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Raff JP, Sege J, Braiotta R, Jafri FN, Cook B, Steiner-Grossman P, Cohen F. The Impact of a Narrative Medicine Life Story Pilot Program on Press Ganey™ Scores in an Outpatient Cancer Center. HEALTH COMMUNICATION 2024; 39:2079-2089. [PMID: 37691170 DOI: 10.1080/10410236.2023.2255761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Oncology patients face challenges beyond those directly affecting their cancer management. Guided personal narrative programs have been shown to help patients with chronic conditions and life-framing events. Few such narrative programs have been reported for cancer patients or analyzed for their impact on patient experience. We established our Life Story Narrative Program, modeled on the United States Veterans Affairs' "My Life, My Story" for outpatient oncology patients in our hospital's cancer center. Press Ganey™ patient experience scores from program participants were compared retrospectively with scores from patients who were not participants. Over an eight-month period, we invited 30 cancer center outpatients to participate. Twenty-seven individuals accepted, and 18 had their stories edited, approved, and scanned into their electronic health record. Cohort matching yielded a control arm consisting of 255 responses from 48 surveys, while the intervention arm consisted of 68 responses from 12 surveys. 78.4% of responses from the control arm were rated 5 compared with 100% in the intervention arm. The mean Press Ganey™ score response in the control arm was 4.71 compared with 5.00 from the intervention arm. Wilcoxon U value was 10,540 with p < .001. An outpatient narrative medicine program for cancer patients to tell their life stories can easily be organized. Patients were willing to participate, enrollment was brisk, and the use of resources was limited. Although our sample size was small, participation in our Life Story Narrative Pilot Program resulted in a statistically significant improvement in Press Ganey™ scores.
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Affiliation(s)
- Joshua P Raff
- Section of Medical Oncology and Hematology, White Plains Hospital
| | | | | | | | - Brennan Cook
- Robert Wood Johnson School of Medicine, Rutgers University
| | - Penny Steiner-Grossman
- Departments of Family & Social Medicine and Pediatrics, Albert Einstein College of Medicine
| | - Fredda Cohen
- Department of Pastoral Care and Education, White Plains Hospital
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Burt CI, McCurdy M, Schneider MB, Zhang T, Weir TB, Langhammer CG, Pensy RA, Akabudike NM, Henn RF. Preoperative opioid use is associated with worse two-year patient-reported outcomes after hand surgery: A retrospective cohort study. J Hand Microsurg 2024; 16:100060. [PMID: 39035863 PMCID: PMC11257131 DOI: 10.1016/j.jham.2024.100060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Introduction Opioid overprescribing has caused a substantial increase in opioid related deaths and billions of dollars in additional healthcare costs. Orthopaedic surgeons commonly prescribe opioids in the perioperative period; however, research has shown preoperative opioid use may be associated with worse postoperative outcomes. Despite this body of evidence, there are few studies investigating the association between preoperative opioid use and two-year outcomes after hand surgery. Materials and methods This study evaluated two-year postoperative patient-reported outcomes in patients who used opioids prior to hand surgery, and those who did not. Patients completed pre and postoperative questionnaires including Patient-Reported Outcomes Measurement Information System (PROMIS) domains, the Brief Michigan Hand Questionnaire (BMHQ), and other questionnaires related to pain, function, and satisfaction. 342 patients undergoing upper-extremity surgery were enrolled into a prospective orthopaedic surgery outcome registry, and 69.9% completed the follow-up surveys. Preoperative opioid use and its association to patient outcome scores was analyzed through bivariate analysis. Significant associations were further tested by multivariable analysis to determine independent predictors. Results Preoperative opioid use was associated with worse two-year PROMIS Fatigue (p < .01), PROMIS Anxiety (p < .01), PROMIS Depression (p < .01), SSQ-8 (p = .01), BMHQ (p = .01), NPS Hand (p < .01) and MODEMS met expectations (p = .03). No significant differences were observed in patient-reported outcome change scores. Multivariable analysis demonstrated that preoperative opioid use was predictive of worse two-year PROMIS Fatigue (p < .01), PROMIS Anxiety (p < .01), PROMIS Depression (p = .02), BMHQ (p = .01), SSQ-8 (p < .01), NPS Hand (p = .02) and MODEMS met expectations (p < .01). Conclusion Preoperative opioid use was associated with worse patient-reported outcomes two years after elective hand surgery. There was no significant difference in the improvement from baseline between the two groups. Clinically significant differences were observed in follow-up PROMIS Anxiety, BMHQ and NPS - Hand scores. Clinically significant change scores were noted in both groups for PROMIS PF, PROMIS PI, PROMIS SS, BMHQ, and NPS - Hand.
