcome estimates. For WOMAC Pain and WOMAC Disability, approximately 34% and 45% of participants, respectively, had a high probability of either minimal improvement via "rarely appropriate" classifications or poor outcome via LCA. In multivariable prediction models, greater contralateral knee pain consistently predicted poor outcome (eg, odds ratio 1.21, 95% confidence interval 1.10-1.33). CONCLUSION Appropriateness criteria and LCA estimates provided combined poor outcome estimates that were approximately double the commonly reported poor outcome of 20%. Rates of poor outcome could be reduced if clinicians screened patients using appropriateness criteria and LCA predictors before surgery to optimize outcome.
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Kambam G, Salehian S, Liu CM, Kleinschmidt N, Dean K, Roy V, Marshall J, Hamdy RF. Association Between Antibiotic Receipt and Provider Rating Within a National Telemedicine Practice. Open Forum Infect Dis 2024; 11:ofae310. [PMID: 38989530 PMCID: PMC11234143 DOI: 10.1093/ofid/ofae310] [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: 02/21/2024] [Accepted: 05/30/2024] [Indexed: 07/12/2024] Open
Abstract
This retrospective cohort study estimated the association between prescription receipt and provider 5-star rating for adult visits with upper respiratory infections in a national telemedicine practice with active antibiotic stewardship initiatives. The odds of a 5-star rating were higher for visits with an antibiotic or nonantibiotic prescription and longer visits.
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Affiliation(s)
- Greeshmasree Kambam
- Department of Epidemiology, George Washington Milken Institute of Public Health, Washington, DC, USA
| | - Shiva Salehian
- Department of Health Policy, Virginia Commonwealth University, School of Medicine, Richmond, Virginia, USA
| | - Cindy M Liu
- Division of Infectious Diseases, Children's National Hospital, Washington DC, USA
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, George Washington Milken Institute of Public Health, Washington, DC, USA
| | - Nina Kleinschmidt
- Department of Clinical Care and Research, Included Health, San Francisco, California, USA
| | - Kristin Dean
- Department of Clinical Care and Research, Included Health, San Francisco, California, USA
| | - Vibin Roy
- Department of Clinical Care and Research, Included Health, San Francisco, California, USA
| | - Jaclyn Marshall
- Department of Clinical Care and Research, Included Health, San Francisco, California, USA
| | - Rana F Hamdy
- Division of Infectious Diseases, Children's National Hospital, Washington DC, USA
- Antibiotic Resistance Action Center, Department of Environmental and Occupational Health, George Washington Milken Institute of Public Health, Washington, DC, USA
- Department of Pediatrics, George Washington University, School of Medicine and Health Sciences, Washington, DC, USA
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Alasiri AA, Alotaibi SA, Schussler E. Patient satisfaction among Saudi academic hospitals: a systematic review. BMJ Open 2024; 14:e081185. [PMID: 38772587 PMCID: PMC11110550 DOI: 10.1136/bmjopen-2023-081185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/27/2024] [Indexed: 05/23/2024] Open
Abstract
PURPOSE To systematically review the patient's satisfaction (PS) levels within academic hospitals in Saudi Arabia from January 2012 to the end of October 2022. DATA SOURCES Articles were gathered from PubMed, ProQuest, Google Scholar and Web of Science. STUDY SELECTION/DATA EXTRACTION This review identified studies that assessed PS in Saudi Arabian university hospitals. Articles published before January 2012, as well as commentary letters, conference papers, theses and dissertations, were excluded. The study employed the five domains of PS as outlined by Boquiren et al. Two independent reviewers independently identified qualifying studies, used the Joanna Briggs Institute tools to evaluate the quality of each study and extracted essential data from each article. RESULTS Out of the 327 studies identified during the search phase, 11 met the project's objectives and criteria. Six studies reported overall PS rates ranging from 78% to 95.2%, with only one study indicating lower PS levels in emergency departments. Most studies demonstrated that technical skill is the primary domain influencing PS in academic hospitals. CONCLUSION There is a need for further investigation to explore the factors influencing PS using standardised survey instruments suitable for Saudi culture. Contradictory results regarding PS are clearly evident in the literature; therefore, it is advisable to standardise the assessment process to reduce discrepancies within the academic hospital setting in Saudi Arabia.
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Affiliation(s)
- Ahmed Ali Alasiri
- Public Health Department, College of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
- Health Services Research,College of Health Sciences, Old Dominion University, Norfolk, VA, USA
| | - Saad A Alotaibi
- Department of Public Health,College of Applied Medical Sciences, Qassim University, Buraydah 51452 P.O. Box 6666, Saudi Arabia
| | - Eric Schussler
- Rehabilitation Sciences, College of Health Sciences, Old Dominion University, Norfolk, Virginia, USA
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Xintong Z, Tao X, Shuying W, Huq KATME, Huiying G, Michiko M. An evaluation of outpatient satisfaction based on the national standard questionnaire: a satisfaction survey conducted in a tertiary hospital in Shenyang, China. Front Public Health 2024; 12:1348426. [PMID: 38784568 PMCID: PMC11111912 DOI: 10.3389/fpubh.2024.1348426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Background Patient satisfaction survey serves as a pivotal tool in evaluating the quality of healthcare services. China's nationwide standard patient satisfaction measurement tool was introduced in 2019. This study aimed to assess the model fit of the national standard outpatient satisfaction questionnaire in a tertiary hospital and evaluate the outpatient satisfaction levels using this tool. Method A cross-sectional survey using the national outpatient satisfaction questionnaire was conducted via message links to all hospital outpatients who registered between April and July 2022. The data collected underwent descriptive analysis, comparative analysis, and confirmatory factor analysis (CFA). Results A total of 6,012 valid responses were received and analyzed during this period, with 52.9% of the participants being women. The confirmatory factor analysis (CFA) model showed a good fit and identified doctor communication as having a positive effect and environmental factors as having a negative effect on outpatients' satisfaction, with standardized regression weights of 0.46 and 0.42, respectively. Despite the remarkably high satisfaction levels, patients' recommendation for using the services of this hospital surpassed the overall evaluation and total satisfaction scores. Conclusion A disparity was identified between the expectations and real experiences of outpatients, leading to some extent of dissatisfaction. To enhance satisfaction levels, the hospital should improve the communication skills of all clinical staff, simplify the environment layout for first-time visitors, and manage patient overloads.
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Affiliation(s)
- Zhou Xintong
- Graduate School of Biomedical and Health Sciences, Division of Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Hospital Infection Management, Shenyang the Fourth People’s Hospital, Shenyang, China
| | - Xin Tao
- Department of Information, Shenyang the Fourth People’s Hospital, Shenyang, China
| | - Wang Shuying
- Department of Doctor-patient Communication, Shenyang the Fourth People’s Hospital, Shenyang, China
| | - K. A. T. M. Ehsanul Huq
- Graduate School of Biomedical and Health Sciences, Division of Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Gao Huiying
- Graduate School of Biomedical and Health Sciences, Division of Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Moriyama Michiko
- Graduate School of Biomedical and Health Sciences, Division of Integrated Health Sciences, Hiroshima University, Hiroshima, Japan
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Chen V, Hara R, Siddiqui AA, Omar HN, Nazareth A, Lightdale-Miric N, Phan A, Wren TAL, Goldstein RY. Dedicated Early Morning Orthopaedic Trauma Operating Room Is Associated With Shorter Time to Surgery and Decreased Length of Hospital Stay for Children Undergoing Surgical Treatment of Supracondylar Humerus Fractures: A Retrospective Cohort Study. J Am Acad Orthop Surg 2024; 32:383-389. [PMID: 37755393 DOI: 10.5435/jaaos-d-20-00929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 08/24/2023] [Indexed: 09/28/2023] Open
Abstract
INTRODUCTION The purpose of this study was to investigate whether the use of a dedicated early morning orthopaedic trauma operating room (OR) resulted in shorter wait times, decreased surgical times, decreased length of stay (LOS), and decreased complications in children treated with urgent surgical intervention for supracondylar humerus fractures. METHODS This retrospective comparative cohort study at a level I pediatric trauma center included patients younger than 12 years with supracondylar humerus fractures urgently treated with closed or open reduction and percutaneous pinning. Index surgical cases from April 28, 2013, to February 26, 2020, were included. Patients with prior humerus fracture, concomitant injuries, open fracture, pulseless supracondylar fracture, or missing data were excluded. Patients were analyzed based on the type of OR: dedicated early morning orthopaedic trauma OR or typical daytime orthopaedic OR. The primary outcome was time from presentation to surgery. Secondary outcomes included surgical time, complications, and LOS. RESULTS A total of 401 patients with a mean age of 5 ± 2 (range: 1 to 11) years and a mean follow-up of 2.0 ± 2.1 (range: 0.5 to 25.0) months were included, of whom 137 patients (34%) underwent surgery in the early morning dedicated orthopaedic trauma OR. The dedicated early morning orthopaedic OR group had significantly less time from presentation to surgery (7.5 versus 9.4 hours; P = 0.0002) and shorter LOS (21.0 versus 24.0 hours; P = 0.004) compared with children treated in the typical daytime orthopaedic OR. Surgical time (31.1 versus 32.6 minutes; P = 0.40) and complication rates (5.8% versus 4.9%; P = 0.65) were similar between the groups. No revision surgery was required in either group. DISCUSSION Surgical wait times were diminished with use of the dedicated early morning OR, as was LOS. Surgical times and complication rates were similar between groups. Institutions may consider adopting a dedicated early morning orthopaedic trauma OR to improve surgical wait times and decrease LOS. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vivian Chen
- From the Jackie and Gene Autry Orthopedic Center, Children's Hospital Los Angeles, Los Angeles, CA (Chen, Hara, Siddiqui, Omar, Nazareth, Lightdale-Miric, Phan, Wren, and Goldstein) and the Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance, CA (Nazareth)
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Khan AZ, Vaughan AK, Aman ZS, Lazarus MD, Williams GR, Namdari S. Reaching Minimal Clinically Important Difference, Substantial Clinical Benefit, and Patient-Acceptable Symptomatic State for Patient-Reported Outcome Measures following Arthroscopic Rotator Cuff Repair Does Not Correlate with Patient Satisfaction. J Clin Med 2024; 13:2550. [PMID: 38731077 PMCID: PMC11084458 DOI: 10.3390/jcm13092550] [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: 03/05/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/13/2024] Open
Abstract
Purpose: Minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) serve as metrics to gauge orthopedic treatment efficacy based on anchoring questions that do not account for a patient's satisfaction with their surgical outcome. This study evaluates if reaching MCID, SCB, or PASS values for American Shoulder and Elbow Surgeons score (ASES), Single Alpha Numeric Evaluation (SANE), Simple Shoulder Test (SST), and Visual Analog Score (VAS) for pain following arthroscopic rotator cuff repair (RCR) correlates with overall patient satisfaction. Methods: This was a single-institution, retrospective study of patients who underwent RCR from 2015 to 2019. Pre-operative and 2 year postoperative ASES, SANE, SST, and VAS scores were recorded. Patients underwent a survey to assess: (1) what is your overall satisfaction with your surgical outcome? (scale 1 to 10); (2) if you could go back in time, would you undergo this operation again? (yes/no); (3) for the same condition, would you recommend this operation to a friend or family member? (yes/no). Spearman correlation coefficients were run to assess relationship between reaching MCID, SCB, or PASS and satisfaction. Results: Ninety-two patients were included. Mean preoperative ASES was 51.1 ± 16.9, SANE was 43.3 ± 20.9, SST was 5.4 ± 2.9, and VAS was 4.6 ± 2.1. Mean 2 year ASES was 83.9 ± 18.5, SANE was 81.7 ± 27.0, SST was 9.8 ± 3.2, and VAS was 1.4 ± 1.9. Mean patient satisfaction was 9.0 ± 1.9; 89 (96.7%) patients would undergo surgery again and recommend surgery. Correlation for reaching PASS for SANE and satisfaction was moderate. Correlation coefficients were very weak for all other outcome metrics. Conclusions: Reaching MCID, SCB, and PASS in ASES, SANE, SST, or VAS following RCR did not correlate with a patient's overall satisfaction or willingness to undergo surgery again or recommend surgery. Further investigation into the statistical credibility and overall clinical value of MCID, SCB, and PASS is necessary.
