Increasing clinical medical service satisfaction: An investigation into the impacts of Physicians' use of clinical decision-making support AI on patients' service satisfaction

BACKGROUND

The medical industry is one of the key industries for the application of artificial intelligence (AI). Although it is believed that the combination of CDSS and physicians could improve the medical service, there are still many concerns about the usage of CDSS. Based on these concerns, limited studies have answered the question that when a physician makes decision independently or with AI's help, will there be any differences in patients' satisfaction with the medical service?

METHODS

This study uses the service fairness theory as a theoretical lens and employs three vignette experiments to address this research gap. There are totally 740 subjects recruited to participate into the three experiments. Group comparison methods and structural equation model are used to verify the hypotheses.

RESULTS

The experimental results reveal that: (1) physicians using AI can reduce patients' service satisfaction (M_difference=0.404,p=0.004); (2) the negative relationship between AI usage and service satisfaction can partially be mediated through distributive fairness and procedural fairness; (3) physicians actively informing their patients about the usage of AI can help mitigate the reduction in service satisfaction (M_difference=0.400,p=0.003) and three types of fairness M_difference^distributive=0.307,p=0.042;M_difference^procedural=0.483,p<0.001;M_difference^{interactional}=0.253,p=0.027.

CONCLUSION

This study investigates the effect of physicians using decision-making support AI on their patients' service satisfaction. These results contribute to the existing literature pertaining to AI and fairness theory, and also help in formulating some practical suggestions for medical staff and AI development companies.

Factors affecting state railway of Thailand (SRT) passenger train service use decision: A structural equation model

The State Railway of Thailand's (SRT) rail passenger ridership has dropped from a peak of 88 million rides in 1994 to less than 23 million in 2022, with the reasons for this collapse being numerous. Therefore, the authors set out to examine how organizational image (OI), service quality (SQ), service motivation (SM), and service satisfaction (SS) affect SRT use decision (SUD) making. From August-October 2022, multiple-stage random sampling was used to select a sample of 1,250 SRT passengers from five regional rail lines and their associated 25 stations. A confirmatory factor analysis goodness-of-fit was used to confirm the model's fit. A structural equation model (SEM) using LISREL 9.10 was then used to analyze the ten hypothesized relationships. The quantitative research used a 5-level questionnaire to measure the study's five constructs and 22 observed variables. The reliability of the items ranged from 0.86 to 0.93. The data analysis included calculating various statistical measures. Results showed that the model's causal variables positively affected passenger SRT use decision, with an R² of 71%. When ranked by total effect (TE) values, service quality (SQ = 0.89) was viewed by the surveyed passengers as most important, followed by service satisfaction (SS = 0.67), organizational image (OI = 0.63), and service motivation (SM = 0.53). Additionally, all ten hypotheses were supported, with service satisfaction judged the most essential to SRT Use Decisions. The study's novelty is the ever-growing requirement for the SRT to serve as a regional hub in a more extensive East Asian rail and infrastructure strategy. The paper contributes significantly to the academic literature on factors affecting rail transportation use intent.

Predictors of Satisfaction with Autism Treatment Services During COVID-19

The COVID-19 pandemic has created unprecedented challenges and disruptions for autistic individuals receiving specialized treatment services. This caregiver-report survey study (n = 339) explored predictors of satisfaction with autism services during COVID-19 to improve perceived support for these families. Specifically, we investigated whether service delivery medium (telehealth vs. in person), child’s emotional functioning, and caregiver stress would predict satisfaction with the most highly utilized services. Satisfaction ratings for ABA/behavioral, speech/language, and occupational therapy were lower when delivered via telehealth as compared to in person. Caregivers who reported higher emotional dysregulation in their children were less satisfied with behavioral therapy services. These results provide a critical caregiver-informed perspective on factors influencing satisfaction with specialized autism services during COVID-19.

Relationship between satisfaction with mental health services, personal recovery and quality of life among service users with psychosis: a cross-sectional study

Background

Mental health policy internationally emphasizes patient centredness and personal recovery. This study investigated the relationship between satisfaction with mental health services among service users with psychosis in Norway, and personal recovery, perceived support for personal recovery, and quality of life.