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Affiliation(s)
- Cameran I. Burt
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Michael McCurdy
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Matheus B. Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tristan B. Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Raymond A. Pensy
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ngozi M. Akabudike
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
| | - R Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD, USA
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Weiss-Laxer NS, Pavlesen S, Arevalo A, Jeffords J, Haider MN, Bisson LJ. Predictors of Postoperative Patient-Reported Outcome Measure Response Rates Among Patients With Rotator Cuff Repair. Am J Sports Med 2024; 52:215-223. [PMID: 38164664 DOI: 10.1177/03635465231209441] [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] [Indexed: 01/03/2024]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) contribute to evaluating and improving the quality of patient care. Patient outcomes after rotator cuff repair (RCR) have been researched; however, the relationship between PROM response rates and individual and health care correlates has not been thoroughly investigated. PURPOSE To examine differences in individual and health care factors among patients who had undergone RCR based on their PROM response rates. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Shoulder-specific and general PROMs were solicited via email and text message of all patients who underwent RCR between 2016 and 2020. Three subgroups were classified: (1) complete responders completed all 1-year postoperative PROMs, (2) partial responders answered enough questions to produce ≥1 usable score, and (3) nonresponders did not respond to a single measure. Correlates were assessed using analysis of variance and chi-square tests. Adjusted multinomial logistic regression models identified predictors of 1-year PROM response. RESULTS Of 2195 patients included at the 1-year follow-up, 34% were complete responders; 11%, partial responders; and 55%, nonresponders. Patients had a mean age of 61.8 years, 63% were men, and 90% were White. Pre- and postoperative PROM scores were similar across responder groups. In stepwise selection, 1-year responses (complete or partial) were associated with older age, later year of surgery, White race, and having workers' compensation insurance. The strongest predictor of PROM response was having workers' compensation insurance. CONCLUSION Patients with workers' compensation insurance compared with other insurance types responded to PROMs at disproportionately higher rates. This could distort postoperative PROM scores in the population studied because there are known differences among patients with this insurance status.
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Affiliation(s)
- Nomi S Weiss-Laxer
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Sonja Pavlesen
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Alfonso Arevalo
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Joycelyn Jeffords
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Mohammad N Haider
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
| | - Leslie J Bisson
- Department of Orthopaedics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA
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Wang AS, Wiginton JG, Tran T, Yanez P, King C, Miulli DE. Patient Satisfaction in Neurosurgery Clinic. Cureus 2024; 16:e53176. [PMID: 38435893 PMCID: PMC10907051 DOI: 10.7759/cureus.53176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 01/29/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND National commercial surveys are used to assess patient satisfaction. However, the information obtained does not always correspond to the clinical situation and therefore may be inadequate to help improve a specific patient experience when through no fault of its design, results in low response rates and inadequate specifics. OBJECTIVE The objective is to investigate patient satisfaction using real-time in-person patient experience survey responses at the end of a neurosurgical clinic visit and review the results from these survey responses and those from national commercial survey responses provided by the hospital for the ability to affect change. METHODS This is a prospective study from October 2023 to December 2023 during which a paper copy of 10 questionnaires derived from a national commercial outpatient clinical survey was given to every unique patient who was neurologically capable of filling it out at the end of his or her neurosurgery clinic visit. The electronic medical record was used to collect patient demographics and details of the clinic visit. National commercial survey responses from July 2022 to November 2023 provided by the hospital were reviewed. RESULTS A total of 149 patients were seen in the neurosurgery clinic from October 2023 to December 2023, 121 patients were given the in-person patient satisfaction survey, and the response rate was 100%. The mean age was 46.5 years with females constituted 45.5% of the patient sample. The visit type included 46 (38.0%) new patients, 53 (43.8%) returning patients, and 22 (18.2%) post-op patients, of which 45.5% presented with cranial pathologies. Comparing the patient satisfaction level between those seen by one provider and those seen by two providers, such as resident, or mid-level with attending, patients seen by two providers were less satisfied with "feeling respected by the providers" (4.92 vs. 4.64, p=0.0088), "feeling listened to by the providers" (4.84 vs. 4.50, p=0.0180), and "feeling appreciated that the providers discussed illness prevention" (4.72 vs. 4.29, p=0.0232). Due to a lack of necessary information from our national commercial outpatient clinic survey responses provided by the hospital, a direct comparison between the in-person survey and our national commercial outpatient clinic survey was not made. CONCLUSIONS Patient satisfaction surveys when not given in real-time in-person run the risk of low response rate and lack of specifics to help guide providers in quality improvement. Our data supports the use of real-time in-person patient satisfaction surveys that not only increase response rate but also provide useful information to help improve patient experience.
