The Dimension of the Press Ganey Survey Most Important in Evaluating Patient Satisfaction in the Academic Outpatient Orthopedic Surgery Setting

The Influence of an Unexpected Symbolic Gift on Postoperative Arthroplasty Patients' Press Ganey Scores

BACKGROUND

Hospitals use Press Ganey surveys to evaluate patient satisfaction. The goal of our study was to evaluate whether surgeon-driven gifting to patients postoperatively affects Press Ganey Survey responses.

METHODS

There were 1,468 patients undergoing arthroplasty at our institution who were randomized to receive a thank-you gift, a small bouquet of flowers, and a note from their provider after surgery, or nothing for completing their preoperative arthroplasty registry questionnaire. Press Ganey surveys were sent to patients who received and did not receive flowers immediately after their hospital stay and after the patients' first postoperative visit. Scores were reported as the mean score and the fraction of responses with a top-box rating. One-sided student t-tests and Fisher's exact tests were used to assess statistical significance.

RESULTS

Hospital Discharge: Patients who received flowers had higher Press Ganey survey scores than patients who did not receive flowers. For example, for "physician's concerns for questions," they had higher scores (mean difference: 3.7 ± 1.6 points, P = .012) and a 9% higher top-box rating (P = .032). For "staff attitude toward visitors," they also had higher scores (mean difference: 2.8 ± 1.3 points, P = .019) and a 7% higher top-box rating (P = .049). First Follow-up: Patients who received flowers had a higher top-box rating for "concern provider showed for questions" and "amount of time provider spent with you" by 6% (P = .046) and 11% (P = .009), respectively. They also had higher scores for "information provider gave about medications" (mean difference: 4.0 ± 1.6 points, P = .009) and 11% higher top-box rating (P = .006).

CONCLUSIONS

Press Ganey Surveys were higher in orthopaedic patients who received bouquets of flowers from their arthroplasty surgeons compared to patients who did not. At follow-up, improved Press Ganey scores persisted if the patient received flowers. The gift of flowers generates patient loyalty to their surgeon.

Net Promoter Score as a Reflection of Patients' Opinions About Telemedical Visits: A Mixed Methods Analysis

Introduction: In order to assess patient experiences of telemedicine, researchers and administrators use the net promoter score (NPS), based on a likelihood to recommend (LTR) question. However, there is reason to doubt validity of this metric for this purpose. We assessed the degree to which the LTR question reflects actual patient preferences about telemedicine. Methods: Using data from a patient experience survey collected in Spring 2020, we compared LTR responses to open comments. Through content analysis, we transformed comments into categorical variables and used those variables in a multiple logistic regression model to predict LTR responses. We also thematically analyzed comments to further elucidate our results. Results: Only about half the comments mentioned telemedicine at all. Around 6% of comments were wholly incongruent with LTR responses. In many comments, ideas about telemedicine were semantically entangled with ideas about providers. Our logistic regression found strong associations between sentiments expressed in comments and LTR responses. However, comments about telemedicine were relatively poor predictors for LTR compared to comments about the provider. Discussion: NPS, which is included on many patient experience surveys used by health systems across the United States, has limitations for use as a measure of the acceptability of telemedicine for patients. Patients have more than telemedicine in mind when responding to the LTR question, and ratings conflate attitudes about providers, office policies, and staff with the telemedicine modality. More direct measures are necessary for meaningful research on the acceptability and usability of telemedicine for patients.

Comparison of Patient Perception and Satisfaction of Face-to-Face Versus Telemedicine Encounters in Hand Surgery

BACKGROUND

The coronavirus disease 2019 (COVID-19) surge has enabled the widespread usage of telemedicine (TM) and presents a unique opportunity to determine the hand surgery patients' perception of care using validated patient satisfaction scores.

METHODS

Electronic surveys were distributed to patients aged 18 years and older who underwent a video TM encounter with a single surgeon at an academic medical center during the initial COVID-19 surge (March 23 to October 22, 2020). The study-specific questions were derived from the Press Ganey (PG) Medical Practice TM Survey and compared with institutional PG Outpatient Medical Practice Survey data. Three cohorts were defined: pre-COVID face-to-face, post-COVID TM, and post-COVID face-to-face.