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Affiliation(s)
- Adam Z. Khan
- Southern California Permanente Medical Group, 13652 Cantara Street, Bldg 2, Panorama City, CA 91402, USA
| | - Alayna K. Vaughan
- Rothman Orthopaedics, 925 Chestnut Street, 5 Floor, Philadelphia, PA 19107, USA (S.N.)
| | - Zachary S. Aman
- Rothman Orthopaedics, 925 Chestnut Street, 5 Floor, Philadelphia, PA 19107, USA (S.N.)
| | - Mark D. Lazarus
- Rothman Orthopaedics, 925 Chestnut Street, 5 Floor, Philadelphia, PA 19107, USA (S.N.)
| | - Gerald R. Williams
- Rothman Orthopaedics, 925 Chestnut Street, 5 Floor, Philadelphia, PA 19107, USA (S.N.)
| | - Surena Namdari
- Rothman Orthopaedics, 925 Chestnut Street, 5 Floor, Philadelphia, PA 19107, USA (S.N.)
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Barrett DR, Nielsen LM, Rhon DI, Young JL. What are patients' perspectives on the value of physical therapy? A prospective cohort study. Musculoskeletal Care 2024; 22:e1871. [PMID: 38393306 DOI: 10.1002/msc.1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE To assess and identify patients' perceptions about the overall value of physical therapy services for musculoskeletal conditions and how these values were associated with their outcomes. METHODS The association between the perceived value of physical therapy (as a score) and Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference and physical function at 6-weeks was assessed in a prospective cohort. Generalised linear models were used to identify relationships between the value of physical therapy score and PROMIS outcomes. Kendall's tau was used to identify correlations between responses and outcomes. RESULTS A total of 133 participants met the final inclusion criteria. The majority of participants were female (63.9%) with a mean age of 55.53 (SD 15.36) years. A majority of participants (63.9%) reported a previous positive personal experience with physical therapy. There was no significant relationship between perceived value of physical therapy and pain interference (β -0.32, p = 0.07, 95% CI-0.67, 0.03) or physical function (β 0.19, p = 0.29, 95% CI-0.16, 0.54). Stronger beliefs in agreement with the value of non-invasive treatment were significant, but weakly correlated with lower pain interference (r = -0.18, p = 0.048) and higher physical function scores (r = 0.22, p = 0.03). CONCLUSIONS Participants had an overall positive perception of the value of physical therapy prior to initiating physical therapy, but this perception was not associated with 6-week pain and function outcomes. A better understanding of the driving factors encouraging patients to seek physical therapy services is needed to provide value-based care.
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Affiliation(s)
- Dustin R Barrett
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Therapy, Emory and Henry College, Marion, Virginia, USA
| | | | - Daniel I Rhon
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
- Department of Physical Medicine & Rehabilitation, F. Edward Hébert School of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland, USA
| | - Jodi L Young
- Bellin College, Physical Therapy, Green Bay, Wisconsin, USA
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Chen X, Yuan J, Zhao W, Qin W, Gao J, Zhang Y. Which aspects of patient experience are the 'moment of truth' in the healthcare context: a multicentre cross-sectional study in China. BMJ Open 2024; 14:e077363. [PMID: 38326249 PMCID: PMC10860089 DOI: 10.1136/bmjopen-2023-077363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/19/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE This study aimed to examine the differential magnitude of associations between specific dimensions of patient experience and overall patient satisfaction. DESIGN A descriptive, cross-sectional design was used to collect patient experience and overall satisfaction data. SETTING Participants were recruited at one tertiary general hospital, one tertiary specialised hospital, and one secondary hospital in Shanghai, China. These three institutes represent the main kinds of hospitals in the Chinese healthcare system. PARTICIPANTS 1532 inpatients were recruited, and 1469 were included. The inclusion criteria were as follows: (1) having received inpatient service for at least 2 days; (2) able to understand the questions in the questionnaires; and (3) aged>18 years old. Patients who had impaired cognitive function and completed the questionnaires with missing information were excluded. PRIMARY AND SECONDARY OUTCOME MEASURE Patient experience was measured using the Inpatient Experience with Nursing Care Scale, which is widely used in the China. The overall patient satisfaction was measured with 10-point response option. RESULTS The LASSO (least absolute shrinkage and selection operator) regression results showed that as the penalty factor (λ) = 0.0162, age, marriage status, financial status, length of hospital stay and numbers of previous of hospitalisation and six dimensions of nursing care remained in the model. As λ increases to 0.1862, only four patient experience variables, potentially the most influential on patient satisfaction, remained in the model. Patient experience with emotional support was the most significant dimension explaining patient satisfaction (β=0.1564), the second most significant dimension was admission and discharge management (β=0.1562), and the third was monitoring and coping with the progress of diseases (β=0.0613). CONCLUSION Patient experience with emotional support, admission and discharge management, monitoring and coping with the progress of diseases, and information and education are the most significant dimensions explaining patient satisfaction.
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Affiliation(s)
- Xiao Chen
- Nursing Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jie Yuan
- Nursing Department, Shanghai Fengxian District Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Wenjuan Zhao
- Nursing Department, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Wei Qin
- Nursing Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Jian Gao
- Biostatistics Department, Zhongshan Hospital Fudan University, Shanghai, China
| | - Yuxia Zhang
- Nursing Department, Zhongshan Hospital Fudan University, Shanghai, China
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Lindenblatt N, Leuenberger NJ, Harder Y, Kappos EA, Pusic AL, Shaw J, Giovanoli P, Fontein DBY. Measuring quality of care in autologous breast reconstruction: a Delphi consensus. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:107254. [PMID: 38056020 DOI: 10.1016/j.ejso.2023.107254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 10/15/2023] [Accepted: 10/29/2023] [Indexed: 12/08/2023]
Abstract
Measuring and benchmarking quality of care in surgical oncology has been gaining popularity. In autologous breast reconstruction (ABR), a standardized set of indicators to assess quality of care is lacking. In this study, we defined a set of evidence-based quality indicators for autologous breast reconstruction. First, we performed a systematic review to identify factors related to quality of care in ABR. Variables were categorized depending on their function: indicators related to outcome, indicators related to process and case-mix variables. The review was followed by a 3-round Delphi Consensus to determine which indicators and case-mix-variables were considered relevant and feasible for inclusion in an ABR standard set of indicators. 932 unique articles were identified, of which 110 papers were included in the study. Indicators were categorized by function: outcome, process and case-mix variables. In total, 8 process indicators and 41 outcome indicators were extracted. 30 case-mix-variables were included. Following 3 rounds of questioning in the Delphi Consensus, all respondents agreed on type of ABR, oncological outcomes and patient satisfaction for the standard set. Indicators related to complications were consistently ranked highly. Most process indicators were not chosen after 3 rounds of questioning. 11 case-mix-variables were included in the final set. Following the Delphi Consensus, it was possible to identify 33 process and outcome indicators and 11 case-mix-variables for inclusion for a standard set of quality indicators. With the inclusion of both objective and patient-reported outcome measures, this set of indicators provides a multidimensional measurement tool for quality assessment for ABR.
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Affiliation(s)
- N Lindenblatt
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - N J Leuenberger
- Department of Hand and Plastic Surgery, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Y Harder
- Department of Plastic, Reconstructive and Aesthetic Surgery, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland; Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - E A Kappos
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - A L Pusic
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - J Shaw
- Patient Advocacy Group, Oncoplastic Breast Consortium, University Hospital Basel, Basel, Switzerland
| | - P Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland
| | - D B Y Fontein
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Zurich, Switzerland.
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Kunze KN, Madjarova S, Jayakumar P, Nwachukwu BU. Challenges and Opportunities for the Use of Patient-Reported Outcome Measures in Orthopaedic Pediatric and Sports Medicine Surgery. J Am Acad Orthop Surg 2023; 31:e898-e905. [PMID: 37279168 DOI: 10.5435/jaaos-d-23-00087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 04/19/2023] [Indexed: 06/08/2023] Open
Abstract
Patient-reported outcome measures (PROMs) are essential tools in assessing treatment response, informing clinical decision making, driving healthcare policy, and providing important prognostic data regarding patient health status change. These tools become essential in orthopaedic disciplines, such as pediatrics and sports medicine, given the diversity of patient populations and procedures. However, the creation and routine administration of standard PROMs alone do not suffice to appropriately facilitate the aforementioned functions. Indeed, both the interpretation and optimal application of PROMs are essential to provide to achieve greatest clinical benefit. Contemporary developments and technologies surrounding PROMs may help augment this benefit, including the application of artificial intelligence, novel PROM structure with improved interpretability and validity, and PROM delivery methods that provide increased access to patients resulting in greater compliance and data acquisition yields. Despite these exciting innovations, several challenges remain in this realm that must be addressed to continue to advance the clinical usefulness and subsequent benefit of PROMs. This review will highlight the opportunities and challenges surrounding contemporary PROM use in the orthopaedic subspecialties of pediatrics and sports medicine.
