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Sergesketter AR, Shammas RL, Langdell HC, Yi VN, Geng Y, Patel A, Erdmann D. The Influence of Patient and Surgeon Characteristics on Press Ganey Provider Ratings in Plastic Surgery. Aesthet Surg J 2024; 44:NP193-NP201. [PMID: 37823701 DOI: 10.1093/asj/sjad325] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/12/2023] [Accepted: 10/11/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Although patient satisfaction ratings are increasingly used as hospital and provider performance metrics, these ratings may be affected by factors extraneous to surgeon performance. OBJECTIVES The aim of this study was to assess whether outpatient Press Ganey ratings for plastic surgery providers were tied more to provider or patient characteristics. METHODS All Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS) responses for plastic surgery providers from 2017 to 2023 from a single institution were analyzed. Ordered logistic regression models were used to identify characteristics associated with provider ratings. RESULTS In total, 6442 surveys from 4594 patients representing 29 plastic surgery providers were analyzed. Across the patient cohort, 23.2% (N = 1492) rated plastic surgery providers lower than a 10/10. After adjustment, provider characteristics including provider gender, patient-provider gender concordance, and years in practice were not associated with overall provider ratings (all P > .05). In contrast, patient characteristics were associated with provider ratings. Older patient age (odds ratio [OR], 1.02; P < .001) was associated with higher ratings. Finally, self-reported overall health and mental health were associated with lower provider ratings (both P < .05); specifically, mental health categories lower than "Excellent" were associated with significantly lower provider ratings (overall mental health "Very Good': OR, 0.57; "Good": OR, 0.53; "Fair": OR, 0.59; "Poor": OR, 0.55; all P < .05). CONCLUSIONS Press Ganey ratings for plastic surgeons are influenced by patient characteristics, including age and mental health. Because satisfaction ratings are increasingly used as performance metrics in plastic surgery, adjusted rating models may be needed to more accurately reflect surgeon performance.
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Karamian BA, Jeyamohan H, Minetos PD, Kothari P, Canseco JA, Bowles DR, Pekuri A, Conaway W, DiMaria SL, Mao JZ, Woods BI, Kaye ID, Lee JK, Rihn JA, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Effect of a Mandatory Prescription Drug Monitoring Program on Patient-initiated Phone Calls After Spine Surgery. Clin Spine Surg 2022; 35:E405-E411. [PMID: 34923502 DOI: 10.1097/bsd.0000000000001276] [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: 03/18/2021] [Accepted: 11/17/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE The objective of this study was to determine the effect of a statewide, government-mandated prescription drug monitoring program (PDMP) on patient-initiated phone calls after lumbar and cervical spinal surgery. SUMMARY OF BACKGROUND DATA Prior studies have examined the most common reasons for a postoperative phone calls, most of which pertain to pain or prescription medications. However, no studies have investigated the effects of mandatory opioid prescription reporting on these calls. METHODS Patients who underwent lumbar decompression, lumbar fusion, or posterior cervical fusion were retrospectively identified. Patients were sorted into 1 of 2 cohorts based on their procedure date's relation to the initiation of the state's PDMP: "pre-PDMP" and "post-PDMP." All clinical and demographic data were obtained from electronic health records. Telephone communications from or on behalf of patients were retrospectively reviewed. Multivariable logistic regression was performed to determine independent factors associated with a postoperative phone call. RESULTS Five hundred and twenty-five patients (2689 phone calls) were included in the study. Average number of phone calls per patient increased significantly after PDMP implementation among lumbar (3.27 vs. 5.18, P<0.001), cervical (5.08 vs. 11.67, P<0.001), and all (3.59 vs. 6.30, P<0.001) procedures. Age [odds ratio (OR): 1.05 (1.01, 1.09), P=0.02], cervical procedure [OR: 4.65 (1.93, 11.21), P=0.001], and a post-PDMP date of surgery [OR: 6.35 (3.55, 11.35), P<0.001] were independently associated with an increased likelihood of a postoperative phone call. A higher percentage of calls were in reference to postoperative care (4.6% vs. 2.4%, P=0.01) and wound care (4.3% vs. 1.4%, P<0.001) in the post-PDMP cohort compared with the pre-PDMP cohort. CONCLUSIONS Patient-initiated telephone calls increased significantly after implementation of a mandatory statewide PDMP. Increasing age, operation involving the cervical spine, and surgery occurring after implementation of the state's PDMP were independently associated with an increased likelihood of postoperative phone call to health care providers.
