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Nihalani S, Bloodworth A, Frith K, Ashley P, Williams KA, Conklin MJ. Utility of Follow-up Radiographs in Type 1 Supracondylar Humerus Fractures. J Pediatr Orthop 2024; 44:e530-e535. [PMID: 38512220 DOI: 10.1097/bpo.0000000000002679] [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: 03/22/2024]
Abstract
OBJECTIVE Supracondylar humerus (SCH) fractures are common among pediatric patients, with the severity categorized using the Gartland classification system. Type 1 SCH fractures are nondisplaced and treated with immobilization, while more displaced fractures require surgery. The need for follow-up radiographs, particularly for type 1 fractures, is an area where evidence is lacking. This study investigates the clinical value and financial implications of follow-up radiographs for type 1 SCH fractures, hypothesizing that they do not alter clinical management and, therefore, represent an unnecessary expense. METHODS This retrospective cohort study, approved by the Institutional Review Board, focused on patients under 18 with nondisplaced SCH fractures treated nonoperatively. One hundred one type 1 SCH fractures, in which the fracture was visible on presenting radiographs, were chosen from patients presenting between January 2021 and December 2022. Charts were reviewed for demographic information, time of cast removal, and complications. A pediatric orthopaedic surgeon and orthopaedic resident reviewed the radiographs to confirm the injury to be a type 1 SCH fracture. RESULTS Among the 101 patients, after the initial presentation, 79 attended an interim visit and 101 attended a "3-week follow-up" at an average of 23 days postinjury. All patients underwent radiographs during these visits for a total of 180 radiographs after confirmation of type 1 SCH fracture. No changes in management resulted from follow-up radiographs. One instance of refracture was noted ~3 months after cast removal. There were 180 superfluous follow-up radiographs taken at subsequent clinic visits. The total charge for these radiographs was $76,001.40, averaging $752.49 per patient. CONCLUSION Follow-up radiographs for type 1 SCH fractures did not lead to changes in clinical management, aligning with previous findings in more severe SCH fractures. This approach can reduce costs, radiation exposure, and clinic time without compromising patient care. The study can reassure providers and parents about the lack of necessity for follow-up radiographs to document healing. LEVEL OF EVIDENCE Level-IV.
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Affiliation(s)
- Shrey Nihalani
- Department of Orthopaedic Surgery, Children's Hospital of Alabama, University of Alabama at Birmingham, Birmingham, AL
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2
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Tang JE, Arvind V, Dominy C, White CA, Cho SK, Kim JS. How Are Patients Reviewing Spine Surgeons Online? A Sentiment Analysis of Physician Review Website Written Comments. Global Spine J 2023; 13:2107-2114. [PMID: 35085039 PMCID: PMC10538314 DOI: 10.1177/21925682211069933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN A Sentiment Analysis of online reviews of spine surgeons. OBJECTIVES Physician review websites have significant impact on a patient's provider selection. Written reviews are subjective, but sentiment analysis through machine learning can quantitatively analyze these reviews. This study analyzes online written reviews of spine surgeons and reports biases associated with demographic factors and trends in words utilized. METHODS Online written and star-reviews of spine surgeons were obtained from healthgrades.com. A sentiment analysis package was used to analyze the written reviews. The relationship of demographic variables to these scores was analyzed with t-tests and word and bigram frequency analyses were performed. Additionally, a multiple regression analysis was performed on key terms. RESULTS 8357 reviews of 480 surgeons were analyzed. There was a significant difference between the means of sentiment analysis scores and star scores for both gender and age. Younger, male surgeons were rated more highly on average (P < .01). Word frequency analysis indicated that behavioral factors and pain were the main contributing factors to both the best and worst reviewed surgeons. Additionally, several clinically relevant words, when included in a review, affected the odds of a positive review. CONCLUSIONS The best reviews laud surgeons for their ability to manage pain and for exhibiting positive bedside manner. However, the worst reviews primarily focus on pain and its management, as exhibited by the frequency and multivariate analysis. Pain is a clear contributing factor to reviews, thus emphasizing the importance of establishing proper pain expectations prior to any intervention.