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Affiliation(s)
- Kyle N Kunze
- From the Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Kunze, Madjarova, and Nwachukwu), Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX (Dr. Jayakumar)
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Versluijs Y, Fatehi A, Gonzalez AI, Reichel L, Laverty D, Ring D. Factors Associated With Patient Satisfaction Measured Using an Iterative Scale. Qual Manag Health Care 2023; 32:69-74. [PMID: 35714285 DOI: 10.1097/qmh.0000000000000352] [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: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient experience measures tend to have notable ceiling effects that make it difficult to learn from gradations of satisfaction to improve care. This study tested 2 different iterative satisfaction measures after a musculoskeletal specialty care visit in the hope that they might have less ceiling effect. We measured floor effects, ceilings effects, skewness, and kurtosis of both questionnaires. We also assessed patient factors independently associated with the questionnaires and the top 2 possible scores. METHODS In this cross-sectional study, 186 patients completed questionnaires while seeing 1 of 11 participating orthopedic surgeons in July and August 2019; the questionnaire measured: (1) demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit on 2 iterative satisfaction scales. Bivariate and multivariable analyses sought associations of the explanatory variable with the satisfaction scales. RESULTS There is a small correlation between the 2 scales ( r = 0.27; P < .001). Neither scale had a floor effect and both had a ceiling effect of 45%. There is a very small correlation between greater health anxiety and lower satisfaction measured with one of the scales ( r = -0.16; P = .05). CONCLUSION An iterative satisfaction questionnaire created some spread in patient experience data, but could not limit ceiling effects. Additional strategies are needed to remove ceiling effects from satisfaction measures.
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Affiliation(s)
- Yvonne Versluijs
- Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin (Drs Versluijs, Fatehi, Gonzalez, Reichel, Laverty, and Ring); and Department of Trauma Surgery, Leiden University Medical Center, Leiden, the Netherlands (Dr Versluijs)
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Characterizing Single-star Negative Online Reviews of Orthopaedic Trauma Association Members. J Am Acad Orthop Surg 2023; 31:397-404. [PMID: 36727955 DOI: 10.5435/jaaos-d-22-00631] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/14/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION The purpose of this study was to characterize factors that contribute to 1-star negative reviews regarding orthopaedic trauma surgeons. METHODS A search was done for Orthopaedic Trauma Association members on Yelp.com, Healthgrade.com, and Vitals.com in New York, Boston, San Francisco, Los Angeles, Dallas, Phoenix, Seattle, Baltimore, Denver, Houston, Philadelphia, and Washington, DC. All single-star reviews (out of a possible 5 stars) were included in this study. Reviews were categorized as either clinical or nonclinical and then further subcategorized. Categorical variables were analyzed using a chi-square test. The rate ratio (the ratio of the rate for nonsurgical divided by surgical reviews) was determined for each category. RESULTS Two hundred eighty-eight single-star reviews were included in the study, comprising 655 total complaints. Of all complaints, 274 (41.8%) were clinically related and 381 (58.2%) were nonclinical. Of the 288 single-star reviews, 96 (33.3%) were from surgically treated patients and 192 (66.7%) were from nonsurgical patients. Most complaints were in reference to nonclinical aspects of care such as physician bedside manner (173 reviews, 60%), not enough time spent with provider (58 reviews, 20%), and wait time (42 complaints, 15%). The most common clinical complaints were for complication (61 reviews, 21%), disagree with decision/plan (49 reviews, 17%), and uncontrolled pain (45 reviews, 16%). Surgical patients had a significantly higher rate of clinical complaints than nonsurgical patients (1.57 vs. 0.64 clinical complaints per review, P < 0.001). Nonsurgical patients had a significantly higher rate of nonclinical complaints than surgical patients (1.43 vs. 1.10 nonclinical complaints per review, P < 0.001). DISCUSSION Most 1-star reviews referenced a nonclinical aspect of care with a physician's bedside manner being the most common complaint. Surgical patients were markedly more likely to reference a clinical aspect of care, such as complications or misdiagnosis compared with nonsurgical patients, who more commonly referenced nonclinical aspects of care.
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Degenerative Lumbar Spondylolisthesis Patients With Movement-related Low Back Pain Have Less Postoperative Satisfaction After Decompression Alone. Spine (Phila Pa 1976) 2022; 47:1391-1398. [PMID: 35853163 DOI: 10.1097/brs.0000000000004377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/10/2022] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective analysis of prospectively collected multicenter observational data. OBJECTIVE The aim was to examine the preoperative factors affecting postoperative satisfaction following posterior lumbar interbody fusion (PLIF) and microendoscopic muscle-preserving interlaminar decompression (ME-MILD) in patients with degenerative lumbar spondylolisthesis (DLS). SUMMARY OF BACKGROUND DATA The technique involved in DLS surgery may either be decompression alone or decompression-fixation. Poor performance may occur after either of these surgical treatments. The author hypothesized that evaluating the correlation between preoperative quality of life and postoperative performance would aid in determining the optimal procedure. MATERIALS AND METHODS This study included 138 patients who underwent surgery for 1-level mild DLS. The authors performed PLIF for 79 patients and ME-MILD for 59 patients. When the satisfaction subscale of the Zurich Claudication Questionnaire exceeded 2 points, postoperative satisfaction was considered poor. The clinical characteristics were investigated. Responses to preoperative health-related quality of life questionnaires, such as the Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ), short form-36 health survey (SF-36), and visual analog scale, were compared between the satisfied and unsatisfied groups. RESULTS In the PLIF group, no endogenous factors influenced postoperative satisfaction. The ME-MILD cohort's satisfied and unsatisfied patients differed significantly in terms of preoperative lumbar spine dysfunction ( P <0.001) items of the JOABPEQ, role physical ( P =0.03), and role emotional ( P =0.03) items of the SF-36. A strong correlation ( r =-0.609 P =0.015) was found between preoperative lumbar spine dysfunction and postoperative satisfaction. CONCLUSIONS In the ME-MILD group, preoperative lumbar spine function was correlated with postoperative satisfaction. Decompression alone may be ineffective in cases with decreased lumbar spine function prior to surgery. The degree of low back pain on movement should be considered before selecting the surgical method. LEVEL OF EVIDENCE 3.
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Sutak AK, Ryan SP, Hong CS, Vovos TJ, Wellman SS, Jiranek WA, Seyler TM. The Effect of Medical Education on Patient Satisfaction: An Asset or a Liability? Orthopedics 2022; 45:276-280. [PMID: 35576485 DOI: 10.3928/01477447-20220511-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies have investigated the influence of trainee involvement on inpatient satisfaction scores in the postoperative joint arthroplasty setting. This study compares Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores at academic and private health care centers to assess the impact of trainees on patient satisfaction. From 2013 to 2017, 3454 HCAHPS surveys were collected at the investigating institution from patients who underwent primary total hip and total knee arthroplasty. Surveys were categorized based on the inpatient practice setting-academic hospitals included orthopedic residents and medical students who were involved in perioperative care, whereas private settings did not have trainee involvement. Patient demographics, including age, body mass index, sex, and American Society of Anesthesiologists score, were retrospectively collected. A total of 2454 HCAHPS surveys from 2 academic hospitals and 1000 surveys from a private hospital were collected. Patients at the academic hospitals were more likely to report that symptoms to look out for were clearly explained (odds ratio, 1.882; P=.001), whereas patients from the private hospital were more likely to report that the hospital was always quiet at night (odds ratio, 1.271; P=.005). The overall satisfaction score was not significantly different between the academic and private settings (78.9 vs 80.2, respectively; P=.111). The overall hospital satisfaction score for patients undergoing primary total hip and knee arthroplasty was not significantly different between private and academic medical facilities. Thus, this study supports the idea that training future orthopedic surgeons will not negatively impact patient satisfaction scores in a way that affects reimbursement. [Orthopedics. 2022;45(5):276-280.].
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McLaughlin RJ, Whitson AJ, Panebianco A, Warme WJ, Matsen FA, Hsu JE. The minimal clinically important differences of the Simple Shoulder Test are different for different arthroplasty types. J Shoulder Elbow Surg 2022; 31:1640-1646. [PMID: 35318157 DOI: 10.1016/j.jse.2022.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/07/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Preoperative and postoperative patient self-reported measures are the key to understanding the benefit of shoulder arthroplasty for patients with different diagnoses and having different surgical approaches. The minimal clinically important difference (MCID) for patient-reported outcomes such as the Simple Shoulder Test (SST) is often used to document the amount of improvement that is of importance to the patient; however, the MCID may differ for different types of shoulder arthroplasty. The objective of this study was to report the MCID of the SST and the MCID of the percentage of maximal possible improvement (%MPI) for 5 different arthroplasty types. METHODS Eight hundred eighty-seven patients undergoing shoulder arthroplasty with preoperative SST scores, 2-year postoperative SST scores, and patient satisfaction were included. The sample comprised 368 patients undergoing anatomic total shoulder arthroplasty (aTSA), 330 patients undergoing ream-and-run arthroplasty (R&R), 80 patients undergoing reverse total shoulder arthroplasty (rTSA), 53 patients undergoing cuff tear arthropathy arthroplasty, and 56 patients undergoing hemiarthroplasty. For each type of arthroplasty, the anchor-based method was used for calculating the MCID for both absolute SST scores and %MPI. RESULTS Significant improvements in SST values were seen for all arthroplasty types. The MCID for SST change was 2.3 overall but ranged from 1.6 for aTSA, to 2.6 for R&R, to 3.7 for rTSA. The MCID for %MPI was 32% overall but ranged from 22% for aTSA to 42% for hemiarthroplasty. The percentage of patients exceeding the MCID threshold was highest for aTSA at 96% and lowest for hemiarthroplasty at 61%. CONCLUSION The same MCID value may not be appropriate for different types of shoulder arthroplasty. This study reports MCID thresholds that can be used when assessing the effectiveness for each of the common types of shoulder arthroplasty.
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Affiliation(s)
- Richard J McLaughlin
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Anastasia J Whitson
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Anna Panebianco
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Winston J Warme
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Frederick A Matsen
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA
| | - Jason E Hsu
- Department of Orthopedics and Sports Medicine, University of Washington Medical Center, Seattle, WA, USA.