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Affiliation(s)
- Brian A Karamian
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA
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Chang M, Russo GS, Canseco JA, Nicholson K, Sharma R, Koomson J, Vaccaro AR. Variations in Patient Satisfaction Scores Between HCAHPS and a Novel Orthopedic Practice-Specific Survey. Am J Med Qual 2021; 36:103-109. [PMID: 32452696 DOI: 10.1177/1062860620926710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Performance on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey can affect up to 33% of a physician's reimbursement from the Centers for Medicare & Medicaid Services. At this pseudo-private orthopedic practice, the authors characterized how physicians often achieve drastically different scores between HCAHPS and an Internal Patient Satisfaction Questionnaire (IPSQ). Eighteen physicians were ranked separately according to percentage of top-box scores on HCAHPS and IPSQ. There was an inverse relationship between physician rank for the 2 surveys according to Spearman correlation coefficient (ρ = -0.36, P = .15). Qualitative subanalysis indicated that although "physician interaction" was the most common reason for negative comments on HCAHPS, "ancillary staff" and "workflow" concerns were common on IPSQ. The outpatient setting remains a critical component in achieving high-quality orthopedic care. Consequently, HCAHPS alone may not be a sufficient indicator of patient satisfaction for orthopedic and other subspecialty practices.
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Affiliation(s)
- Michael Chang
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA Quinnipiac University, Hamden, CT Drexel University, Philadelphia, PA
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Patient-Reported Outcomes: Quality of Care on a Neurosurgical Ward. Qual Manag Health Care 2021; 30:194-199. [PMID: 33591084 DOI: 10.1097/qmh.0000000000000284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Patient experience has become a quality measure in hospitals across the United States. To improve our understanding of our neurosurgical patient population's satisfaction needs, we undertook a detailed survey to identify areas of needed improvement. METHODS Upon institutional review board approval, a detailed survey adopted from the Swedish quality-of-care patient questionnaire was distributed to all patients being discharged from the neurosurgical ward over a month period. From June 2014 to July 2014, all patients admitted to the neurosurgery service through the emergency department, clinic, or other facilities were enrolled. There were no specific inclusion criteria except for age older than 18 years, intact cognition to complete the survey, and return of a completed survey. Data were collected in 6 major categories, including information availability, patient accessibility, treatment received, caring perception, hospital environment, and overall satisfaction. Patients were evaluated by age, gender, surgery, and admission type. RESULTS Our analysis demonstrated an improved overall satisfaction in those patients being admitted electively from the clinic as compared with emergency department admissions or hospital transfers. In addition, patients admitted on an emergent basis reported a lower satisfaction pertaining to receiving information, specifically test results. CONCLUSIONS Emergent admissions represent a subpopulation that may require additional strategies to improve patient satisfaction survey scores.
