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1.
MMWR Morb Mortal Wkly Rep ; 69(37): 1300-1304, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32941409

RESUMO

Nursing homes are high-risk settings for outbreaks of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (1,2). During the COVID-19 pandemic, U.S. health departments worked to improve infection prevention and control (IPC) practices in nursing homes to prevent outbreaks and limit the spread of COVID-19 in affected facilities; however, limited resources have hampered health departments' ability to rapidly provide IPC support to all nursing homes within their jurisdictions. Since 2008, the Centers for Medicare & Medicaid Services (CMS) has published health inspection results and quality ratings based on their Five-Star Quality Rating System for all CMS-certified nursing homes (3); these ratings might be associated with facility-level risk factors for COVID-19 outbreaks. On April 17, 2020, West Virginia became the first state to mandate and conduct COVID-19 testing for all nursing home residents and staff members to identify and reduce transmission of SARS-CoV-2 in these settings (4). West Virginia's census of nursing home outbreaks was used to examine associations between CMS star ratings and COVID-19 outbreaks. Outbreaks, defined as two or more cases within 14 days (with at least one resident case), were identified in 14 (11%) of 123 nursing homes. Compared with 1-star-rated (lowest rated) nursing homes, the odds of a COVID-19 outbreak were 87% lower among 2- to 3-star-rated facilities (adjusted odds ratio [aOR] = 0.13, 95% confidence interval [CI] = 0.03-0.54) and 94% lower among 4- to 5-star-rated facilities (aOR = 0.06, 95% CI = 0.006-0.39). Health departments could use star ratings to help identify priority nursing homes in their jurisdictions to inform the allocation of IPC resources. Efforts to mitigate outbreaks in high-risk nursing homes are necessary to reduce overall COVID-19 mortality and associated disparities. Moreover, such efforts should incorporate activities to improve the overall quality of life and care of nursing home residents and staff members and address the social and health inequities that have been recognized as a prominent feature of the COVID-19 pandemic in the United States (5).


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Qualidade da Assistência à Saúde/normas , Idoso , Centers for Medicare and Medicaid Services, U.S. , Humanos , Casas de Saúde/normas , Pandemias , Medição de Risco/métodos , Estados Unidos/epidemiologia , West Virginia/epidemiologia
6.
Malawi Med J ; 32(1): 19-23, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32733655

RESUMO

Background: Globally, critical illness causes up to 45 million deaths every year. The burden is highest in low-income countries such as Malawi. Critically ill patients require good quality, essential care in emergency departments and in hospital wards to avoid negative outcomes such as death. Little is known about the quality of care or the availability of necessary resources for emergency and critical care in Malawi. The aim of this study was to assess the availability of resources for emergency and critical care in Malawi using data from the Service Provision Assessment (SPA). Methods: We conducted a secondary data analysis of the SPA - a nationwide survey of all health facilities. We assessed the availability of resources for emergency and critical care using previously developed standards for hospitals in low-income countries. Each health facility received an availability score, calculated as the proportion of resources that were present. Resource availability was sub-divided into the seven a-priori defined categories of drugs, equipment, support services, emergency guidelines, infrastructure, training and routines. Results: Of the 254 indicators in the standards necessary for assessing the quality of emergency and critical care, SPA collected data for 102 (40.6%). Hospitals had a median resource availability score of 51.6% IQR (42.2-67.2) and smaller health facilities had a median of 37.5% (IQR 28.1-45.3). For the category of drugs, the hospitals' median score was 62.0% IQR (52.4-81.0), for equipment 51.9% IQR (40.7-66.7), support services 33.3% IQR (22.2-77.8) and emergency guidelines 33.3% IQR (0-66.7). SPA did not collect any data for resources in the categories of infrastructure, training or routines. Conclusion: Hospitals in Malawi lack resources for providing emergency and critical care. Increasing data about the availability of resources for emergency and critical care and improving the hospital systems for the care of critically ill patients in Malawi should be prioritized.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Estado Terminal/terapia , Serviço Hospitalar de Emergência/normas , Recursos em Saúde/provisão & distribução , Qualidade da Assistência à Saúde/normas , Estado Terminal/mortalidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Instalações de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , Malaui/epidemiologia , Inquéritos e Questionários
8.
Health Qual Life Outcomes ; 18(1): 241, 2020 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-32690091

RESUMO

BACKGROUND: With a shift in the healthcare paradigm towards a more patient-centered approach, data on inflammatory bowel disease (IBD) needs to be further explored. This study aimed to determine patient perspectives on the effect of IBD and features of patients with lower satisfaction level and compare patient and physician perception of IBD-related Quality of Care (QoC). METHODS: A previously developed pre-standardised set of questions regarding patient-centered outcome (PRO) measures for IBD, comprising 36 items, was administered in five centers, and a concomitant questionnaire for specialised physicians was adapted and administered. RESULTS: Overall, 1005 patients with IBD met the inclusion criteria. Sixty-five questionnaires were administered to specialised physicians. Both patients and physicians perceived the IBD-related QoC as being satisfactory. Furthermore, this study revealed areas of shortcomings where it comes to patient perceptions. Female sex and the presence of negatively impacting disease characteristics (presence of significant pain or discomfort, lack of energy, feeling fatigued most of the time, experiencing anxiety or depression in the last 2 weeks) were associated with lower satisfaction levels. CONCLUSIONS: Our findings can be used in establishing strategies aimed at improving patient QoC and defining strategic priorities. These data can aid in improving the communication of the pressing needs of IBD patients, to both the public payers and health authorities.