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Richman EH, Ogbaudu E, Pollock JR, Brinkman JC, Moore ML, Arthur JR, Karlen JW. Characterizing Negative Online Reviews of Pediatric Orthopaedic Surgeons. J Pediatr Orthop 2022; 42:e533-e537. [PMID: 35200216 DOI: 10.1097/bpo.0000000000002121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The growing focus on subjective patient experiences has created an increase in popularity for physician rating websites. The purpose of this study was to characterize extremely negative reviews of pediatric orthopaedic surgeons. METHODS Pediatric orthopaedic surgeons were randomly selected using the Pediatric Orthopaedic Society of North America comprehensive list of surgeons. A search was then performed on Healthgrades.com, Vitals.com, and Yelp.com for 1-star reviews. Reviews were classified into clinical and nonclinical categories. Statistical analyses were performed regarding the frequency of reviews and complaints for each respective category. RESULTS Of the 279 one-star reviews categorized, 248 reviews (88.9% of reviews) included nonclinical complaints, and 182 reviews (65.2% of reviews) included clinical complaints. Nonsurgical patients were associated with 255 reviews, and the remaining 24 were related to surgical patients. Of the 430 comments within reviews, 248 referenced nonclinical aspects of care, and 182 referenced clinical care. Clinical factors most frequently noted included clinical disagreement (37%), unclear treatment plan (25%), complication (17%), misdiagnosis (15%), uncontrolled pain (13%), and delay in care (8%). The most addressed nonclinical factors included physician bedside manner (68%), time spent with provider (21%), wait time (18%), unprofessional staff (17%), scheduling issues (9%), cost (8%), and billing (8%). Compared with surgical reviews, nonsurgical reviews were more likely to contain nonclinical complaints (rate ratio: 1.5; P<0.05) and less likely to contain clinical complaints (rate ratio: 0.7; P<0.05). The most common complaint by surgical patients was complications (91.7%). CONCLUSIONS To our knowledge, this is the first study to examine the factors associated with negative reviews of pediatric orthopaedic surgeons. The majority of reviews of pediatric orthopaedic surgeons were left by nonsurgical patients and were related to nonclinical aspects of care. We also found surgeon-dependent factors such as poor physician bedside manner, unclear treatment plan, or parents' disagreement with treatment plan were the most common reasons for negative reviews. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Evan H Richman
- Creighton University School of Medicine-Phoenix Regional Campus
| | | | | | | | | | | | - Judson W Karlen
- Department of Orthopaedic Surgery, Phoenix Children's Hospital, Phoenix
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Ventimiglia DJ, Chrencik M, Schneider MB, Zhang T, Munn M, Kolakowski L, Gilotra MN, Hasan SA, Henn RF. Preoperative Factors Associated with Patient Satisfaction Two Years After Elective Shoulder Surgery. JSES Int 2022; 6:649-654. [PMID: 35813145 PMCID: PMC9264137 DOI: 10.1016/j.jseint.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Purpose Patient satisfaction has become an increasingly important component of quality measures for both hospital reimbursement and quality assessment. Additionally, patient satisfaction influences patient behavior and patient follow-up. The purpose of this study was to identify preoperative factors associated with patient satisfaction 2 years after shoulder surgery. Methods Electronic surveys were used to collect patient information including demographic, surgical, and social history, as well as outcome data. Satisfaction was measured 2 years after surgery using the Surgical Satisfaction Questionnaire. Results Multivariable linear regression identified preoperative Patient-Reported Outcomes Measurement Information System Pain Interference, annual income, and American Society of Anesthesiologists score as independent predictors of lower patient satisfaction, while total shoulder arthroplasty was an independent predictor of greater patient satisfaction. The model accounted for 15% of the variance in satisfaction scores (R2 = 0.15). Conclusion Patient satisfaction 2 years after shoulder surgery is associated with preoperative patient-reported outcome scores. Lower patient satisfaction is independently predicted by greater preoperative PROMIS PI, income less than $70,000, and ASA score >1, while higher patient satisfaction is predicted by total shoulder arthroplasty.
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Odei BC, Pan X, Bello-Pardo E, Mitchell D, Thomas CR, Diaz DA. Racial and Gender Differences in Patient Satisfaction Scores Among Oncologists. Am J Clin Oncol 2022; 45:112-115. [PMID: 35195560 DOI: 10.1097/coc.0000000000000895] [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: 11/25/2022]
Abstract
BACKGROUND Patient satisfaction scores (PSS) have been adopted in health care reimbursement and faculty promotion metrics. Oncology patients face a challenging prognosis, where PSS may be perceived differently. We hypothesized that PSS differed based on gender and racial demographics of oncologists. MATERIALS AND METHODS This was an institutional review board exempt cross-sectional study utilizing PSS data for outpatient oncologists within a large comprehensive cancer center. Patient demographics included age, gender, race/ethnicity, geographical residence, and disease site. Characteristics of oncologists included gender and race/ethnicity. We used PSS ≥95 to make comparisons. The association between patient and physician characteristics were evaluated using the t test and χ2 test. RESULTS A total of 15,849 oncology patients were identified between 2011 and 2020. Survey respondents were predominantly female (53.2%), white (93.4%), between 50 and 70 years of age (55.3%), and living in an urban setting (63.6%). There were 303 oncologists with the majority being male (64.4%) and white (58.1%). Compared with white oncologists, Asian and Hispanic oncologists received lower PSS (P=0.001 and 0.0085, respectively). On subset analysis, these differences were significant among patients older than 50 years, living in rural counties, and reporting white or non-Hispanic race/ethnicity, or among patients of either gender (all P<0.05). Patients with genitourinary malignancies provided lower PSS for female oncologists (P=0.005). CONCLUSIONS Asian and Hispanic oncologists were more likely to receive lower PSS. In addition, female oncologists treating genitourinary malignancies received lower PSS. Appropriate statistical adjustments are needed for PSS among oncologists to account for race, gender, and physician subspecialization to allow for equitable professional opportunities across demographics.
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Affiliation(s)
- Bismarck C Odei
- Department of Radiation Oncology, The Ohio State University/James Cancer Hospital
| | - Xueliang Pan
- Department of Biomedical Informatics, The Ohio State Unviersity
| | | | - Darrion Mitchell
- Department of Radiation Oncology, The Ohio State University/James Cancer Hospital
| | - Charles R Thomas
- Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Lebanon, NH
| | - Dayssy A Diaz
- Department of Radiation Oncology, The Ohio State University/James Cancer Hospital
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Hoang V, Parekh A, Sagers K, Call T, Howard S, Hoffman J, Lee D. Patient Utilization of Online Information and its Influence on Orthopedic Surgeon Selection: Cross-sectional Survey of Patient Beliefs and Behaviors. JMIR Form Res 2022; 6:e22586. [PMID: 35044319 PMCID: PMC8811697 DOI: 10.2196/22586] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/29/2021] [Accepted: 11/23/2021] [Indexed: 01/29/2023] Open
Abstract
Background Patient attitudes and behavior are critical to understand owing to the increasing role of patient choice. There is a paucity of investigation into the perceived credibility of online information and whether such information impacts how patients choose their surgeons. Objective The purpose of this study was to explore the attitudes and behavior of patients regarding online information and orthopedic surgeon selection. Secondary purposes included gaining insight into the relative importance of provider selection factors, and their association with patient age and education level. Methods This was a cross-sectional study involving five multispecialty orthopedic surgery groups. A total of 329 patients who sought treatment by six different orthopedic surgeons were asked to anonymously answer a questionnaire consisting of 25 questions. Four questions regarded demographic information, 10 questions asked patients to rate the importance of specific criteria regarding the selection of their orthopedic surgeon (on a 4-point Likert scale), and 6 questions were designed to determine patient attitude and behaviors related to online information. Results Patient-reported referral sources included the emergency room (29/329, 8.8%), friend (42/329, 12.8%), insurance company (47/329, 14.3%), internet search/website (28/329, 8.5%), primary care physician (148/329, 45.0%), and other (34/329, 10.3%). Among the 329 patients, 130 (39.5%) reported that they searched the internet for information before their first visit. There was a trend of increased belief in online information to be accurate and complete in younger age groups (P=.02). There was an increased relative frequency in younger groups to perceive physician rating websites to be unbiased (P=.003), provide sufficient patient satisfaction information (P=.01), and information about physician education and training (P=.03). There was a significant trend for patients that found a surgeon’s website to be useful (P<.001), with the relative frequency increased in younger age groups. Conclusions This study shows that insurance network, physician referrals, appointment availability, and office location are important to patients, whereas advertising and internet reviews by other patients were considered to be not as helpful in choosing an orthopedic surgeon. Future studies may seek to identify obstacles to patients in integrating online resources for decision-making and strategies to improve health-seeking behaviors.
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Affiliation(s)
- Victor Hoang
- Valley Hospital Medical Center, Las Vegas, NV, United States
| | - Amit Parekh
- Valley Hospital Medical Center, Las Vegas, NV, United States
| | - Kevin Sagers
- Valley Hospital Medical Center, Las Vegas, NV, United States
| | - Trevor Call
- Valley Hospital Medical Center, Las Vegas, NV, United States
| | - Shain Howard
- Valley Hospital Medical Center, Las Vegas, NV, United States
| | - Jason Hoffman
- Valley Hospital Medical Center, Las Vegas, NV, United States
| | - Daniel Lee
- Valley Hospital Medical Center, Las Vegas, NV, United States
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Bloom DA, Manjunath AK, Dinizo M, Fried JW, Jazrawi LM, Protopsaltis TS, Fischer CR. Reducing Postoperative Opioid-prescribing Following Posterior Lumbar Fusion Does Not Significantly Change Patient Satisfaction. Spine (Phila Pa 1976) 2022; 47:34-41. [PMID: 34091561 DOI: 10.1097/brs.0000000000004138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective comparative; LOE-3. OBJECTIVE The purpose of this study was to investigate what effect, if any, an institutional opioid reduction prescribing policy following one- or two-level lumbar fusion has on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey results. SUMMARY OF BACKGROUND DATA Previous research has demonstrated that high levels of opioid-prescribing may be related, in part, to a desire to produce superior patient satisfaction. METHODS A retrospective review of prospectively collected data was conducted on patients who underwent one- or two-level lumbar fusions L3-S1 between October 2014 and October 2019 at a single institution. Patients with complete survey information were included in the analysis. Patients with a history of trauma, fracture, spinal deformity, fusions more than two levels, or prior lumbar fusion surgery L3-S1 were excluded. Cohorts were based on date of surgery relative to implementation of an institutional opioid reduction policy, which commenced in October 1, 2018. To better compare groups, opioid prescriptions were converted into milligram morphine equivalents (MME). RESULTS A total of 330 patients met inclusion criteria: 259 pre-protocol, 71 post-protocol. There were 256 one-level fusions and 74 two-level fusions included. There were few statistically significant differences between groups with respect to patient demographics (P > 0.05) with the exception of number of patients who saw the pain management service, which increased from 36.7% (95) pre-protocol to 59.2% (42) post-protocol; P < 0.001. Estimated blood loss (EBL) decreased from 533 ± 571 mL to 346 ± 328 mL (P = 0.003). Percentage of patients who underwent concomitant laminectomy decreased from 71.8% to 49.3% (P < 0.001). Average opioids prescribed on discharge in the pre-protocol period was 534 ± 425 MME, compared to after initiation of the protocol, that is 320 ± 174 MME (P < 0.001). There was no statistically significant difference with respect to satisfaction with pain control, 4.49 ± 0.85 pre-protocol versus 4.51 ± 0.82 post-protocol (P = 0.986). CONCLUSION A reduction in opioids prescribed at discharge after one- or two-level lumbar fusion is not associated with any statistically significant change in patient satisfaction with pain management, as measured by the HCAHPS survey.Level of Evidence: 3.