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Lee MO, Altamirano J, Garcia LC, Gisondi MA, Wang NE, Lippert S, Maldonado Y, Gharahbaghian L, Ribeira R, Fassiotto M. Patient Age, Race and Emergency Department Treatment Area Associated with "Topbox" Press Ganey Scores. West J Emerg Med 2020; 21:117-124. [PMID: 33207156 PMCID: PMC7673899 DOI: 10.5811/westjem.2020.8.47277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/06/2020] [Indexed: 12/30/2022] Open
Abstract
Introduction Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. PG scores range from 1 to 5, with 5 being the highest, which is known as the “topbox” score. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED). Methods We looked at PG surveys from January 2015–December 2017 at an academic, urban hospital with 78,000 ED visits each year. Outcomes were topbox scores for the questions: “Likelihood of your recommending our ED to others”; and “Courtesy of the doctor.” We analyzed topbox scores using generalized estimating equation models clustered by physician and adjusted for patient and physician factors. Patient factors included age, gender, race, ethnicity, and ED area where patient was seen. The ED has four areas based on patient acuity: emergent; urgent; vertical (urgent but able to sit in a recliner rather than a gurney); and fast track (non-urgent). Physician factors included age, gender, race, ethnicity, and number of years at current institution. Results We analyzed a total of 3,038 surveys. For “Likelihood of your recommending our ED to others,” topbox scores were more likely with increasing patient age (odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03–1.12); less likely among female compared to male patients (OR 0.81; 95% CI, 0.70–0.93); less likely among Asian compared to White patients (OR 0.71; 95% CI, 0.60–0.83); and less likely in the urgent (OR 0.71; 95% CI, 0.54–0.93) and vertical areas (OR 0.71; 95% CI 0.53–0.95) compared to fast track. For “Courtesy of the doctor,” topbox scores were more likely with increasing patient age (OR 1.1; CI, 1.06–1.14); less likely among Asian (OR 0.70; 95% CI, 0.58–0.84), Black (OR 0.66; 95% CI, 0.45–0.96), and Hispanic patients (OR 0.68; 95% CI, 0.55–0.83) compared to White patients; and less likely in urgent area (OR 0.69; 95% CI, 0.50–0.95) compared to fast track. Conclusion Increasing patient age was associated with increased likelihood of topbox scores, while Asian patients, and urgent and vertical areas had decreased likelihood of topbox scores. We encourage hospitals that use PG topbox scores as financial incentives to understand the contribution of non-service factors to these scores.
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Affiliation(s)
- Moon O Lee
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Jonathan Altamirano
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Luis C Garcia
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Michael A Gisondi
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - N Ewen Wang
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Suzanne Lippert
- Kaiser-Permanente East Bay, Department of Emergency Medicine, Oakland, California
| | - Yvonne Maldonado
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
| | - Laleh Gharahbaghian
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Ryan Ribeira
- Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California
| | - Magali Fassiotto
- Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California
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Tisano BK, Nakonezny PA, Gross BS, Martinez JR, Wells JE. Depression and Non-modifiable Patient Factors Associated with Patient Satisfaction in an Academic Orthopaedic Outpatient Clinic: Is it More Than a Provider Issue? Clin Orthop Relat Res 2019; 477:2653-2661. [PMID: 31764330 PMCID: PMC6907291 DOI: 10.1097/corr.0000000000000927] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 08/01/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient satisfaction surveys play an increasingly important role in United States healthcare policy and serve as a marker of provided physician services. In attempts to improve the patient's clinical experience, focus is often placed on components of the healthcare system such as provider interaction and other experiential factors. Patient factors are often written off as "non-modifiable"; however, by identifying and understanding these risk factors for dissatisfaction, another area for improvement and intervention becomes available. QUESTIONS/PURPOSES (1) Do patients in the orthopaedic clinic with a preexisting diagnosis of depression report lower satisfaction scores than those without a preexisting diagnosis of depression? (2) What other non-modifiable patient factors influence patient-reported satisfaction? METHODS We reviewed Press Ganey Survey scores, which assess patient experiential satisfaction with a single clinical encounter, from 3044 clinic visits (2527 patients) in adult reconstructive, sports, and general orthopaedic clinics at a single academic medical center between November 2010 and May 2017, during which time approximately 19,000 encounters occurred. Multiple patient factors including patient age, gender, race, health insurance status, number of previous clinic