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Affiliation(s)
- Alice S Wang
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| | - James G Wiginton
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Theo Tran
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - Paulino Yanez
- Neurosurgery, Kaiser Fontana Medical Center, Fontana, USA
| | - Christopher King
- Neurosurgery, Riverside University Health System Medical Center, Colton, USA
| | - Dan E Miulli
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
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Levens B, Kim BS, Aksu N, Dorris CS, Svoboda S, Douoguih W, Dreese J. Young or Old Age and Non-White Race Are Associated With Poor Patient-Reported Outcome Measure Response Compliance After Orthopaedic Surgery. Arthrosc Sports Med Rehabil 2023; 5:100817. [PMID: 38023444 PMCID: PMC10661514 DOI: 10.1016/j.asmr.2023.100817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 09/28/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose To investigate orthopaedic patient compliance with patient-reported outcome measures (PROMs) and identify factors that improve response rates. Methods Our search strategy comprised a combination of key words and database-specific subject headings for the concepts of orthopaedic surgical procedures, compliance, and PROMs from several research databases from inception to October 11, 2022. Duplicates were removed. A total of 97 studies were included. A table was created for the remaining articles to be appraised and analyzed. The collected data included study characteristics, follow-up/compliance rate, factors that increase/decrease compliance, and type of PROM. Follow-up/compliance rate was determined to be any reported response rate. The range and average used for analysis was based on the highest or lowest number reported in the specific article. Results The range of compliance reported was 11.3% to 100%. The overall response rate was 68.6%. The average baseline (preoperative/previsit) response rate was 76.6%. Most studies (77%) had greater than 50% compliance. Intervention/reminder of any type (most commonly phone call or mail) resulted in improved compliance from 44.6% to 70.6%. Young and elderly non-White male patients had the lowest compliance rate. When directly compared, phone call (71.5%) resulted in a greater compliance rate than electronic-based (53.2%) or paper-based (57.6%) surveys. Conclusions The response rates for PROMs vary across the orthopaedic literature. Patient-specific factors, such as age (young or old) and race (non-White), may contribute to poor PROM response rate. Reminders and interventions significantly improve PROM response rates. Clinical Relevance PROMs are important tools in many aspects of medicine. The data generated from these tools not only provide information about individual patient outcomes but also make hypothesis-driven comparisons possible. Understanding the factors that affect patient compliance with PROMs is vital to our accurate understanding of patient outcomes and the overall advancement of medical care.