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Tran TB, Raoof M, Melstrom L, Kyulo N, Shaikh Z, Jones VC, Erhunmwunsee L, Fong Y, Warner SG. Racial and Ethnic Bias Impact Perceptions of Surgeon Communication. Ann Surg 2021; 274:597-604. [PMID: 34506314 DOI: 10.1097/sla.0000000000005060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate patient satisfaction scores as a function of physician and patient race and sex. BACKGROUND Patient satisfaction is increasingly used as a surrogate for physician performance. How patient and surgeon race and ethnicity affect perceptions of surgeon communication and care is not widely explored. METHODS Press Ganey patient satisfaction surveys collected from January 2019 to September 2020 were studied. Multivariate logistic regressions were used to identify factors associated with favorable surgeon performance as a function of patient and surgeon demographics. RESULTS A total of 4732 unique outpatient satisfaction survey responses were analyzed. The majority of patients were White (60.5%), followed by Asian (8.6%), Black (4.2%), and Hispanic (4.3%). URM accounted for 8.9% of the 79 surgeons evaluated, and 34% were female. Black, Hispanic, and Asian patients were more likely to report unfavorable experiences than their White counterparts (P < 0.01). Spanish-speaking patients were most likely to perceive that surgeon show less respect for patient concerns (13.9% vs 9.3%, P = 0.004) and inadequate time spent explaining health concerns (12.6% vs 9.2%, P < 0.001). Female surgeons were more likely to achieve the highest overall ratings for effective communication, whereas Asian surgeons received lower scores. Asian surgeons were more likely than non-Asian surgeons to receive lower scores in explanation (37.3% vs 44.1%, P = 0.003). After adjusting for confounding factors, Asian surgeons had 26% lower odds of receiving favorable scores for overall communication (odds ratio: 0.736, 95% confidence interval: 0.619-0.877, P = 0.001). CONCLUSIONS Both patient and surgeon race and sex drive negative perceptions of patient-physician communication. As URM report more negative experiences, further studies should focus on effects of surgeon cultural awareness on underrepresented patient satisfaction.
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Affiliation(s)
- Thuy B Tran
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Mustafa Raoof
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Laleh Melstrom
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Namgyal Kyulo
- Department of Patient Experience, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Zameer Shaikh
- Department of Patient Experience, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Veronica C Jones
- Department of Surgery, Division of Breast Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Loretta Erhunmwunsee
- Department of Surgery, Division of Thoracic Surgery, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Yuman Fong
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
| | - Susanne G Warner
- Department of Surgery, Division of Surgical Oncology, City of Hope Comprehensive Cancer Center, Duarte, California
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Hu F, Wu G, Zhao Q, Wu J. Evaluation of analgesic effect, joint function recovery and safety of meloxicam in knee osteoarthritis patients who receive total knee arthroplasty: A randomized, controlled, double-blind study. Medicine (Baltimore) 2021; 100:e26873. [PMID: 34477120 PMCID: PMC8415958 DOI: 10.1097/md.0000000000026873] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/14/2021] [Indexed: 01/05/2023] Open
Abstract
Meloxicam is commonly administrated to control postoperative pain in orthopedic surgery, while its efficacy in total knee arthroplasty (TKA) is not clear. Therefore, this study aimed to explore the postoperative analgesic effect and tolerance of meloxicam in knee osteoarthritis (OA) patients undergoing TKA.Totally, 128 knee OA patients scheduled for TKA were enrolled in this randomized, controlled, double-blind study, then randomized into meloxicam group (N = 65) and control group (N = 63) as 1:1 ratio. Patients took meloxicam or placebo from 4 hours (h) to 72 h after TKA. Patients were followed up at 6 h, 12 h, day (D)1, D2, D3, D7, month (M)1, and M3.Pain visual analog scale score at rest was decreased in meloxicam group at 12 h, D1 and D3 compared to control group; pain visual analog scale score at flexion was reduced in meloxicam group at 6 h, 12 h, D1, D2, and D3 compared to control group. Additional and total consumption of patient-controlled analgesia were both attenuated in meloxicam group compared to control group. Furthermore, patient satisfaction score was higher on D1, D2, D3 in meloxicam group compared to control group. However, no difference of hospital for special surgery knee score score at M1 or M3 was found between the 2 groups. Moreover, the occurrence of adverse events was similar between the 2 groups.Meloxicam displays good effect on controlling postoperative pain and improving patient satisfaction, while does not affect long-term knee function recovery or safety profile in knee OA patients undergoing TKA.
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Dostálová V, Bártová A, Bláhová H, Holmerová I. The experiences and needs of frail older people receiving home health care: A qualitative study. Int J Older People Nurs 2021; 17:e12418. [PMID: 34418315 PMCID: PMC9285561 DOI: 10.1111/opn.12418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 08/04/2021] [Accepted: 08/09/2021] [Indexed: 01/26/2023]
Abstract
Background Due to the rapid ageing of the population, there is increasing demand for long‐term care in the people's home environment. Such care aims to allow the people to stay at home and avoid hospitalisation or other institutional care. In home health care, care must be provided at the highest possible quality, with the focus on the people's needs and experiences. Objectives This study explores the experiences and needs of frail older people receiving home health care. Design and methods An exploratory descriptive qualitative approach was chosen. Audio‐taped semi‐structured interviews were conducted with fifteen older people receiving home health care. A content analysis was used to analyse the data collected. Results The content analysis identified one main theme, three categories and seven subcategories related to frail older people's needs and experiences of home health care. The main theme was quality of care. The first category, Safe and Secure Care, consisted of three subcategories: Education and Experience of Nurses, Information, and Continuity of Care in terms of personnel continuity and regular care. The second category, Autonomy, contained two subcategories: Decision‐making and Self‐sufficiency. The last category, Relationship with Professionals, consisted of two subcategories: Personality of Nurse and Partnerships. Conclusion Older people are able to express their satisfaction or dissatisfaction with home health care. The results of this study revealed that the quality of care is crucial for frail older people. Implication for practice The provision of home health care is inherently highly specific; home care nurses should work to provide the highest possible quality of care. In particular, nurses should focus on ensuring that the care they provide is safe, effective, timely, efficient and person‐centred.
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Affiliation(s)
- Vladimíra Dostálová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Alžběta Bártová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Hana Bláhová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Iva Holmerová
- Department of Longevity Studies, Faculty of Humanities, Charles University, Prague, Czech Republic
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Heimdal TR, Gardner SS, Dhanani UM, Harris JD, Liberman SR, McCulloch PC. Factors Affecting Orthopedic Sports Medicine Surgeons' Online Reputation. Orthopedics 2021; 44:e281-e286. [PMID: 33316825 DOI: 10.3928/01477447-20201210-07] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Physician rating websites (PRWs) rate physicians based on experiences of previous patients. Although a high rating is desirable, it may not correlate with quality of care, experience, or other physician-specific variables. This study examined the impact of physician-specific variables, such as American Board of Orthopaedic Surgery Sports Certificate of Added Qualification (CAQ) status, years in practice, sex, and geographic location, on the PRW patient satisfaction rating and number of ratings. A list of orthopedic sports medicine surgeons was obtained from the American Orthopaedic Society for Sports Medicine database. Demographic data were recorded. Surgeon profiles were gathered from the most commonly used PRWs (Healthgrades and Vitals), and a mean rating value was recorded on a 1- to 5-star scale. The t test and analysis of variance were used for comparisons. Multivariable linear regression was used to identify factors contributing to PRW ratings. Female sex had the biggest positive effect on PRW rating (R=0.04, P=.029). The PRW rating was positively affected by the number of ratings (R=0.04, P<.001) and negatively affected by an increase in years of practice (R=0.04, P<.001). Surgeons with fewer than 10 years in practice had higher PRW ratings than surgeons practicing longer than 10 years. The PRW ratings were not affected by sports CAQ status or geographic location. Fewer years in practice, female sex, and greater number of reviews were associated with higher PRW ratings. Number of reviews was the only modifiable factor. There was no observed association between sports medicine CAQ status and PRW rating. [Orthopedics. 2021;44(2):e281-e286.].
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Bovonratwet P, Shen TS, Islam W, Sculco PK, Padgett DE, Su EP. Is There an Association Between Negative Patient-Experience Comments and Perioperative Outcomes After Primary Total Hip Arthroplasty? J Arthroplasty 2021; 36:2016-2023. [PMID: 33551144 DOI: 10.1016/j.arth.2021.01.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/04/2021] [Accepted: 01/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Multiple stakeholders are interested in improving patient experience after primary total hip arthroplasty due to shifts toward patient-centered care. Patient free-text narratives are a potentially valuable but largely unexplored source of data. METHODS The records of 383 patients who underwent primary total hip arthroplasty between August 2016 and August 2019 were combined with vendor-supplied patient satisfaction data, which included patient free-text comments and the Press Ganey satisfaction survey. A total of 1295 patient comments were analyzed for sentiment, and negative comments were categorized into nine themes. Postoperative outcomes, patient-reported outcome measures, and traditional measures of satisfaction were compared between patients who provided a negative comment vs those who did not. Multivariable regression was used to determine perioperative variables associated with providing a negative comment. RESULTS Of the 1295 patient comments: 54% were positive, 24% were negative, 10% were mixed, and 12% were neutral. Top two themes of negative comments were room condition (25%) and inefficient communication (23%). There were no differences in studied outcomes (eg. peak pain intensity, length of stay, or improvements in hip injury and osteoarthritis outcome scores Jr. and pain visual analog scale scores at 6-week follow-up) between those who provided negative comments vs those who did not (P > .05). However, patients who made negative comments were less likely to recommend their hospital care to peers (P < .001). Finally, patients who had >2 allergies (P = .024) were more likely to provide negative comments. CONCLUSION The present study demonstrates that patient satisfaction appears not to be a reliable sole proxy for traditional objective outcome measures of pain relief and functional improvement.