RESULTS

Thirty of 65 TM patients (46.2%) responded. No differences in sex, age, or visit type were identified between cohorts. The TM cohort was more likely to live greater than 300 miles from the institution. Median response for all cohorts for the PG care provider and overall experience responses were "very good," and no differences were identified between cohorts. Patient satisfaction with their TM experience was high with median satisfaction scores for arranging and connecting to a TM visit, talking with the provider over a video connection, and having the provider understand the clinical problem were "very good." Patients in the TM cohort reported no difference in preference for face-to-face or TM visits.

CONCLUSIONS

Patients are satisfied with TM as a substitute for face-to-face visits suggesting that TM can possibly be used to deliver comparable patient experience for hand surgery encounters.

Patient Satisfaction with Virtual Clinic Encounters: Analysis of Factors that Impact the Press Ganey Survey in the Hand Surgery Population

Purpose

Our purpose was to identify patient characteristics and visit components that affect patient satisfaction with virtual new patient visits in an outpatient hand surgery clinic as measured by the Press Ganey Outpatient Medical Practice Survey (PGOMPS) total score (primary outcome) and provider subscore (secondary outcome).

Methods

Adult patients evaluated through virtual new patient visits at a tertiary academic medical center between January 2020 and October 2020 who completed the PGOMPS for virtual visits were included. Data regarding demographics and visit characteristics were collected via chart review. Factors associated with satisfaction were identified using a Tobit regression model on the continuous score outcomes (Total Score and Provider Subscore) to account for substantial ceiling effects.

Results

A total of 95 patients were included: 54% were men and the mean age was 54 ± 16 years. Mean area deprivation index was 32 ± 18, and the mean driving distance to the clinic was 97 ± 188 mi. Common diagnoses include compressive neuropathy (21%), hand arthritis (19%), hand mass (12%), and fracture/dislocation (11%). Treatment recommendations included small joint injection (20%), in-person evaluation (25%), surgery (36%), and splinting (20%). Multivariable Tobit regressions showed notable differences in satisfaction by the provider on the Total Score but not on the Provider Subscore. Other factors known to affect the PGOMPS scores for in-person visits were not notably associated with the Total or Provider Sub-Scores for virtual visits (area deprivation index, age, and offer of surgery or injection) other than the body mass index.

Conclusions

Virtual clinic visit satisfaction was affected by the provider. Wait time strongly affects satisfaction with in-person visits but is not accounted for by the PGOMPS scoring system for virtual visits, which is a limitation of their survey. Further work is required to determine how to improve the patient experience with virtual visits.

Type of study/level of evidence

Prognostic IV.

Topics most predictive of favorable overall assessment in outpatient radiology

BACKGROUND

Patients' subjective experiences during clinical interactions may affect their engagement in healthcare, and better understanding of the issues patients consider most important may help improve service quality and patient-staff relationships. While diagnostic imaging is a growing component of healthcare utilization, few studies have quantitatively and systematically assessed what patients deem most relevant in radiology settings. To elucidate factors driving patient satisfaction in outpatient radiology, we derived quantitative models to identify items most predictive of patients' overall assessment of radiology encounters.

METHODS

Press-Ganey survey data (N = 69,319) collected over a 9-year period at a single institution were retrospectively analyzed, with each item response dichotomized as "favorable" or "unfavorable." Multiple logistic regression analyses were performed on 18 binarized Likert items to compute odds ratios (OR) for those question items significantly predicting Overall Rating of Care or Likelihood of Recommending. In a secondary analysis to identify topics more relevant to radiology than other encounter types, items significantly more predictive of concordant ratings in radiology compared to non-radiology visits were also identified.