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Affiliation(s)
- Justin E. Tang
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Varun Arvind
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Calista Dominy
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Christopher A. White
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun S. Kim
- Department of Orthopedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Liao EN, Chehab LZ, Neville K, Liao J, Patel D, Sammann A. Using a human-centered, mixed methods approach to understand the patient waiting experience and its impact on medically underserved Populations. BMC Health Serv Res 2022; 22:1388. [PMID: 36419056 PMCID: PMC9682738 DOI: 10.1186/s12913-022-08792-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 11/04/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To use a mixed methods approach to investigate the patient waiting experience for a medically underserved population at an outpatient surgical clinic. METHODS We used lean methodology to perform 96 time-tracked observations of the patient journey in clinic, documenting the duration of activities from arrival to departure. We also used human-centered design (HCD) to perform and analyze 43 semi-structured interviews to understand patients' unmet needs. RESULTS Patients spent an average of 68.5% of their total clinic visit waiting to be seen. While the average visit was 95.8 minutes, over a quarter of visits (27%) were over 2 hours. Patients waited an average of 24.4 minutes in the waiting room and 41.2 minutes in the exam room; and only spent 19.7% of their visit with an attending provider and 11.8% with a medical assistant. Interviews revealed that patients arrive to their visit already frustrated due to difficulties related to scheduling and attending their appointment. This is exacerbated during the visit due to long wait times, perceived information opacity, and an uncomfortable waiting room, resulting in frustration and anxiety. CONCLUSIONS While time tracking demonstrated that patients spend a majority of their visit waiting to be seen, HCD revealed that patient frustrations span the waiting experience from accessing the appointment to visit completion. These combined findings are crucial for intervention design and implementation for medically underserved populations to improve the quality and experience with healthcare and also address system inefficiencies such as long wait times.
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Affiliation(s)
- Elizabeth N. Liao
- grid.266102.10000 0001 2297 6811Division of General Surgery, Department of General Surgery, University of California, 513 Parnassus Avenue, CA 94115 San Francisco, USA
| | - Lara Z. Chehab
- grid.266102.10000 0001 2297 6811Division of General Surgery, Department of General Surgery, University of California, 513 Parnassus Avenue, CA 94115 San Francisco, USA
| | - Kathryn Neville
- grid.168010.e0000000419368956Department of Engineering Design, Stanford University, Stanford, USA
| | - Jennifer Liao
- grid.412726.40000 0004 0442 8581Department of Emergency Medicine, Thomas Jefferson University Hospitals, Philadelphia, USA
| | - Devika Patel
- grid.266102.10000 0001 2297 6811Division of General Surgery, Department of General Surgery, University of California, 513 Parnassus Avenue, CA 94115 San Francisco, USA
| | - Amanda Sammann
- grid.266102.10000 0001 2297 6811Division of General Surgery, Department of General Surgery, University of California, 513 Parnassus Avenue, CA 94115 San Francisco, USA
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Liao EN, Chehab LZ, Ossmann M, Alpers B, Patel D, Sammann A. Using Architectural Mapping to Understand Behavior and Space Utilization in a Surgical Waiting Room of a Safety Net Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13870. [PMID: 36360748 PMCID: PMC9656663 DOI: 10.3390/ijerph192113870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To use architectural mapping to understand how patients and families utilize the waiting space at an outpatient surgery clinic in a safety-net hospital. BACKGROUND The waiting period is an important component of patient experience and satisfaction. Studies have found that patients value privacy, information transparency and comfort. However, approaches common in the architecture field have rarely been used to investigate interactions between patients and the built environment in a safety-net healthcare setting. METHODS This was a prospective observational study in a general surgery outpatient clinic at a safety-net hospital and level 1 trauma center. We used a web-based application generated from the design and architecture industry, to quantitatively track waiting space utilization over 2 months. RESULTS A total of 728 observations were recorded across 5 variables: time, location, chair selection, person/object, and activity. There were 536 (74%) observations involving people and 179 (25%) involving personal items. People most frequently occupied chairs facing the door (43%, n = 211), and least frequently occupied seats in the hallway (5%, n = 23), regardless of the time of their appointment (p-value = 0.92). Most common activities included interacting with personal phone, gazing into space, and talking face to face. Thirteen percent of people brought mobility devices, and 64% of objects were placed on an adjacent chair, indicating the desire for increased personal space. CONCLUSION Architectural behavioral mapping is an effective information gathering tool to help design waiting space improvement in the safety-net healthcare setting.
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Affiliation(s)
- Elizabeth N. Liao
- Division of General Surgery, Department of General Surgery, University of California (San Francisco), San Francisco, CA 94143, USA
| | - Lara Z. Chehab
- Division of General Surgery, Department of General Surgery, University of California (San Francisco), San Francisco, CA 94143, USA
| | | | - Benjamin Alpers
- Division of General Surgery, Department of General Surgery, University of California (San Francisco), San Francisco, CA 94143, USA
| | - Devika Patel
- Division of General Surgery, Department of General Surgery, University of California (San Francisco), San Francisco, CA 94143, USA
| | - Amanda Sammann
- Division of General Surgery, Department of General Surgery, University of California (San Francisco), San Francisco, CA 94143, USA
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Pashankar DS, Brown T, Votto P, Follo M, Formica RN, Schilsky ML, Mulligan DC, Khokhar B. Sustained Improvement in Patient Experience by Optimizing Patient Flow in Ambulatory Settings. J Patient Exp 2022; 9:23743735221092610. [PMID: 35402702 PMCID: PMC8990690 DOI: 10.1177/23743735221092610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Patient experience has become a priority for healthcare institutions as it
affects clinical quality of care, financial reimbursement, provider, and patient
satisfaction. We report our experience of improving patient experience measured
by Press Ganey surveys in a busy multidisciplinary clinic over 65 months. We
optimized patient flow in the clinic by technology-facilitated communication
among the clinic staff and by a modest space redesign. We noted a significant
improvement in “clinic visit” scores from baseline of 82.1 to 84.6 at year 1,
86.1 at year 2, 88.7 at year 3, and 88.9 at year 4
(P < .001). In comparison with previous short-term studies,
we were able to sustain improvement in patient experience scores over 4 years
due to optimized patient flow and monitoring of clinic operations. A similar
approach can be implemented in other ambulatory settings and is likely to cause
a long-term positive impact on patient experience.