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Affiliation(s)
- Patawut Bovonratwet
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Tony S Shen
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY; Department of Orthopaedic Surgery, New York-Presbyterian Hospital, Weill Cornell Medical Center, New York, NY
| | - Wasif Islam
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Peter K Sculco
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Douglas E Padgett
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
| | - Edwin P Su
- Department of Adult Reconstruction and Joint Replacement Service, Hospital for Special Surgery, New York, NY
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Downie S, Stillie A, Moran M, Sudlow C, Simpson H. Patient-reported assessment of outcome after surgery for bone metastases. Orthop Rev (Pavia) 2021; 13:9062. [PMID: 33953891 PMCID: PMC8077288 DOI: 10.4081/or.2021.9062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/20/2021] [Indexed: 12/14/2022] Open
Abstract
Regardless of prognosis, surgery is often considered in metastatic bone disease (MBD) as a palliative procedure to improve function and quality of life. Traditional focus on objective outcomes such as mortality is inappropriate in this group, and there is a drive to assess outcomes via patient-reported outcome measures (PROMs). This is an overview of current understanding of MBD outcomes and how this should influence future decision-making and research. The objectives of this review were to identify difficulties in measuring PROMs in the MBD patient population and explore alternatives to patientreported outcomes. We also provide an overview of current understanding of outcomes in MBD and how this should influence decision-making and direct research.
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Affiliation(s)
- Samantha Downie
- Orthopaedics and Trauma Department, The University of Edinburgh, Edinburgh
| | | | | | - Cathie Sudlow
- Division of Clinical Neurosciences, The University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - Hamish Simpson
- Orthopaedics and Trauma Department, The University of Edinburgh, Edinburgh
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Natural Language Processing of Patient-Experience Comments After Primary Total Knee Arthroplasty. J Arthroplasty 2021; 36:927-934. [PMID: 33127238 DOI: 10.1016/j.arth.2020.09.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/12/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND There is interest in improving patient experience after total knee arthroplasty (TKA) due to recent shifts toward value-based medicine. Patient narratives are a valuable but unexplored source of information. METHODS Records of 319 patients who had undergone primary TKA between August 2016 and August 2019 were linked with vendor-supplied patient satisfaction data, which included patient comments and the Press Ganey satisfaction survey. Using machine-learning-based natural language processing, 1048 patient comments were analyzed for sentiment and classified into themes. Postoperative outcomes, patient-reported outcome measures, and traditional measures of satisfaction were compared between patients who provided a negative comment vs those who did not (positive, neutral, mixed grouped together). Multivariable regression was used to determine perioperative variables associated with providing a negative comment. RESULTS Of the 1048 patient comments, 25% were negative, 58% were positive, 8% were mixed, and 9% were neutral. Top 2 themes of negative comments were room condition (25%) and inefficient communication (23%). There were no differences in most of the studied outcomes (eg, peak pain intensity, length of stay, or Knee Injury and Osteoarthritis Outcome Score Junior and pain scores at 6-week follow-up) between the 2 cohorts (P > .05). However, patients who made negative comments were less likely to highly recommend their hospital care to peers (P < .001). Finally, patients who had higher American Society of Anesthesiologists Score and those who received a scopolamine patch were more likely to provide negative comments (P < .05). CONCLUSION Although the current study showed that patient satisfaction might not be a proxy for traditional objective perioperative outcomes, efforts to improve the nontechnical aspects of medicine are still crucial in providing patient-centered care.
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Nuyen B, Altamirano J, Fassiotto M, Alyono J. Effects of surgeon sociodemographics on patient-reported satisfaction. Surgery 2021; 169:1441-1445. [PMID: 33531133 DOI: 10.1016/j.surg.2020.12.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/29/2020] [Accepted: 12/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient-reported satisfaction scores, including the Press Ganey surveys, are increasingly used as measures for quality healthcare among surgical subspecialties. However, the influence of surgeon sociodemographics is not clear. METHODS This cross-sectional study analyzed Press Ganey surveys linked to outpatient surgical visits at a single academic institution from January 2015 to December 2018 as they related to surgeon age, gender, and race. The primary outcome variable was achievement of a top-box score (5/5) on likelihood to recommend surgeon queries. Secondary analysis examined the relationship of likelihood to recommend surgeon to other survey questions, such as those regarding surgeon courtesy, concern, understandability, patient inclusion in medical decision making, and patient confidence in surgeon. χ2 tests and generalized estimating equation regression models were run to assess correlation. RESULTS In bivariate analysis of 36,840 surveys, non-Hispanic white surgeons were more likely to receive likelihood to recommend surgeon top-box ratings than Asian (P < .001) or underrepresented minority surgeons (P < .001). Additionally, male gender (P < .01) and older surgeon age (P < .001) were associated with higher top-box scores. However, in multivariate generalized estimating equation analysis, the effect of age was no longer significant, but female gender continued to be associated with lower odds of top-box likelihood to recommend surgeon ratings (odds ratio 0.83; 95% confidence interval, 0.70%-0.99%), as did Asian compared with white race (odds ratio 0.78; 95% confidence interval, 0.65%-0.95%). Likelihood to recommend surgeon scores correlated most closely with patients' "confidence" in the surgeon rather than measures of courtesy, concern, understandability, or inclusion in medical decision making. CONCLUSION Top-box scores varied by surgeon race and gender in correlation with patients' perceived confidence in the provider. Interpretation of Press Ganey scores should account for potential bias in patient satisfaction surveys based on surgeon demographics.
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Affiliation(s)
- Brian Nuyen
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Jennifer Alyono
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA.
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Greif DN, Shallop BJ, Rizzo MG, Cade WH, Letter M, Muñoz J, Baraga MG, Kaplan LD. Telehealth in an Orthopedic Sports Medicine Clinic: The First 100 Patients. Telemed J E Health 2021; 27:1275-1281. [PMID: 33513048 DOI: 10.1089/tmj.2020.0462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Orthopedic specialties have begun to embrace telehealth as an alternative to in-person visits. We have not found studies assessing telehealth in sports medicine. Our goal is to evaluate patient perception of telehealth in an orthopedic sports medicine practice. Methods: Institutional review board (IRB) approval was obtained. The first 100 patients 18 years and older who had their initial videoconference telehealth appointment with our sports medicine providers from March to April 2020 were contacted at the conclusion of their visit. Surveys assessed satisfaction with telehealth, the provider, and whether attire played a role in their perception of the quality of the telehealth visit. Results: Patients on average stated excellent satisfaction with their visit (4.76 out of 5) and their provider (4.98 out of 5). Patients slightly disagreed with the notion that telehealth is equivalent to in-person provider visits (2.95 out of 5). This did not affect their perception to telehealth itself. It did not discourage patients from recommending telehealth or their provider to future patients. Patients overall felt that attire of the provider does not influence their opinion as to the standard of care they received. Returning patients versus new patient visits were more likely to recommend telehealth to others (4.83 vs. 4.56, p = 0.04). The responses from both groups were overwhelmingly positive. Conclusion: Telehealth is a viable clinic option in an orthopedic sports medicine clinic. Patients who have seen providers in-person previously are more likely to recommend telehealth versus new patients. New patients were satisfied with their telehealth experience. Level of Evidence: IV.
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Affiliation(s)
- Dylan N Greif
- Department of Orthopaedics, University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Brandon J Shallop
- Department of Orthopaedics, University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Michael G Rizzo
- Department of Orthopaedics, University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - William H Cade
- Department of Orthopaedics, University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Michael Letter
- Department of Orthopaedics, University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Julianne Muñoz
- Department of Orthopaedics, University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Michael G Baraga
- Department of Orthopaedics, University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Lee D Kaplan
- Department of Orthopaedics, University of Miami Sports Medicine Institute, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
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Riddle DL. Letter to the Editor on "Assessment of a Satisfaction Measure for Use After Primary Total Joint Arthroplasty". J Arthroplasty 2020; 35:3417-3418. [PMID: 32712117 DOI: 10.1016/j.arth.2020.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/01/2020] [Indexed: 02/02/2023] Open
Affiliation(s)
- Daniel L Riddle
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, VA
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Borrelli M, Ting JY, Rabbani CC, Tan BK, Higgins TS, Walgama ES, Liu GC, Chen HH, Lee MK, Hopp ML, Illing EA, Mirocha J, Wu AW. Patient satisfaction survey experience among American otolaryngologists. Am J Otolaryngol 2020; 41:102656. [PMID: 32836038 DOI: 10.1016/j.amjoto.2020.102656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient Satisfaction (PS) is a commonly used metric in health care settings to assess the quality of care given by physicians. Monitoring physicians in this way may impact physician quality of life. Studies evaluating this impact are not available. This study sought to examine the physician experience of measuring PS among practicing otolaryngologists. METHODS Using an online survey platform, a 34-item survey was given to practicing otolaryngologists through email distribution. The survey included questions about physician, practice and patient demographics, as well as inquiries regarding the way in which PS was measured and how it affected physician work and personal life. Data from these questions were reviewed and analyzed. RESULTS 174 otolaryngologists responded to the survey. A majority of physicians' (55.3%) PS scores had been tracked with 89.9% reporting being tracked for a length of at least 1 year. PS scores for individual physicians were noted to be inconsistent and vary significantly between reports. Measuring patient satisfaction led to increased occupational stress, yet most physicians (63.8%) felt the monitoring did not lead to improvements in their practice. Some physicians (36.2%) reported that the collection of patient satisfaction scores had negatively influenced the way they practiced medicine, including the pressure to order superfluous tests or to prescribe unnecessary medications. CONCLUSION Overall, physicians are negatively affected by the tracking of patient satisfaction scores. Occupational stress caused by the collection of patient satisfaction scores may contribute to physician burnout.
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Falchi AG, Spadoni A, Blatti C, Manzoni F, Perlini S. Pain management in the emergency department: results from an observational longitudinal prospective study in a second-level urban hospital. EMERGENCY CARE JOURNAL 2020. [DOI: 10.4081/ecj.2020.8871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Although a correct assessment of pain and an adequate analgesia represent a priority in the setting of emergency care, many studies documented an inadequate pain control. The purpose of our study is to characterize the present status of a second level Emergency Department in Italy in terms of pain assessment and treatment. Our survey investigates the multidimensional aspects of pain, the accomplishment of appropriate pain evaluation by the medical and nursing staff and the effectiveness of the treatment, in terms of pain reduction and also of customer satisfaction.