RESULTS

Among radiology survey respondents, top predictors of Overall Rating and Likelihood of Recommending were items addressing patient concerns or complaints (OR 6.8 and 4.9, respectively) and sensitivity to patient needs (OR 4.7 and 4.5, respectively). When comparing radiology and non-radiology visits, the top items more predictive for radiology included unfavorable responses to helpfulness of registration desk personnel (OR 1.4-1.6), comfort of waiting areas (OR 1.4), and ease of obtaining an appointment at the desired time (OR 1.4).

CONCLUSIONS

Items related to patient-centered empathic communication were the most predictive of favorable overall ratings among radiology outpatients, while underperformance in logistical issues related to registration, scheduling, and waiting areas may have greater adverse impact on radiology than non-radiology encounters. Findings may offer potential targets for future quality improvement efforts.

Patient Satisfaction With Otolaryngology Care: Stratification by Race, Age, Gender, Income, and Language

OBJECTIVE

To understand how race, gender, income, and language are correlated with patient satisfaction scores.

STUDY DESIGN

Cross-sectional analysis of patient satisfaction data.

SETTING

An urban/suburban academic otolaryngology practice.

METHODS

Patients presenting for outpatient otolaryngology visits from 2017 to 2020 were surveyed for patient satisfaction following a visit with their otolaryngology provider. Categorical responses and numerical responses were collected regarding overall satisfaction as well as a variety of more specific satisfaction questions. Responses were matched to both provider characteristics and patient demographic data. Differences in satisfaction by demographic data were assessed with descriptive statistics as well as a multivariable mixed-effect model to adjust for repeated responder data and control for confounding factors.

RESULTS

In total, 55,469 surveys were included, the majority of which were from white, English-speaking patients. Overall satisfaction levels were very high across all questions. The individual provider was associated highly with satisfaction, but provider gender was not. Race, age, and gender of the patient had a statistically significant impact on patient satisfaction, with higher levels of satisfaction among patients who were older, white, and male; income and language did not.

CONCLUSION

Patient factors including race, age, and gender had a significant impact on ratings on outpatient otolaryngology patient satisfaction surveys, with nonwhite, younger, female patients reporting lower scores.

Does Adjusting for Social Desirability Reduce Ceiling Effects and Increase Variation of Patient-Reported Experience Measures?

Social desirability bias (a tendency to underreport undesirable attitudes and behaviors) may account, in part, for the notable ceiling effects and limited variability of patient-reported experience measures (PREMs) such as satisfaction, communication effectiveness, and perceived empathy. Given that there is always room for improvement for both clinicians and the care environment, ceiling effects can hinder improvement efforts. This study tested whether weighting of satisfaction scales according to the extent of social desirability can create a more normal distribution of scores and less ceiling effect. In a cross-sectional study 118 English-speaking adults seeking musculoskeletal specialty care completed 2 measures of satisfaction with care (one iterative scale and one 11-point ordinal scale), a measure of social desirability, and basic demographics. Normality of satisfaction scores was assessed using Shapiro-Wilk tests. After weighting for social desirability, scores on the iterative satisfaction scale had a more normal distribution while scores on the 11-point ordinal satisfaction scale did not. The ceiling effects in satisfaction decreased from 47% (n = 56) to 2.5% (n = 3) for the iterative scale, and from 81% (n = 95) to 2.5% (n = 3) for the ordinal scale. There were no differences in mean satisfaction when the social desirability was measured prior to completion of the satisfaction surveys compared to after. The observation that adjustment for levels of social desirability bias can reduce ceiling effects suggests that accounting for personal factors could help us develop PREMs with greater variability in scores, which may prove useful for quality improvement efforts.

Preoperative Factors Associated with Press Ganey Patient Satisfaction Scores after Anterior Cruciate Ligament Reconstruction