visits with their physician, BMI, and a diagnosis of depression were recorded. Patient satisfaction was operationalized as a binary outcome as satisfied or less satisfied, and a multiple logistic regression analysis was used to estimate the odds of being satisfied. RESULTS After adjusting for all other covariates in the model, we found that patients with a diagnosis of depression were less likely to be satisfied than patients without this diagnosis (odds ratio 0.749 [95% confidence interval, 0.600-0.940]; p = 0.01). Medicare-insured patients were more likely to be satisfied than non-Medicare patients (OR 1.257 [95% CI, 1.020-1.549]; p = 0.03), patients in the sports medicine clinic were more likely to be satisfied than those seen in the general orthopaedic clinic (OR 1.397 [95% CI, 1.096-1.775]; p = 0.007), and established patients were more likely to be satisfied than new patients (OR 0.763 [95% CI, 0.646-0.902]; p = 0.002). CONCLUSIONS Given the association of depression with lower satisfaction with a single visit at the orthopaedic clinic, providers should screen for depression and address the issue during the outpatient encounter. The impact of such comprehensive care or subsequent treatment of depression on improving patient-reported satisfaction offers areas of future study. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Breann K Tisano
- B. K. Tisano, B. S. Gross, J. R. Martinez, J. E. Wells, Department of Orthopaedic Surgery, University of Texas Southwestern Medical School, Dallas, TX, USA P. A. Nakonezny, Department of Population and Data Sciences, Division of Biostatistics, University of Texas Southwestern Medical School, Dallas, TX, USA
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30-Day Emergency Department Visits After Primary Lumbar Fusion: Incidence, Causes, Risk Factors, and Costs. Clin Spine Surg 2019; 32:113-119. [PMID: 30628923 DOI: 10.1097/bsd.0000000000000766] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our objective was to describe the incidence, causes, risk factors, and costs associated with 30-day emergency department (ED) visits after primary lumbar fusion. A national insurance database was retrospectively analyzed to study patients with primary lumbar fusions performed for degenerative pathology of the spine between 2007 and Q3-2015. Risk factors for ED visits, and ED to hospital transfer were studied using multiple-variable logistic regression analysis. Our cohort included 37,559 patients with a mean age of 66.0±10.0 years. A total of 4806 (12.8%) patients had 10,281 ED visits within 30 days after surgery. Of these, 945 (19.9%) had multiple (≥3) visits, and 1466 (30.5%) were admitted to the hospital for management. Common causes for presentation in the ED were cardiorespiratory complaints (49.4%, n=2377), and back and/or leg pain (47.7%, n=2294). Risk factors for all ED visits, multiple ED visits, and hospital admission from the ED have been identified. The overall ED cost burden was nearly two-thirds as much as hospital readmissions within 30 days ($6,994,260 vs. $10,880,999). There is a sizable subset of patients that present to the ED for acute care but do not require hospitalization. Causes and risk factors for presentation in patients with multiple ED visits are somewhat different than patients requiring hospital readmission.
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The opioid epidemic and patient satisfaction: a review of one institution’s experience. CURRENT ORTHOPAEDIC PRACTICE 2018. [DOI: 10.1097/bco.0000000000000690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Hills JM, Khan I, Sivaganesan A, Weisenthal B, Daryoush J, Butler M, Bydon M, Archer KR, Asher A, Devin CJ. Emergency Department Visits After Elective Spine Surgery. Neurosurgery 2018; 85:E258-E265. [DOI: 10.1093/neuros/nyy445] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/17/2018] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Emergency department (ED) overuse is a costly and often neglected source of postdischarge resource utilization after spine surgery. Failing to investigate drivers of ED visits represents a missed opportunity to improve the value of care in spine patients.
OBJECTIVE
To identify the prevalence, drivers, and timing of ED visits following elective spine surgery.
METHODS
Patients undergoing elective spine surgery for degenerative disease at a major medical center were enrolled in a prospective longitudinal registry. Patient and surgery characteristics, and patient-reported outcomes were recorded at baseline and 3 mo after surgery, along with self-reported 90-d ED visits. A multivariable regression model was used to identify independent factors associated with 90-d ED visits. For a sample of patients presenting to our institution's ED, charts were reviewed to identify the reason and time to ED postdischarge.
RESULTS
Of 2762 patients, we found a 90-d ED visit rate of 9.4%. One-third of patients presented to our institution's ED and of these, 70% presented due to pain or medical concerns at 9 and 7 d postdischarge, respectively, with 60% presenting outside normal clinic hours. Independent risk factors for 90-d ED visits included younger age, preoperative opioid use, chronic obstructive pulmonary disorder, and more vertebral levels involved.