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Affiliation(s)
| | - Troy Brown
- Yale New Haven Transplantation Center, Yale School of Medicine, New Haven, CT, USA
| | - Paul Votto
- Clinical Optimization Service, Yale Medicine, New Haven, CT, USA
| | - Marie Follo
- Ambulatory Operations, Yale Medicine, New Haven, CT, USA
| | - Richard N Formica
- Yale New Haven Transplantation Center, Yale School of Medicine, New Haven, CT, USA
| | - Michael L Schilsky
- Yale New Haven Transplantation Center, Yale School of Medicine, New Haven, CT, USA
| | - David C Mulligan
- Yale New Haven Transplantation Center, Yale School of Medicine, New Haven, CT, USA
| | - Babar Khokhar
- Clinical Optimization Service, Yale Medicine, New Haven, CT, USA
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Rabah NM, Khan HA, Winkelman RD, Levin JM, Mroz TE, Steinmetz MP. Key drivers of patient satisfaction with spine surgeons in the outpatient setting. J Neurosurg Spine 2021; 34:871-878. [PMID: 33740767 DOI: 10.3171/2020.9.spine201292] [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: 07/12/2020] [Accepted: 09/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS) was developed as a result of the value-based purchasing initiative by the Center for Medicare & Medicaid Services. It allows patients to rate their experience with their provider in the outpatient setting. These ratings are then reported in aggregate and made publicly available, allowing patients to make informed choices during physician selection. In this study, the authors sought to elucidate the primary drivers of patient satisfaction in the office-based spine surgery setting as represented by the CG-CAHPS. METHODS All patients who underwent lumbar spine surgery between 2009 and 2017 and completed a patient experience survey were studied. The satisfied group comprised patients who selected a top-box score (9 or 10) for overall provider rating (OPR) on the CG-CAHPS, while the unsatisfied group comprised the remaining patients. Demographic and surgical characteristics were compared using the chi-square test for categorical variables and the Student t-test for continuous variables. A multivariable logistic regression model was developed to analyze the association of patient and surgeon characteristics with OPR. Survey items were then added to the baseline model individually, adjusting for covariates. RESULTS The study population included 647 patients who had undergone lumbar spine surgery. Of these patients, 564 (87%) selected an OPR of 9 or 10 on the CG-CAHPS and were included in the satisfied group. Patient characteristics were similar between the two groups. The two groups did not differ significantly regarding patient-reported health status measures. After adjusting for potential confounders, the following survey items were associated with the greatest odds of selecting a top-box OPR: did this provider show respect for what you had to say? (OR 21.26, 95% CI 9.98-48.10); and did this provider seem to know the important information about your medical history? (OR 20.93, 95% CI 11.96-45.50). CONCLUSIONS The present study sought to identify the key drivers of patient satisfaction in the postoperative office-based spine surgery setting and found several important associations. After adjusting for potential confounders, several items relating to physician communication were found to be the strongest predictors of patient satisfaction. This highlights the importance of effective communication in the patient-provider interaction and elucidates avenues for quality improvement efforts in the spine care setting.
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Affiliation(s)
- Nicholas M Rabah
- 1Center for Spine Health, Cleveland Clinic
- 2Case Western Reserve University School of Medicine
- 3Department of Neurosurgery, Cleveland Clinic
- 4Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio; and
| | - Hammad A Khan
- 1Center for Spine Health, Cleveland Clinic
- 2Case Western Reserve University School of Medicine
- 3Department of Neurosurgery, Cleveland Clinic
- 4Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio; and
| | - Robert D Winkelman
- 1Center for Spine Health, Cleveland Clinic
- 3Department of Neurosurgery, Cleveland Clinic
| | - Jay M Levin
- 5Department of Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas E Mroz
- 1Center for Spine Health, Cleveland Clinic
- 4Department of Orthopedic Surgery, Cleveland Clinic, Cleveland, Ohio; and
| | - Michael P Steinmetz
- 1Center for Spine Health, Cleveland Clinic
- 3Department of Neurosurgery, Cleveland Clinic
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Gholamzadeh M, Abtahi H, Ghazisaeeidi M. Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion. BMC Health Serv Res 2021; 21:458. [PMID: 33985502 PMCID: PMC8116646 DOI: 10.1186/s12913-021-06456-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
Background One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process. Objective The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice. Methods Web of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts. Results Out of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care. Conclusion This survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06456-7.
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Affiliation(s)
- Marsa Gholamzadeh
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeeidi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran.
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