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Affiliation(s)
| | | | | | | | - Steven Svoboda
- Medstar Health at Lafayette Centre, Washington, DC, U.S.A
| | - Wiemi Douoguih
- Medstar Health at Lafayette Centre, Washington, DC, U.S.A
| | - James Dreese
- Medstar Union Memorial Hospital, Baltimore, Maryland, U.S.A
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Rogo-Gupta LJ, Altamirano J, Homewood LN, Donnellan NM, Miles S, Stuparich M, Salinaro J, Lum D, Fassiotto M. Women physicians receive lower Press Ganey patient satisfaction scores in a multicenter study of outpatient gynecology care. Am J Obstet Gynecol 2023; 229:304.e1-304.e9. [PMID: 37330126 DOI: 10.1016/j.ajog.2023.06.023] [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: 01/02/2023] [Revised: 05/17/2023] [Accepted: 06/09/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Emerging data suggest that patient satisfaction data are subject to inherent biases that negatively affect women physicians. OBJECTIVE This study aimed to describe the association between the Press Ganey patient satisfaction survey and physician gender in a multi-institutional study of outpatient gynecologic care. STUDY DESIGN This was a multisite, observational, population-based survey study using the results of Press Ganey patient satisfaction surveys from 5 unrelated community-based and academic medical institutions with outpatient gynecology visits between January 2020 and April 2022. The primary outcome variable was the likelihood to recommend a physician, and individual survey responses served as the unit of analysis. Patient demographic data were collected through the survey, including self-reported age, gender, and race and ethnicity (categorized as White, Asian, or Underrepresented in Medicine, which groups together Black, Hispanic or LatinX, American Indian or Alaskan Native, and Hawaiian or Pacific Islander). Bivariate comparisons between demographics (physician gender, patient and physician age quartile, patient and physician race) and likelihood to recommend were assessed using generalized estimating equation models clustered by physician. Odds ratios, 95% confidence intervals, and P values for these analyses are reported, and results were considered statistically significant at P<.05. Analysis was performed using SAS, version 9.4 (SAS Institute Inc., Cary, NC). RESULTS Data were obtained from 15,184 surveys for 130 physicians. Most physicians were women (n=95 [73%]) and White (n=98 [75%]), and patients were also predominantly White (n=10,495 [69%]). A little over half of all visits were race-concordant, meaning that both patient and physician reported the same race (57%). Women physicians were less likely to receive a topbox survey score (74% vs 77%) and in the multivariate model had 19% lower odds of receiving a topbox score (95% confidence interval, 0.69-0.95). Patient age had a statistically significant relationship with score, with patients aged ≥63 years having >3-fold increase in odds of providing a topbox score (odds ratio, 3.10; 95% confidence interval, 2.12-4.52) compared with the youngest patients. After adjustment, patient and physician race and ethnicity showed similar effects on the odds of a topbox likelihood-to-recommend score, with Asian physicians and Asian patients having lower odds of a topbox likelihood-to-recommend score when compared with White physicians and patients (odds ratio: 0.89 [95% confidence interval, 0.81-0.98] and 0.62 [95% confidence interval, 0.48-0.79], respectively). Underrepresented in medicine physicians and patients showed significantly increased odds of a topbox likelihood-to-recommend score (odds ratio: 1.27 [95% confidence interval, 1.21-1.33] and 1.03 [95% confidence interval, 1.01-1.06], respectively). The physician age quartile was not significantly associated with odds of a topbox likelihood-to-recommend score. CONCLUSION Women gynecologists were 18% less likely to receive top patient satisfaction scores compared with men in this multisite, population-based survey study using the results of Press Ganey patient satisfaction surveys. The results of these questionnaires should be adjusted for bias given that they provide data currently being used to understand patient-centered care.
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Affiliation(s)
- Lisa J Rogo-Gupta
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA.