Patient satisfaction is increasingly used as a metric to evaluate the quality of healthcare services and to determine hospital and physician compensation. The aim of this study was to identify preoperative factors associated with Press Ganey Ambulatory Surgery (PGAS) satisfaction scores, and to evaluate the effect of each PGAS domain score on the total PGAS score variability in patients undergoing anterior cruciate ligament reconstruction (ACLR). A review of a Press Ganey (PG) database at a single center was performed for patients undergoing ACLR between 2015 and 2019. Ninety-nine patients completed the PGAS survey and 54 also completed preoperative demographic and patient-reported outcome measures (PROMs) for an orthopaedic registry. PGAS scores were calculated and bivariate analysis was performed. Multivariable linear regression determined the effect of each of the six PGAS domains on the total PGAS score variability. In the total cohort of 99 patients, no factors were significantly associated with the total PGAS score or any domain scores. For the 54 patients who also participated in the orthopaedic registry, none of the preoperative PROMs were significantly correlated with total PGAS score. However, having a college degree (89 vs. 95 or 97 points; p = 0.02) and continuous femoral nerve catheter (92 vs. 100 points; p = 0.04) was associated with lower personal issue domain scores, while patients with a greater number of prior surgeries had worse registration domain scores (ρ = -0.27; p = 0.049). For the entire cohort, the registration and facility domains contributed the most variability to the total PGAS score, while the physician domain contributed the least. Few preoperative factors are associated with PGAS scores, and total PGAS scores do not significantly correlate with baseline PROMs. Surgeons may have limited ability to improve their PGAS scores given most of the variability in total scores stems from systemic aspects of the patient experience.

Differences in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores for a Single Surgeon Comparing Two Institutions: An Unfair Reimbursement Metric

BACKGROUND

Emphasis on value-based purchasing links physician financial remuneration to patient-derived outcome scores. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys aim to provide a uniform comparison tool. Of the 22 different survey questions, only 3 (13.6%) focus on experience related to doctors. We sought to determine how HCAHPS scores differ for a single surgeon performing more than 500 total joint arthroplasties annually, divided almost equally between two centers.

METHODS

HCAHPS data from 2015 to 2018 for a single, fellowship-trained arthroplasty surgeon were collected from two different hospitals. More than 200 cases were performed at each center with the same staff. One center is a large metropolitan academic-teaching hospital, and the other is a suburban private hospital. The purpose of the study was to determine if differences existed regarding HCHAPS scores between the two institutions.

RESULTS

A significant difference was found between institutions regarding questions pertaining to "hospital environment," "admission process," and "hospital staff concern for pain," with more patients responding favorably in Institution Two than Institution One.

CONCLUSION

Patient perceptions and ratings of overall experience differ significantly between hospitals even when surgery is performed by a single surgeon. These results lend credence to the fact that surgeons should not be unduly penalized for the hospital in which they operate, and financial remuneration involving HCAHPS scores must be approached with caution. This unfair system could potentially drive surgeons to perform the majority of their cases in the hospital system with higher scores in the nonphysician related domains as this would affect overall patient satisfaction, and thus, financial compensation.

Telehealth in an Orthopedic Sports Medicine Clinic: The First 100 Patients

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.

Utilizing Oral Surveys to Better Understand Patient Satisfaction in a Low-Income, Urban Surgical Clinic

Oral surveys allow patients to elaborate on their experience in the hospital, giving context to numerical values often used to assess patient satisfaction. This allows patients to speak about factors affecting satisfaction, which is important in complex, low-income populations. Spoken surveys were administered to 80 patients in surgery clinics at Temple University Hospital. Responses were transcribed and coded to analyze patient responses. Relationships among patient responses were identified, and responses were categorized to determine the most important factors related to patient satisfaction. Numerical data were also used to assess satisfaction. Patients were satisfied with their experience with the physician and the hospital, reporting averages scores of 9.73 and 9.19, respectively. Regarding physician satisfaction, patients cited effective communication and professionalism as being most important. As long as nothing went wrong, patients scored their experience outside their interactions with the physician highly. Negative experiences were mainly related to wait times and ineffective communication with office staff and were seldom related to the physician. By using a spoken survey, patients could elaborate on their responses which provides context to the numerical data. Despite the positive feedback for physicians, patients spoke openly about communication. In low-income populations, communication failures can be exacerbated by the power differential present between the patient and physician. Our study demonstrates the utility of oral surveys in understanding complex patient populations, and the results can be used to shape surgical and nonsurgical practices in similar patient populations.