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Early Postoperative Radiographs Have No Effect on Orthopaedic Trauma Patient's Satisfaction With Their Clinic Visit. J Am Acad Orthop Surg 2020; 28:e125-e130. [PMID: 31977614 DOI: 10.5435/jaaos-d-18-00697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient satisfaction plays a prominent role in modern orthopaedic care, reimbursement, and quality assessment, even if it runs contrary to the "standard of care." The literature shows that routine early radiographs after acute fracture care have no impact on clinical decision-making or patient outcomes, but little is known about their effect on patient satisfaction and understanding of their injuries. We hypothesized that eliminating these radiographs would negatively influence patient satisfaction scores with their clinic visit. METHODS One hundred patients were prospectively enrolled after acute fracture fixation. Half the patients obtained radiographs at the 2-week follow-up visit, whereas the other half did not. All patients completed a satisfaction survey about their clinic visit. RESULTS No difference was observed between the groups in overall satisfaction with the clinic visit (P = 0.62) or complications. However, patients with radiographs were more satisfied with the surgeon's explanations of their injury and progression (P = 0.03). CONCLUSION Eliminating routine early postoperative radiographs had no effect on overall patient satisfaction with the clinic visit, but it did affect satisfaction with the surgeon's explanation of their injury. This could save time, money, and radiation exposure without adversely affecting patient outcome or satisfaction, but an equivalent educational tool should be identified for clinic visits.
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Pfeifauf KD, Snyder-Warwick AK, Scheve S, Grellner CL, Skolnick GB, Wilkey A, Foy J, Naidoo SD, Patel KB. One Multidisciplinary Cleft and Craniofacial Team's Experience in Shifting to Family-Centered Care. Cleft Palate Craniofac J 2020; 57:909-918. [PMID: 31950854 DOI: 10.1177/1055665619899518] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Family-centered care is a high-priority focus area in health care and is associated with increased family satisfaction and quality of life, better health outcomes and family follow-up, decreased burden of care, and improved efficiency of resource utilization. Motivated by our aim to improve clinic efficiency and patient retention, our multidisciplinary cleft palate and craniofacial center has been undergoing a complex family-centered reorganization over the past 3 years. We seek to share our experience in hope the information will be a useful starting point to other teams in structuring their own family-centered improvements. We suggest the following stepwise method to achieve a more family-centered process: (1) gathering preintervention data, (2) brainstorming challenges with stakeholders, (3) brainstorming solutions with stakeholders, (4) implementation, (5) follow-up and troubleshooting, (6) further implementation, and (7) gathering postintervention data. Additionally, we found the use of institutional resources added substantial value to our efforts.
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Affiliation(s)
- Kristin D Pfeifauf
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Alison K Snyder-Warwick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,St. Louis Children's Hospital, St. Louis, MO, USA
| | - Sibyl Scheve
- St. Louis Children's Hospital, St. Louis, MO, USA
| | | | - Gary B Skolnick
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Jordan Foy
- St. Louis Children's Hospital, St. Louis, MO, USA
| | - Sybill D Naidoo
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,St. Louis Children's Hospital, St. Louis, MO, USA
| | - Kamlesh B Patel
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.,St. Louis Children's Hospital, St. Louis, MO, USA
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Billig JI, Sears ED, Travis BN, Waljee JF. Patient-Reported Outcomes: Understanding Surgical Efficacy and Quality from the Patient's Perspective. Ann Surg Oncol 2019; 27:56-64. [PMID: 31489556 DOI: 10.1245/s10434-019-07748-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 01/10/2023]
Abstract
In surgery, quality assessment encourages improved care delivery, better outcomes, and helps determine surgical efficacy. Quality is important from a patient, provider, payer, and policy maker standpoint. However, given the growth of outpatient procedures, expansion of surgical indications to enhance function, and the decline of perioperative morbidity and mortality, many traditional quality metrics, such as mortality, readmissions, and complications, may not fully capture quality. As such, patient-reported outcomes (PROs) can be used to complement the established clinical outcomes and describe surgical efficacy and quality from the patient's point of view. Generic and disease-specific PRO measures capture health-related quality of life, functional status, and pain. These measures permit a more holistic understanding of how surgery affects different aspects of a patient's health, augment other clinical outcomes, and are commonly used to determine efficacy in clinical trials. Moreover, our national reimbursement structure is currently evolving to include PROs for certain surgical conditions in measures of quality and with direct linkage to payments. Even so, there continues to be challenges in the implementation of PRO measures in everyday surgical practice, with questions of optimal administration and how to integrate these measures into provider work flow. Despite these challenges, PROs provide vital information regarding surgical efficacy and quality and are critical in the delivery of patient-centered care.
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Affiliation(s)
- Jessica I Billig
- VA/National Clinician Scholars Program, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI, USA
| | - Erika D Sears
- Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI, USA.,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI, USA
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Abstract
Background: Rating the patient experience is an increasingly important component of value-based health care. Generation of lower ratings on validated functional assessments by patients with Workers’ Compensation is well known; however, the relationship between Workers’ Compensation status and patient satisfaction is poorly described in orthopaedic patient populations. Methods: All orthopaedic outpatient patient satisfaction surveys (Press Ganey) generated over an 18-month period at a U.S. academic tertiary care center were included in this study. Data with regard to the primary payer, demographic characteristics, orthopaedic subspecialty, and planned surgical interventions with the provider for whom the survey was completed were analyzed in conjunction with patient satisfaction data. Results: During the study period, 3,720 consecutive patient satisfaction surveys were generated, and 244 surveys were generated by 215 patients with Workers’ Compensation. Satisfied patients with Workers’ Compensation were more likely to be male (p = 0.0007), to have higher mental health self-assessments (p = 0.004), and to be scheduled for surgical intervention (p = 0.03). Scheduling a surgical procedure was independently associated with improved patient satisfaction, whereas Workers’ Compensation status was independently associated with dissatisfaction when adjusting for sex, language, race, and marital status. Across all patient satisfaction domains, patients with Workers’ Compensation gave significantly lower scores (p < 0.05) compared with all other patients. Patients with Workers’ Compensation were more likely to rate their overall health as lower compared with other patients (p < 0.0001). Patients with Workers’ Compensation were more likely to give lower ratings to providers on a 1-to-10 scale (p < 0.0001) and were less likely to recommend the practice to others (p < 0.0001). Conclusions: Workers’ Compensation status is a non-modifiable independent predictor of dissatisfaction with health care compared with other primary payer groups. Further research is warranted to understand the factors influencing patient satisfaction ratings.
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Affiliation(s)
- Jocelyn Compton
- Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Natalie Glass
- Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Timothy Fowler
- Department of Orthopedic Surgery and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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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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Levy JC. Don't Lose Sight of the Outcome: Commentary on an article by Mariano E. Menendez, MD, et al.: "Negative Patient-Experience Comments After Total Shoulder Arthroplasty". J Bone Joint Surg Am 2019; 101:e15. [PMID: 30801383 DOI: 10.2106/jbjs.18.01351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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39
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Westermann RW, Mather RC, Bedard NA, Anthony CA, Glass NA, Lynch TS, Duchman KR. Prescription Opioid Use Before and After Hip Arthroscopy: A Caution to Prescribers. Arthroscopy 2019; 35:453-460. [PMID: 30612773 DOI: 10.1016/j.arthro.2018.08.056] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/02/2018] [Accepted: 08/18/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine pre- and postoperative opioid utilization while identifying risk factors for prolonged postoperative opioid use following hip arthroscopy. METHODS All patients undergoing hip arthroscopy between 2007 and the second quarter of 2016 were identified within the Humana Inc. administrative claims database. Chronic preoperative opioid utilization was defined as filling of any opioid prescription 1 to 3 months before surgery, whereas acute preoperative opioid utilization was defined as filling any opioid prescription within 1 month of surgery. Rates of pre- and postoperative opioid utilization were calculated, and patient demographic characteristics and medical conditions associated with pre- and postoperative opioid utilization were identified. RESULTS Of the 1,208 patients undergoing hip arthroscopy, chronic and acute preoperative opioid utilization was observed in 24.9% and 17.3% of patients, respectively. Chronic preoperative opioid utilization was more frequently observed in obese (P < .001) patients, those ≥50 years of age (P = .002), and those with preexisting anxiety and/or depression (P < .001). In multivariate analysis, chronic preoperative opioid utilization was the strongest predictor of opioid prescription filling at 3, 6, 9, and 12 months postoperatively (odds ratio at 3 months, 18.60, 95% confidence interval, 12.41 to 28.55), whereas preexisting anxiety and/or depression and obesity were additionally identified as predictors of prolonged postoperative opioid utilization. CONCLUSIONS Chronic preoperative opioid utilization before hip arthroscopy is common at 24.9%. The high rate of chronic preoperative opioid utilization is particularly important considering that chronic preoperative opioid utilization is the strongest predictor of continued postoperative opioid prescription filling out to 12 months postoperatively. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Robert W Westermann
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | | | - Nicholas A Bedard
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Christopher A Anthony
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Natalie A Glass
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - T Sean Lynch
- Columbia University Medical Center, New York, New York, U.S.A
| | - Kyle R Duchman
- Department of Orthopedics & Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A.; Duke University Medical Center, Durham, North Carolina, U.S.A..
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Jildeh TR, Taylor KA, Khalil LS, Okoroha KR, Matar RN, Geisenhoff A, Moutzouros V. Risk Factors for Postoperative Opioid Use in Arthroscopic Meniscal Surgery. Arthroscopy 2019; 35:575-580. [PMID: 30612767 DOI: 10.1016/j.arthro.2018.10.122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To evaluate the influence of preoperative opioid use on postoperative consumption after arthroscopic meniscal surgery and (2) to determine preoperative patient factors associated with increased opioid use after meniscal surgery. METHODS We performed a retrospective review of all patients with a primary diagnosis of a meniscal tear at a single institution between August 2013 and February 2017. Patients were classified as opioid nonusers if they had not received any opioid medications in the 3 months before meniscal surgery, as acute users if they received at least 1 opioid prescription within 1 month preceding meniscal surgery, or as chronic users if they received at least 1 opioid prescription within 3 months preceding meniscal surgery. Clinical records were reviewed for postoperative opioid use within a year after surgery. We also recorded patient demographic characteristics and the degree of knee osteoarthritis at the time of surgery using the Outerbridge classification. RESULTS A total of 735 patients were included. The average age was 46.7 years (range, 12-79 years), and the average body mass index was 30.2 ± 6.2 (range, 13.3-55.4). Patients who were acute or chronic opioid users preoperatively were more likely to continue to use opioids beyond 1 month postoperatively (P < .001). A higher percentage of patients with advanced osteoarthritis (Outerbridge grade 3 or 4) were found to continue to use opioids at all time points beyond the first postoperative month (P < .05). Pair-wise comparisons showed that the number of total opioid prescriptions filled was significantly higher in the group with Outerbridge grade 1 or 2 and the group with Outerbridge grade 3 or 4 than the group with Outerbridge grade 0 (P = .023 and P = .014, respectively). No significant difference in postoperative opioid use was noted when we compared meniscal repair versus resection, primary procedure versus revision, different tear types, or concomitant procedures. CONCLUSIONS In patients undergoing arthroscopic meniscal surgery, the chronicity of preoperative opioid intake and degree of knee osteoarthritis were found to have a significant effect on postoperative opioid use. LEVEL OF STUDY Level III, retrospective comparative study.