| | - Jonathan Altamirano
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
| | - Laura N Homewood
- Department of Obstetrics and Gynecology, University of Virginia, Charlottesville, VA
| | - Nicole M Donnellan
- Department of Obstetrics and Gynecology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - Shana Miles
- Department of Obstetrics and Gynecology, UPMC Magee-Womens Hospital, Pittsburgh, PA
| | - Mallory Stuparich
- Department of Obstetrics and Gynecology, University of California, Riverside, Riverside, CA
| | - Julia Salinaro
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC
| | - Deirdre Lum
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Magali Fassiotto
- Office of Faculty Development and Diversity, Stanford University School of Medicine, Stanford, CA
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Levitt EB, Paul KD, Vatsia SK, Scannell B, Patt JC, Templeton K, McGwin G, Ponce BA. Benefits of an Orthopedic Education Research Collaborative: An Innovative Approach. Cureus 2023; 15:e34903. [PMID: 36938282 PMCID: PMC10016735 DOI: 10.7759/cureus.34903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2023] [Indexed: 02/16/2023] Open
Abstract
Background Graduate Medical Education (GME) research in orthopedic surgery is an important but underrepresented subject in the medical literature. It was unknown if orthopedic residency leaders were interested in a surgical education research collaborative (orthopedic collaborative). The objectives of this study were to assess the potential benefit of an orthopedic collaborative from orthopedic residency leaders and investigate the factors associated with the support of a research collaborative within a surgical subspecialty. Methodology An anonymous 19-question survey-based study was distributed through REDCap (Nashville, TN, USA) to orthopedic residency leaders in the United States, from July to October 2020. The main outcome was perceived benefit. Additional aspects included program characteristics, challenges in performing resident education research, and organizational issues such as authorship, frequency of study requests, and governance. Results Almost all orthopedic faculty leadership (99%, 73/74) stated that resident education and faculty development research projects would benefit from an orthopedic education research collaborative. In comparison to unsupportive respondents, younger age (P = 0.006), 15 or fewer years in practice (P = 0.04), and having 0 to 100 peer-reviewed publications (P = 0.047) were associated with support for an orthopedic collaborative. Conclusions Challenges related to survey-based study quality and generalizability at single institutions can benefit from multi-institutional collaboration to develop high-quality studies that capture a representative sample to support orthopedic surgery program development.
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Affiliation(s)
- Eli B Levitt
- Orthopedic Surgery, Herbert Wertheim College of Medicine, Florida International University, Miami, USA
- Internal Medicine, Palmetto General Hospital, Hialeah, USA
| | - Kyle D Paul
- Orthopedic Surgery, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, USA
- Orthopedic Surgery, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health Science Center, San Antonio, USA
| | | | | | | | - Kim Templeton
- Orthopedic Surgery, University of Kansas School of Medicine, Kansas City, USA
| | - Gerald McGwin
- Epidemiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, USA
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Potter J, Watson D, Gardner A, O'Neill J, Watkins C, Husain I. Virtual First Uses Virtual Emergency Medicine Clinicians as a Health System Entry Point: A Cross-Sectional Survey Study (Preprint). J Med Internet Res 2022. [PMID: 37276547 PMCID: PMC10402882 DOI: 10.2196/42840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic accelerated the use and acceptance of telemedicine. Simultaneously, emergency departments (EDs) have experienced increased ED boarding. With this acceptance of telemedicine and the weighty increase in patient boarding, we proposed the innovative Virtual First (VF) program to leverage emergency medicine clinicians' (EMCs) ability to triage patients. VF seeks to reduce unnecessary ED visits by connecting patients with EMCs prior to seeking in-person care rather than using traditional ED referral systems. OBJECTIVE The goal of this study is to investigate how patients' access to EMCs from home via the establishment of VF changed how patients sought care for acute care needs. METHODS VF is a synchronous virtual video visit at a tertiary care academic hospital. VF was staffed by EMCs and enabled full management of patient complaints or, if necessary, referral to the appropriate level of care. Patients self-selected this service as an alternative to seeking in-person care at a primary care provider, urgent care center, or ED. A postvisit convenience sample survey was collected through a phone SMS text message or email to VF users. This is a cross-sectional survey study. The primary outcome measure is based on responses to the question "How would you have sought care if a VF visit was not available to you?" Secondary outcome measures describe valued aspects and criticisms. Results were analyzed using descriptive statistics. RESULTS There were 3097 patients seen via VF from July 2021 through May 2022. A total of 176 (5.7%) patients completed the survey. Of these, 87 (49.4%) would have sought care at urgent care centers if VF had not been available. There were 28 (15.9%) patients, 26 (14.8%) patients, and 1 (0.6%) patient that would have sought care at primary care providers, EDs, or other locations, respectively. Interestingly, 34 (19.3%) patients would not have sought care. The most valued aspect of VF was receiving care in the comfort of the home (n=137, 77.8%). For suggested improvements, 58 (33%) patients most commonly included "Nothing" as free text. CONCLUSIONS VF has the potential to restructure how patients seek medical care by connecting EMCs with patients prior to ED arrival. Without the option of VF, 64.2% (113/177) of patients would have sought care at an acute care facility. VF's innovative employment of EMCs allows for acute care needs to be treated virtually if feasible. If not, EMCs understand the local resources to better direct patients to the appropriate site. This has the potential to substantially decrease patient costs because patients are given the appropriate destination for in-person care, reducing the likelihood of the need for transfer and multiple ED visits.
