Race, Ethnicity, and Other Patient and Clinical Encounter Characteristics Associated with Patient Experiences of Access to Care.

The Press Ganey (PG) Outpatient Medical Practice Survey measures patients' experiences of healthcare access in the U.S. We aimed to identify differences in experiences of access to care by patient race, ethnicity, and other sociodemographic characteristics, an important first step in informing health policy and ensuring equitable healthcare delivery. We performed a cross-sectional analysis of PG surveys for adult outpatient visits within the University of Pennsylvania Health System from 2014-2017, including 119,373 unique patients. Compared with White patients, Black (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.80-0.87), Asian (OR 0.62; 95% CI 0.58-0.66), and other/unknown race patients (OR 0.83; 95% CI 0.72-0.94) were each less likely to report the maximum score for timely access to care. Patients of all minoritized groups, as well as those whose primary language was not English, reported lower scores in secondary access measures related to communication and respect, compared to White and primarily English-speaking patients, respectively. Efforts to improve the experience of access to care among racial and ethnic minoritized patients are imperative to achieve equity in healthcare delivery.

Patient Experience with Virtual Preoperative Consultations in Pediatric Surgical Specialties.

BACKGROUND: A cross-sectional study was conducted to assess the comparative effectiveness of virtual visits for preoperative evaluation and surgical decision-making in three pediatric surgical subspecialties. METHODS: Patients who underwent surgical procedures in the departments of Urology, Ophthalmology, and Plastic and Oral Surgery at a tertiary care pediatric hospital over a one-year period during the COVID-19 pandemic were included. Patients were assigned to one of three clinical pathways based on their preoperative visit(s): only in-person visit(s) (IP), a combination of in-person and virtual visit(s) (IP/VV), and only virtual visit(s) (VV). Demographics, procedure information, and patient experience survey results were collected. We then assessed variations in procedure types and patient experience scores in these three patient groups. RESULTS: There were 431 patients who completed the modified patient experience survey. The most common procedures were circumcision (17%), excision of lesion (16%), and strabismus repair (11%). Survey results were positive, with 90% of participants rating that they would recommend the service to others. No significant differences were found among groups in their demographics, overall care rating, and duration between preoperative clinic visit and procedure. Post-hoc power analysis indicated 87% power to detect a 10% difference in survey ratings between IP and VV cases, confirming non-inferiority in patient satisfaction for virtual preoperative visits. CONCLUSION: This study demonstrated the non-inferiority of preoperative virtual visits in three pediatric surgical subspecialties as measured by patient experience scores. Additional studies with more granular scope are necessary to further elucidate telemedicine's safety and efficacy for select diagnoses. LEVEL OF EVIDENCE: III.

What factors influence patient experience in orthopedic oncology office visits?

BACKGROUND: Patient satisfaction and reported outcomes are becoming increasingly important in determining the efficacy of clinical care. To date no study has evaluated the patient experience in the orthopedic oncology outpatient setting to determine which factors of the encounter are priorities to the patient. AIM: To evaluate what factors impact patient experience and report satisfaction in an outpatient orthopedic oncology clinic. METHODS: Press Ganey® patient surveys from a single outpatient orthopedic oncology clinic at a tertiary care setting were prospectively collected per routine medical care. All orthopedic oncology patients who were seen in clinic and received electronic survey were included. All survey responses were submitted within one month of clinic appointment. IRB approval was obtained to retrospectively collect survey responses from 2015 to 2016. Basic demographic data along with survey category responses were collected and statistically analyzed. RESULTS: One hundred sixty-two patient surveys were collected. Average patient age was 54.4 years (SD = 16.2 years) and were comprised of 51.2% female and 48.4% male. 64.2% of patients were from in-state. Out of state residents were more likely to recommend both the practice and attending physician. The likelihood to recommend attending physician was positively associated with MD friendliness/courtesy (OR = 14.4, 95%CI: 2.5-84.3), MD confidence (OR = 48.2, 95%CI: 6.2-376.5), MD instructions follow-up care (OR = 2.5, 95%CI: 0.4-17.4), and sensitivity to needs (OR = 16.1, 95%CI: 1-262.5). Clinic operations performed well in the categories of courtesy of staff (76%) and cleanliness (75%) and less well in ease of getting on the phone (49%), information about delays (36%), and wait time (37%). CONCLUSION: Orthopedic specialties can utilize information from this study to improve care from the patient perspective. Future studies may be directed at how to improve these areas of care which are most valued by the patient.

Pain intensity in total hip arthroplasty patients: how communication influences satisfaction.