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Affiliation(s)
- Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A..
| | - Kevin A Taylor
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Lafi S Khalil
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Robert N Matar
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan, U.S.A
| | | | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
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Renggli S, Mayumana I, Mboya D, Charles C, Mshana C, Kessy F, Glass TR, Pfeiffer C, Schulze A, Aerts A, Lengeler C. Towards improved health service quality in Tanzania: appropriateness of an electronic tool to assess quality of primary healthcare. BMC Health Serv Res 2019; 19:55. [PMID: 30670011 PMCID: PMC6341708 DOI: 10.1186/s12913-019-3908-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/15/2019] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Progress in health service quality is vital to reach the target of Universal Health Coverage. However, in order to improve quality, it must be measured, and the assessment results must be actionable. We analyzed an electronic tool, which was developed to assess and monitor the quality of primary healthcare in Tanzania in the context of routine supportive supervision. The electronic assessment tool focused on areas in which improvements are most effective in order to suit its purpose of routinely steering improvement measures at local level. METHODS Due to the lack of standards regarding how to best measure quality of care, we used a range of different quantitative and qualitative methods to investigate the appropriateness of the quality assessment tool. The quantitative methods included descriptive statistics, linear regression models, and factor analysis; the qualitative methods in-depth interviews and observations. RESULTS Quantitative and qualitative results were overlapping and consistent. Robustness checks confirmed the tool's ability to assign scores to health facilities and revealed the usefulness of grouping indicators into different quality dimensions. Focusing the quality assessment on processes and structural adequacy of healthcare was an appropriate approach for the assessment's intended purpose, and a unique key feature of the electronic assessment tool. The findings underpinned the accuracy of the assessment tool to measure and monitor quality of primary healthcare for the purpose of routinely steering improvement measures at local level. This was true for different level and owner categories of primary healthcare facilities in Tanzania. CONCLUSION The electronic assessment tool demonstrated a feasible option for routine quality measures of primary healthcare in Tanzania. The findings, combined with the more operational results of companion papers, created a solid foundation for an approach that could lastingly improve services for patients attending primary healthcare. However, the results also revealed that the use of the electronic assessment tool outside its intended purpose, for example for performance-based payment schemes, accreditation and other systematic evaluations of healthcare quality, should be considered carefully because of the risk of bias, adverse effects and corruption.
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Affiliation(s)
- Sabine Renggli
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Iddy Mayumana
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Dominick Mboya
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Christopher Charles
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Christopher Mshana
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Flora Kessy
- Ifakara Health Institute, Dar es Salaam/Ifakara, United Republic of Tanzania
| | - Tracy R. Glass
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Constanze Pfeiffer
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
| | | | - Ann Aerts
- Novartis Foundation, Basel, Switzerland
| | - Christian Lengeler
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, P.O. Box, 4002 Basel, Switzerland
- University of Basel, Basel, Switzerland
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Wojahn RD, Bogunovic L, Brophy RH, Wright RW, Matava MJ, Green JR, Zalomek CA, Haas AK, Holloway WL, Garofoli EA, Smith MV. Opioid Consumption After Knee Arthroscopy. J Bone Joint Surg Am 2018; 100:1629-1636. [PMID: 30277992 DOI: 10.2106/jbjs.18.00049] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The opioid epidemic in the United States has placed increased pressure on physicians to engage in responsible opioid prescribing practices. However, surgeons currently have little information to guide their postoperative prescription decision-making. The purpose of this study was to assess opioid consumption after knee arthroscopy and identify preoperative factors that may predict higher opioid usage. METHODS A prospective observational study of 221 patients was conducted in patients undergoing outpatient knee arthroscopy for meniscal repair, partial meniscectomy, debridement, chondroplasty, or loose body removal. Participants recorded their daily opioid consumption in a postoperative pain diary. Total opioid consumption was calculated from counts of remaining pills at the 2-week and 6-week postoperative office visits. Variables, including age, sex, body mass index, smoking status, alcohol consumption, preoperative pain severity and duration, preoperative opioid usage, Patient-Reported Outcomes Measurement Information System (PROMIS) scores, and the Connor-Davidson Resilience Scale, were evaluated for an association with opioid consumption. RESULTS Total opioid consumption ranged from 0 to 188 pills, with a median of 7 pills (hydrocodone 5-mg equivalents). Forty-six percent of patients took ≤5 pills, 59% took ≤10 pills, and 81% took ≤20 pills. Fifty-six percent of patients had discontinued opioid usage by the third postoperative day. Eighty-eight percent of patients had surplus opioid medication at the time of the final follow-up. Patients undergoing meniscal repair, smokers, and those taking preoperative opioids were significantly more likely to take ≥20 pills (p < 0.05). CONCLUSIONS The median number of pills taken after knee arthroscopy is 7, with the majority of patients consuming ≤20 pills. Meniscal repair, smoking, and preoperative opioid usage were associated with higher postoperative opioid consumption. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Robert D Wojahn
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Ljiljana Bogunovic
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Robert H Brophy
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Rick W Wright
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Matthew J Matava
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - John R Green
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Corinne A Zalomek
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Amanda K Haas
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Wendy L Holloway
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Elizabeth A Garofoli
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Matthew V Smith
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
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Abstract
As newer pharmacologic and procedural interventions, technology, and data on outcomes in pain management are becoming available, effective acute pain management will require a dedicated Acute Pain Service (APS) to help determine the most optimal pain management plan for the patients. Goals for pain management must take into consideration the side effect profile of drugs and potential complications of procedural interventions. Multiple objective optimization is the combination of multiple different objectives for acute pain management. Simple use of opioids, for example, can reduce all pain to minimal levels, but at what cost to the patient, the medical system, and to public health as a whole? Many models for APS exist based on personnel's skills, knowledge and experience, but effective use of an APS will also require allocation of time, space, financial, and personnel resources with clear objectives and a feedback mechanism to guide changes to acute pain medicine practices to meet the constantly evolving medical field. Physician-based practices have the advantage of developing protocols for the management of low-variability, high-occurrence scenarios in addition to tailoring care to individual patients with high-variability, low-occurrence scenarios. Frequent feedback and data collection/assessment on patient outcomes is essential in evaluating the efficacy of the Acute Pain Service's intervention in improving patient outcomes in the acute and perioperative setting.
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Lobo Prabhu K, Cleghorn MC, Elnahas A, Tse A, Maeda A, Quereshy FA, Okrainec A, Jackson TD. Is quality important to our patients? The relationship between surgical outcomes and patient satisfaction. BMJ Qual Saf 2017; 27:48-52. [DOI: 10.1136/bmjqs-2017-007071] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/11/2017] [Accepted: 10/22/2017] [Indexed: 11/04/2022]
Abstract
BackgroundWith greater transparency in health system reporting and increased reliance on patient-centred outcomes, patient satisfaction has become a priority in delivering quality care. We sought to explore the relationship between patient satisfaction and short-term outcomes in patients undergoing general surgical procedures.MethodsSatisfaction surveys were distributed to patients following discharge from the general surgery service at an academic hospital between June 2012 and March 2015. Short-term clinical outcomes were obtained from the American College of Surgeons National Surgical Quality Improvement Program database. Patients rated their level of satisfaction on a 5-point Likert scale, and ordered logistic regression model was used to determine predictors of high patient satisfaction.Results757 patient satisfaction surveys were completed. The mean age of patients surveyed was 52.2 years; 60.0% of patients were female. The majority of patients underwent a laparoscopic procedure (85.9%) and were admitted as inpatients following surgery (72%). 91.5% of patients rated satisfaction of 4–5, and 95.0% said they would recommend the service. The odds of overall satisfaction were lower in patients who had complications (OR: 0.52, 95% CI 0.31 to 0.87) and 30-day readmission (OR: 0.35, 95% CI 0.17 to 0.70). Having elective surgery was associated with higher odds of satisfaction (OR: 1.62, 95% CI 1.07 to 2.47).ConclusionsWe found a significant association between patient satisfaction and both 30-day readmission and the occurrence of postoperative surgical complications. Given this association, further study is warranted to evaluate patient satisfaction as a healthcare quality indicator.
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Ricciardi BF, Waddell BS, Nodzo SR, Lange J, Nocon AA, Amundsen S, Tarity TD, McLawhorn AS. Provider-Initiated Patient Satisfaction Reporting Yields Improved Physician Ratings Relative to Online Rating Websites. Orthopedics 2017; 40:304-310. [PMID: 28817163 DOI: 10.3928/01477447-20170810-03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/10/2017] [Indexed: 02/03/2023]
Abstract
Recently, providers have begun to publicly report the results of patient satisfaction surveys from their practices. However, these outcomes have never been compared with the findings of commercial online physician rating websites. The goals of the current study were to (1) compare overall patient satisfaction ratings for orthopedic surgeons derived from provider-based third-party surveys with existing commercial physician rating websites and (2) determine the association between patient ratings and provider characteristics. The authors identified 12 institutions that provided publicly available patient satisfaction outcomes derived from third-party surveys for their orthopedic surgeons as of August 2016. Orthopedic surgeons at these institutions were eligible for inclusion (N=340 surgeons). Provider characteristics were recorded from publicly available data. Four high-traffic commercial online physician rating websites were identified: Healthgrades.com, UCompareHealthCare.com, Vitals.com, and RateMDs.com. For each surgeon, overall ratings (on a scale of 1-5), total number of ratings, and percentage of negative ratings were compared between provider-initiated internal ratings and each commercial online website. Associations between baseline factors and overall physician ratings and negative ratings were assessed. Provider-initiated internal patient satisfaction ratings showed a greater number of overall patient ratings, higher overall patient satisfaction ratings, and a lower percentage of negative comments compared with commercial online physician rating websites. A greater number of years in practice had a weak association with lower internal ratings, and an academic practice setting and a location in the Northeast were protective factors for negative physician ratings. Compared with commercial online physician rating websites, provider-initiated patient satisfaction ratings of orthopedic surgeons appear to be more favorable, with greater numbers of responses. [Orthopedics. 2017; 40(5):304-310.].
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Michard F, Gan T, Kehlet H. Digital innovations and emerging technologies for enhanced recovery programmes. Br J Anaesth 2017; 119:31-39. [DOI: 10.1093/bja/aex140] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Affiliation(s)
- Jennifer F Waljee
- Department of Surgery, Center for Health Outcomes and Policy, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Justin B Dimick
- Department of Surgery, Center for Health Outcomes and Policy, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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