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9
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Zhang T, Schneider MB, Weir TB, Shaw NM, Foster MJ, Meredith SJ, Leong NL, Packer JD, Henn Iii RF. Response Bias for Press Ganey Ambulatory Surgery Surveys after Knee Surgery. J Knee Surg 2022. [PMID: 35817060 DOI: 10.1055/s-0042-1748896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The Press Ganey Ambulatory Surgery (PGAS) survey is an emerging tool used to capture patient satisfaction after elective surgery. Evaluating patient satisfaction is important; however, quality improvement (QI) surveys used to capture the patient experience may be subject to nonresponse bias. An orthopaedic registry was used to retrospectively identify patients who underwent ambulatory knee surgery from June 2015 to December 2019. Multivariable logistic regression was performed to identify independent predictors of PGAS survey nonresponse and response. In the cohort of 1,161 patients, 142 (12.2%) completed the PGAS survey. Multiple logistic regression demonstrated that male sex, Black race, not living with a caretaker, student or unemployment status, and worse preoperative Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue were predictors of nonresponse. The results of this study highlight the presence of nonresponse bias in the PGAS survey after elective knee surgery.
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Affiliation(s)
- Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Matheus B Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Tristan B Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Nichole M Shaw
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Michael J Foster
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Sean J Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Natalie L Leong
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - Jonathan D Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
| | - R Frank Henn Iii
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland
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10
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Kung JE, Zhang T, Weir TB, Schneider MB, Aneizi A, Leong NL, Packer JD, Meredith SJ, Henn RF. Correlation of Press Ganey Scores With Early Patient Satisfaction After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2022; 10:23259671221083704. [PMID: 35386839 PMCID: PMC8977719 DOI: 10.1177/23259671221083704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Patient satisfaction metrics are commonly used to assess the quality of
health care and affect reimbursement. The Press Ganey Ambulatory Surgery
(PGAS) is a satisfaction survey that has emerged as a prominent quality
assessment tool; however, no data exist on whether PGAS scores correlate
with early postsurgical satisfaction during the PGAS survey administration
period in patients who underwent anterior cruciate ligament reconstruction
(ACLR). Purpose: To determine if PGAS scores correlate with measures of satisfaction and
patient-reported outcomes (PROs) at 2 weeks postoperatively in ACLR
patients. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A retrospective review of patients who underwent ACLR at a single institution
was performed. Patients who completed the PGAS survey and PROs at 2 weeks
postoperatively were included in the study. Surgical satisfaction was
measured with the Surgical Satisfaction Questionnaire (SSQ-8), and PROs
included 6 Patient-Reported Outcomes Measurement Information System domains.
Bivariate analysis between PGAS and PRO scores was conducted using the
Spearman rank correlation coefficient (rS). Results: Of the 716 patients who received the PGAS survey after ACLR, 81 patients
completed the survey, and 39 patients also completed PROs and were included
in the study. Total converted (mean scaled score) and “top box” (percentages
of questions with highest rating selected) PGAS scores showed no significant
correlations with the SSQ-8 (rS =–0.24; P = .14). There were no significant
correlations between SSQ-8 and PGAS domain scores except for a negative
correlation with Facility domain top box scores (rS =–0.33; P = .04), meaning that patients with
higher surgical satisfaction had lower PGAS Facility scores. Total PGAS
(converted and top box scores) and PGAS domain scores showed no significant
correlation with any of the other PROs. Conclusion: PGAS scores showed no significant positive correlation with surgical
satisfaction, function, pain, mental health, activity, or expectations of
surgery in patients 2 weeks after ACLR. This suggests little to no
relationship between PGAS score and surgical satisfaction in the early
recovery period after ACLR.
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Affiliation(s)
- Justin E. Kung
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tina Zhang
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Tristan B. Weir
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Matheus B. Schneider
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Ali Aneizi
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Natalie L. Leong
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jonathan D. Packer
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sean J. Meredith
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - R. Frank Henn
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, USA
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