INTRODUCTION: An important global measure of health care quality is patient satisfaction. Patient satisfaction partially determines hospital reimbursement for procedures such as total hip arthroplasty (THA). Press Ganey (PG) survey responses assess patient satisfaction, and impact reimbursement. Current efforts to maximise repayment for THA include reducing postoperative pain. The "Pain Management" survey domain is considered a significant factor in patient ratings, but other studies have highlighted staff communication domains as determinants of satisfaction. Therefore, the purpose of this study is to compare PG survey responses to inpatient pain intensity. METHODS: We queried the PG database for all patients who underwent a THA between November 2012 and January 2015. This yielded a total of 302 patients. Descriptive statistics were performed to analyse patient-level demographics. A multivariate regression model was constructed utilising pain intensity as the dependent variable. RESULTS: Patients rating of "Communication with Doctors" (B = -25.534; p < 0.001) and "Communication about Medicines" (B = -31.49; p = < 0.001) domains were representative of patient pain intensity. No other factors demonstrated a significant relationship to pain intensity. CONCLUSIONS: Patient satisfaction continues to be important in care quality. Surrogate markers, such as the PG survey, can guide institutions looking to improve care. Our study revealed scores for "Communication with Doctors" and "Communication about Medicines" best represented true pain intensity levels for THA recipients during the postoperative period. The "Pain Management" domain did not display a relationship to pain intensity. The current method of measuring patient satisfaction should be reassessed to better represent patient responses and outcomes.

No Correlation Between Press Ganey Survey Responses and Outcomes in Post-Total Hip Arthroplasty Patients.

BACKGROUND: In the era of the online orthopedic market, patients tend to equate publicly available online satisfaction surveys with what they presume their ultimate surgical outcome will be. Therefore, the purpose of this study was to assess whether there is a correlation between Press Ganey (PG) scores and (1) Hip Western Ontario and McMaster Universities Osteoarthritis Index and Harris Hip Score; (2) Short Form-12 and Short Form-36 scores; (3) University of California Los Angeles and Visual Analog Scale scores assessed at a mean of 3 years (range, 1 to 6 years) after surgery. In addition, we assessed whether (4) these correlations persist in patients who were evaluated under 2 years and 3 or more years after surgery. METHODS: Six-hundred ninety-two patients from November 2009 to January 2015 were identified from our institutional PG database. One-hundred ninety (27%) responded to the survey. One-hundred forty-nine (78%) patients were given the total hip arthroplasty assessment tools at a minimum of 2-year follow-up, and 33 patients (17%) completed their survey before 2 years after surgery. We assessed whether overall hospital rating scores correlated with the above assessment tools. RESULTS: Pearson correlation analysis revealed no correlation between the PG survey score and the assessment tools. HHS had the highest correlation coefficient (r = .120; P = .316); however, this was not significant. After removing the patients who had their follow-up survey administered under 2 years after surgery (33 patients), there was still no statistically significant correlation between the above-mentioned outcome scores and PG overall hospital rating (P > .05). CONCLUSION: No statistically significant relationship was found between commonly used total hip arthroplasty assessment tools and the PG overall hospital rating. Based on these results, PG surveys may not be a suitable implementation of the Center for Medicare and Medicaid services. A set of measures that can be widely collected and reported by hospitals for patients to use in order to evaluate hip arthroplasty outcomes needs to be developed. These results are of paramount importance, indicating a necessary reevaluation of PG surveys as a major determinant for reimbursements rendered by orthopedists and their use by patients.

Factors impacting Press Ganey patient satisfaction scores in orthopedic surgery spine clinic.

BACKGROUND CONTEXT: Patient satisfaction is and will continue to become an important metric in the American health care system. To our knowledge, there is no current literature exploring the factors that impact patient satisfaction in outpatient orthopedic spine surgery clinic. PURPOSE: The purpose of this study was to determine which factors impact patient satisfaction in an outpatient orthopedic spine clinic. STUDY DESIGN: This is a case series, level of evidence IV. PATIENT SAMPLE: We reviewed the Press Ganey Associates database to identify patients seen in an orthopedic spine surgery clinic from 2013 to 2015. OUTCOME MEASURES: Outcome measures were self-reported, which included visual analog pain scores and Press Ganey satisfaction scores. METHODS: Retrospective computerized Press Ganey survey review was performed to identify patient demographics and patient visit characteristics. Bivariate analysis was used by splitting the patient response into the following: 0-3 (not satisfied), 4-7 (somewhat satisfied), and 8-11 (satisfied). Kruskal-Wallis test and Fisher exact test were used to evaluate the significance of patient and visit characteristics. Any variable that had a p-value less than .20 was subjected to the Poisson regression model. RESULTS: Overall, 353 patients were seen in an orthopedic spine surgery clinic and completed the Press Ganey survey. Three hundred and thirty-two patients were satisfied with their visit. Patients who were satisfied had a mean pain score of 4.02; patients who were somewhat satisfied or not satisfied had a pain score of 7 and 6, respectively (p=.009). Of 21 patients who felt the provider did not spend enough time with him or her, five (24%) patients were not satisfied with their visit. Poisson regression model confirmed significance of pain score and "provider time spent with you." Most impactful was "provider spent enough time with you" where a "yes, definitely" answer predicted a nearly 60% increase in Press Ganey overall satisfaction score. CONCLUSIONS: Two patient variables that have a statistical significance on Press Ganey patient satisfaction scores were pain score and "provider spent enough time with you."