CONCLUSION
Nearly 10% of elective spine patients had 90-d ED visits not requiring readmission. Pain and medical concerns accounted for 70% of visits at our center, occurring within 10 d of discharge. This study provides the clinical details and a timeline necessary to guide individualized interventions to prevent unnecessary, costly ED visits after spine surgery.
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Affiliation(s)
- Jeffrey M Hills
- Department of Orthopaedics and Reha-bilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Inamullah Khan
- Department of Orthopaedics and Reha-bilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ahilan Sivaganesan
- Department of Neurological Surgery, Vander-bilt University Medical Center, Nashville, Tennessee
| | - Benjamin Weisenthal
- Department of Orthopaedics and Reha-bilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Joshua Daryoush
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Marjorie Butler
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Mohamad Bydon
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Kristin R Archer
- Department of Orthopaedics and Reha-bilitation, Vanderbilt University Medical Center, Nashville, Tennessee
- Department of Physical Medicine and Reha-bilitation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony Asher
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina
| | - Clinton J Devin
- Department of Orthopaedics and Reha-bilitation, Vanderbilt University Medical Center, Nashville, Tennessee
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Patient-Initiated Telephone Calls in the Postoperative Period After Female Pelvic Reconstructive Surgery. Female Pelvic Med Reconstr Surg 2018; 26:626-629. [PMID: 30247168 DOI: 10.1097/spv.0000000000000636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate reasons and factors associated with patient calls in the postoperative period after female pelvic medicine and reconstructive surgery. METHODS A retrospective review using electronic medical records was performed on consecutive patients who underwent surgery within our academic female pelvic medicine and reconstructive surgery practice during a 6-month period. Calls after postoperative discharge until first scheduled postoperative visit were included. Reasons and number of calls were tabulated. Clinical and surgical factors were extracted. Continuous data were evaluated with a Student t test or analysis of variance; categorical data were evaluated with a χ test. P < 0.05 was considered significant. RESULTS During the designated period, 302 patients underwent surgery, and 173 (57.3%) patients made 345 calls (mean ± SD, 2.0 ± 1.5 calls). Reasons were categorized under 6 distinct domains: bowel, pain, activity, medication regimen, urinary, and bleeding. The most frequent concern within each domain was constipation (11.6%), abdominal pain (6.4%), physical activity (8.7%), pain regimen (14.5%), urinary catheter related (13.3%), and vaginal bleeding (12.1%), respectively. A greater number of phone calls were recorded among patients discharged home with catheters (P = 0.015), and patients who underwent posterior colporrhaphy (P = 0.005) and retropubic urethropexy (P = 0.014). Patients discharged with home nursing (11, 6.4%) demonstrated a significantly higher number of phone calls (3.8 ± 2.5, P < 0.001). Evaluations were required for 37% of callers. Twelve patients were seen in the emergency department, of whom 3 (1.7%) were readmitted to the hospital. CONCLUSIONS Postoperative patient-initiated telephone calls after pelvic reconstructive surgery are common. Bowel-, urinary-, and medication-based phone calls account for the highest frequency and volume.
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Abstract
Over 100 years ago, the orthopaedic surgeon, Ernest Codman, recommended that surgeons and hospitals be paid by the "end result." Healthcare Reform is moving to value over volume, and patient-reported outcomes (PROs) are 1 measure of quality and outcomes that are becoming pervasive. In this study, the current status of patient-reported outcomes and their use in orthopaedic trauma was reviewed. The contributors presented the state of PRO measurements at the Basic Science Focus Forum at the OTA Annual Meeting in 2016. Information on the currently available PROs was presented and analyzed to determine whether they were adequate for research in orthopaedic trauma. PROs were then discussed in the context of which were the most appropriate for determining outcomes in trauma surgery. The concept of mobility as a validated PRO for an assessment of general health was then presented. The final topic was a summary of how PROs will be used by insurers and governmental agencies. These topics provide a comprehensive overview of the current state of PROs in the context of orthopaedic trauma.
