RESUMEN
BACKGROUND: The use of telemedicine for postoperative visits is increasing, especially in rural areas. Few studies have investigated its use for arthroscopic shoulder patients. This study aims to evaluate patient satisfaction with telemedicine for postoperative clinic visits following arthroscopic shoulder procedures in a rural setting. METHODS: Patients were prospectively enrolled using the following exclusion criteria: <18 years, open procedures, and non-compliance follow-up at 6 weeks postoperatively. All patients completed a 13-question satisfaction survey, while telemedicine patients completed an additional, separate seven-question survey. Patients who switched groups completed a four-question prompt to determine the reasons for switching. Differences between groups were evaluated by either Student t-test or Mann-Whitney U-test. RESULTS: The study enrolled 32 patients, with five patients following up by telemedicine and 27 in person. Age and distance from clinic were similar between patients who were assigned to the telemedicine group, completed the telemedicine visit, and opted for in-person visits (all p>0.05). Patient satisfaction did not vary significantly based on care by the surgeon, concerns being addressed, thoroughness of visit, overall clinical assessment at a prior visit, and improvements in pain and physical function (all p>0.05). Among patients who opted out of telemedicine visits, the most common reason was a preference to meet in-person but these patients agreed that telemedicine visits are a good idea. CONCLUSIONS: Regardless of type of follow-up, individuals reported similar levels of satisfaction with treatment during the visit and improvements in pain and physical function.
RESUMEN
BACKGROUND: In pancreatic cancer, surgical resection with neoadjuvant therapy improves survival, but survival relies significantly on the margin status of the resected tissue. This study aimed to develop a model that predicts margin positivity, and then to identify facility-specific factors that influence the observed-to-expected (O/E) ratio for positive margins among facilities. METHODS: This retrospective review analyzed patients in the National Cancer Database (2004-2016) with pancreatic head adenocarcinoma [tumor-node-metastasis (TNM) stage 1 or 2] who received neoadjuvant therapy for a pancreaticoduodenectomy. Logistic regression was used to develop a model that predicts margin positivity. This model then was used to identify outlier facilities with regard to the O/E ratio. Hospital volume was defined as the total number of pancreaticoduodenectomies per year. RESULTS: The study enrolled 4085 patients, and 16.8% of these patients had positive margins. Most of the patients (64%) had a tumor size of 2 to 4 cm, and approximately 51% of the patients did not have positive lymph nodes at resection. A logistic regression model showed that the predictors of positive margins after resection with neoadjuvant therapy were male sex, larger tumor size, and positive lymph nodes. This model was validated to yield a bootstrap-corrected concordance index of 0.632. The study calculated O/E ratios with the model, identifying 12 low- and 17 high O/E-ratio outlier facilities among 401 studied hospitals. The outlier hospitals did not differ in facility type (i.e., academic vs integrated network), but did differ significantly in terms of yearly hospital volume (low outlier of 20.6 vs high outlier of 10.7; p = 0.008). CONCLUSIONS: An association of lower-volume facilities with higher than expected rates of positive margins was found to indicate a disparity in care. This disparity was identified via an O/E ratio as a quality indicator for facilities. Facilities can gauge the efficiency of their own practices by referencing their O/E ratios, and they also can improve their practices by analyzing the framework of low O/E-ratio facilities.