Methods

Cross-sectional data were collected from 292 service users diagnosed with psychosis from 39 clinical sites across Norway. Satisfaction with services was assessed using the Client Satisfaction Questionnaire-8. A linear mixed model was estimated to explore the relationship between satisfaction with services and preselected covariates, and to control for confounding factors.

Results

A large majority of participants (89%) reported moderate-to-high levels of satisfaction. Satisfaction with services was positively associated with perceived support for personal recovery, but not with personal recovery or quality of life. In addition, service users under a Community Treatment Order (CTO) were significantly less satisfied than those who were not.

Conclusions

Satisfaction levels among service users were higher compared with similar, international studies. Those who feel supported in their personal recovery were more satisfied with the care they receive, which support the need for implementation of recovery-oriented practices for service users with psychosis. However, satisfaction with services was not related to service user-rated quality of life or level of personal recovery; thus, more follow-up studies are needed. The lower satisfaction of service users placed under CTOs shows the importance of targeted interventions to improve satisfaction with services among this group.

Trial registration

NCT03271242, date of registration: 5 sept. 2017.

What was the impact of a global pandemic (COVID-19) lockdown period on experiences within an eating disorder service? A service evaluation of the views of patients, parents/carers and staff

BACKGROUND

The World Health Organization declared the outbreak of COVID-19 as a global pandemic on the 11th March 2020. As a result, the UK Government imposed severe restrictions on working and social contact as part of "lockdown." Whilst the full extent of the pandemic's impact on eating disorder patients is unknown, the literature suggests that patients with pre-existing mental illness may be more vulnerable to the mental health impacts. In addition, the restrictions greatly reduced the access to mental health services and presented new challenges to service delivery. A service evaluation was carried out to explore how the COVID-19 global pandemic changed service provision in a young person's eating disorder service and how this affected patient, family and staff experiences.

METHODS

An audit was carried out to explore how the lockdown period had impacted referrals and service delivery. Quantitative data was collected in an online survey and qualitative data was collected in two formats: open ended answers as part of the online survey and open-ended focus groups, structured using narrative enquiry. The 43 participants consisted of 12 patients, 19 parents/carers, and 12 staff members. Patients were under the age of 18 and had a diagnosis of an eating disorder.

RESULTS

COVID-19 and lockdown increased the pressure on the service and changed service provision significantly. This has impacted the relational experiences for patients and their carers and staff have been faced with new challenges. Patients, parents/carers and staff all preferred face-to-face appointments over virtual options. There was no difference in service satisfaction before and during COVID-19.

CONCLUSIONS

It is possible to provide an eating disorder service in lockdown restrictions that patients and parents report high satisfaction with. Providing face-to-face appointments at the beginning of treatment and including families in the planning should be prioritised. Staff support is crucial to be able to continue delivering high quality services. The key themes are identified, and clinical recommendations are made to guide service delivery.

Assessing health service satisfaction among users with substance use disorders within the municipalities in Norway

BACKGROUND

The purpose of this study was to assess what is associated with health service satisfaction among adults with a substance use disorder receiving services provided within different municipalities in Norway. An additional aim was to examine demographic and municipality characteristics, mental health, and types of substance use associated with health service satisfaction.

METHOD

A cross-sectional partial explorative study was executed in 2017 among 491 service users with substance use disorders from 20 randomly selected municipalities. The sample consisted of 70% males. The sample majority were single and unemployed, and their main sources of healthcare were the general practitioner (78%), The Norwegian Labor and Welfare Administration (72%), and addiction counsellors (62%).

RESULTS

Overall satisfaction was negatively associated with age, size of municipality, Global Severity Index (GSI) and illicit substance use during the last 12 months. Satisfaction with practical help, such as housing, economy, work and education, was negatively associated with GSI and positively associated with onset of first alcohol intoxication. Satisfaction with personnel was positively associated with onset of first alcohol intoxication and negatively associated with municipality size, GSI and illicit use the last 12 months. The results showed that more than half of the respondents (54%) to a large or great extent were satisfied with the overall services provided. The services they were less satisfied with were related to housing, economy, getting started with exercise and establishing a social network.