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Emergency department visits after lumbar spine surgery are associated with lower Hospital Consumer Assessment of Healthcare Providers and Systems scores. Spine J 2018; 18:226-233. [PMID: 28739479 DOI: 10.1016/j.spinee.2017.06.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/12/2017] [Accepted: 06/28/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys are used to assess the quality of the patient experience following an inpatient stay. Hospital Consumer Assessment of Healthcare Providers and Systems scores are used to determine reimbursement for hospital systems and incentivize spine surgeons nationwide. There are conflicting data detailing whether early readmission or other postdischarge complications are associated with patient responses on the HCAHPS survey. Currently, the association between postdischarge emergency department (ED) visits and HCAHPS scores following lumbar spine surgery is unknown. PURPOSE To determine whether ED visits within 30 days of discharge are associated with HCAHPS scores for patients who underwent lumbar spine surgery. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE A total of 453 patients who underwent lumbar spine surgery who completed the HCAHPS survey between 2013 and 2015 at a single tertiary care center. OUTCOME MEASURES The HCAHPS survey-the Centers for Medicare and Medicaid Services' official measure of patient experience-results for each patient were analyzed as the primary outcome of this study. METHODS All patients undergoing lumbar spine surgery between 2013 and 2015 who completed an HCAHPS survey were studied. Patients were excluded from the study if they had been diagnosed with spinal malignancy or scoliosis. Patients who had an ED visit at our institution within 30 days of discharge were included in the ED visit cohort. The primary outcomes of this study include 21 measures of patient experience on the HCAHPS survey. Statistical analysis included Pearson chi-square for categorical variables, Student t test for normally distributed continuous variables, and Mann-Whitney U test for nonparametric variables. Additionally, log-binomial regression models were used to analyze the association between ED visits within 30 days after discharge and odds of top-box HCAHPS scores. No funds were received in support of this study, and the authors report no conflict of interest-associated biases. RESULTS After adjusting for patient-level covariates using log-binomial regression models, we found postdischarge ED visits were independently associated with lower likelihood of top-box score for several individual questions on HCAHPS. Emergency department visits within 30 days of discharge were negatively associated with perceiving your doctor as "always" treating you with courtesy and respect (risk ratio [RR] 0.26, p<.001), as well as perceiving your doctor as "always" listeningcarefully to you (RR 0.40, p=.003). Also, patients with an ED visit were less likely to feel as if their preferences were taken into account when leaving the hospital (RR 0.61, p=.008), less likely to recommend the hospital to family or friends (RR 0.46, p=.020), and less likely to rate the hospital as a 9 or a 10 out of 10, the top-box score (RR 0.43, p=.005). CONCLUSIONS Our results demonstrate a strong association between postdischarge ED visits and low HCAHPS scores for doctor communication, discharge information, and global measures of hospital satisfaction in a lumbar spine surgery population.
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Abstract
PURPOSE OF REVIEW This is a literature review of the measurement of patient satisfaction in musculoskeletal medicine. Its purpose is to better understand the motivation for such measurements, the potential confounders, and the potential physician behaviors that may modulate such measures. RECENT FINDINGS There have been studies documenting that physician conveyance of empathy, the extent to which patients' expectations for pain control and timeliness of care are met, as well as patient demographics and health status all affect the current measures of patient satisfaction. In the mission to affect patient-centered care are met, musculoskeletal providers will be measured by their patients' satisfaction. There is much yet to be understood regarding patients' expectations of care; the science behind case-mix adjustment in this sphere is in its infancy, but there are some compelling reasons for musculoskeletal providers to attempt to optimize their patients' satisfaction.
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Affiliation(s)
- Matthew J. Smith
- Outpatient Clinics, Department of Orthopaedic Surgery, University of Missouri, Columbia, MO 65212 USA
| | - Theodore J. Choma
- Division of Spine Surgery, Department of Orthopaedic Surgery, University of Missouri, 1100 Virginia Ave, MOI 4036, Columbia, MO 65212 USA
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