CONCLUSION

The results show areas associated with satisfaction and domains where the municipalities can improve their services to meet the users' needs and increase service satisfaction.

Developing a measure of mental health service satisfaction for use in low income countries: a mixed methods study

Background

Service satisfaction is integral to quality of care and measures are therefore considered important indicators of quality. Patient’s responses to their experiences of using services are under-researched in the context of mental healthcare in low income countries. Our aim was to use mixed methods to develop a new measure of satisfaction for use among consumers of the new models of mental healthcare which are currently being scaled-up.

Methods

We used qualitative methods to explore the concept of service satisfaction. On the basis of these findings, we developed a new ‘Mental health service satisfaction scale’ (MHSSS v0.0) by adapting existing measures of service satisfaction. We evaluated psychometric properties of the new measure, among a sample of service users with severe mental disorder (SMD) (n = 200) and caregivers (n = 200). Following expert review, a modified version of the measure was developed (MHSSS v1.0) and psychometric properties were examined with data from a second independent sample (n = 150 service users with SMD and n = 150 caregivers).

Results

Factors identified in analysis of the first quantitative sample coincide with core concepts of service satisfaction as reported in the literature and were reflected in the key themes which emerged from our qualitative study: interpersonal factors, efficacy, communication, technical competency and adequacy of facilities. There was generally consensus among caregivers and service users regarding dimensions of satisfaction. However there was evidence of some differences in prioritization. Revisions made to version 0.0 of the Mental Health Service Satisfaction Scale (MHSSS) led to an improved instrument, with excellent internal consistency, convergent validity and factor loadings indicative of a uni-dimensional construct.

Conclusions

Our findings suggest that conceptions of service satisfaction among people accessing a service for SMD are broadly similar with those established in the literature. Our findings indicate that the MHSSS might be a useful candidate for inclusion in the new toolkit of measures needed to facilitate monitoring of service satisfaction which will be crucial to quality improvement.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2126-2) contains supplementary material, which is available to authorized users.

The role of positive youth development practices in building resilience and enhancing wellbeing for at-risk youth

Services that utilise positive youth development practices (PYD) are thought to improve the quality of the service experience leading to better outcomes for at-risk youth. This article reports on a study of 605 adolescents (aged 12-17 years) who were concurrent clients of two or more service systems (child welfare, juvenile justice, additional education, mental health). It was hypothesised that services adopting PYD approaches would be related to increases in youth resilience and better wellbeing outcomes. It was also hypothesised that risks, resilience, service experiences and wellbeing outcomes would differ by age, gender and ethnicity. Youth completed a self-report questionnaire administered individually. Path analysis was used to determine the relationship between risk, service use, resilience and a wellbeing outcome measure. MANOVA was then used to determine patterns of risk, service use, resilience and wellbeing among participants based on their demographic characteristics. Services using PYD approaches were significantly related to higher levels of youth resilience. Similarly, increased resilience was related to increased indicators of wellbeing, suggesting the mediating role of resilience between risk factors and wellbeing outcomes. When professionals adopt PYD practices and work with the positive resources around youth (their own resilience processes) interventions can make a significant contribution to wellbeing outcomes for at-risk youth.

Client satisfaction with a new group-based model of case management for supported housing services

Supportive housing typically offers rental subsidies and individual intensive community-based case management and has become a predominant service model for homeless adults. Alternative case management models have not been adequately explored. This study evaluates satisfaction with a novel group-intensive peer support (GIPS) model of case management for the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program. A total of 95 HUD-VASH clients rated their satisfaction with services and responded to open-ended questions about what they liked best and least about the program. Quantitative and qualitative analyses compared clients who attended groups as part of the GIPS model and those who did not. No significant difference in satisfaction between group and non-group attenders were found. Clients reported what they liked best about the program was the staff; those who attended groups reported what they liked best was the social interaction and peer support. These findings suggest clients who attend groups for their primary source of case management may be as satisfied as those who receive only individual case management. GIPS offers a feasible and acceptable service model and should be further explored along with other alternative models of care in supportive housing services.