Assuntos
Doenças Inflamatórias Intestinais/psicologia , Medidas de Resultados Relatados pelo Paciente , Satisfação do Paciente , Adulto , Idoso , Consenso , Estudos Transversais , Feminino , Humanos , Doenças Inflamatórias Intestinais/terapia , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/normas , Qualidade da Assistência à Saúde/normas , Qualidade de Vida , Adulto Jovem
9.
PLoS One ; 15(7): e0236019, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32667953

RESUMO

BACKGROUND: Delivery of preventive care and chronic disease management are key components of a high functioning primary care practice. Health Centers (HCs) funded by the Health Resources and Services Administration (HRSA) have been delivering affordable and accessible primary health care to patients in underserved communities for over fifty years. This study examines the association between health center organization's health information technology (IT) optimization and clinical quality performance. METHODS AND FINDINGS: Using 2016 Uniform Data System (UDS) data, we performed bivariate and multivariate analyses to study the association of Meaningful Use (MU) attestation as a proxy for health IT optimization, patient centered medical home (PCMH) recognition status, and practice size on performance of twelve electronically specified clinical quality measures (eCQMs). Bivariate analysis demonstrated performance of eleven out of the twelve preventive and chronic care eCQMs was higher among HCs attesting to MU Stage 2 or above. Multivariate analysis demonstrated that Stage 2 MU or above, PCMH status, and larger practice size were positively associated with performance on cancer screening, smoking cessation counseling and pediatric weight assessment and counseling eCQMs. CONCLUSIONS: Organizational advancement in MU stages has led to improved quality of care that augments HCs patient care capacity for disease prevention, health promotion, and chronic care management. However, rapid technological advancement in health care acts as a potential source of disparity, as considerable resources needed to optimize the electronic health record (EHR) and to undertake PCMH transformation are found more commonly among larger HCs practices. Smaller practices may lack the financial, human and educational assets to implement and to maintain EHR technology. Accordingly, targeted approaches to support small HCs practices in leveraging economies of scale for health IT optimization, clinical decision support, and clinical workflow enhancements are critical for practices to thrive in the dynamic value-based payment environment.


Assuntos
Promoção da Saúde/normas , Informática Médica/normas , Assistência Centrada no Paciente/normas , Atenção Primária à Saúde/normas , Melhoria de Qualidade , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
Med Care ; 58(8): 696-702, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692135

RESUMO

BACKGROUND: Poor coordination between the Department of Veterans Affairs (VA) and non-VA care may negatively impact health care quality. Recent legislation is intended to increase Veterans' access to care, in part through increased use of non-VA care. However, a possible consequence may be diminished patient experiences of coordination. OBJECTIVE: The objective of this study was to determine VA patients' and clinicians' experiences of coordination across VA and non-VA settings. DESIGN: Observational mixed methods using patient surveys and clinician interviews. Sampled patients were diagnosed with type 2 diabetes mellitus and either cardiovascular or mental health comorbidities. PARTICIPANTS AND MEASURES: Patient perspectives on coordination were elicited between April and September 2016 through a national survey supplemented with VA administrative records (N=5372). Coordination was measured with the 8-dimension Patient Perceptions of Integrated Care survey. Receipt of non-VA care was measured through patient self-report. Clinician perspectives were elicited through individual interviews (N=100) between May and October 2017. RESULTS: Veterans who received both VA and non-VA care reported significantly worse care coordination experiences than Veterans who only receive care in VA. Clinicians report limited information exchange capabilities, which, combined with bureaucratic and opaque procedures, adversely impact clinical decision-making. CONCLUSIONS: VA is working through a shift in how Veterans receive health care by increasing access to care from non-VA providers. Study findings suggest that VA should prioritize coordination of care in addition to access. This could include requiring monitoring of patient-experienced care coordination, surveys of referring and consulting clinicians, and pilot testing and evaluation of interventions to improve coordination.


Assuntos
Pessoal de Saúde/psicologia , Organização e Administração/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Veteranos/psicologia , Adulto , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários , Estados Unidos , Veteranos/estatística & dados numéricos
11.
Med Care ; 58(8): 744-748, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692141

RESUMO

INTRODUCTION: Cancer patients' experience of care is an important component of quality that has not previously been used for comparing performance. We administered a new patient experience survey to cancer patients receiving outpatient chemotherapy treatment. We examined its measures for sensitivity to adjustment for case-mix and response tendency (level of general optimism/pessimism) and reliability for making performance comparisons between practices. METHODS: We surveyed 2304 cancer patients who received chemotherapy at 23 medical oncology practices in Southeastern Pennsylvania, receiving 715 responses (response rate 31%; 14 practices had 10 or more responses). We aggregated patient responses to calculate practice-level scores on 5 predefined composites: Affective Communication, Shared Decision-Making, Patient Self-Management, Exchanging Information, and Access. We then ranked the practices on each composite before and after adjustment for standard case-mix variables and supplemental adjustment for response tendency (measured via the Life Orientation Test-Revised). We calculated the reliability of practice scores on each composite using hierarchical linear models and calculated minimum sample sizes necessary to achieve reliabilities exceeding 0.7. RESULTS: After adjusting responses for case-mix and converting to a 0-100 scale, composite scores ranged from 77 for the Patient Self-Management composite to 92 for the Access composite. Adjustment for response tendency had an impact on practice rankings only for the Shared Decision-Making composite. The number of responses necessary to create reliable practice-level measurements ranged from 17 (Access composite) to 96 (Affective Communication composite). CONCLUSIONS: Patient experiences at oncology practices can be measured reliably using reasonable sample sizes. Standard case-mix adjustment is adequate for making comparisons on most composites.


Assuntos
Institutos de Câncer/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer/estatística & dados numéricos , Tomada de Decisão Compartilhada , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania , Relações Profissional-Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
12.
J Nurs Adm ; 50(7-8): 385-394, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32701643

RESUMO

OBJECTIVES: Study objectives were to: 1) explore how nursing care quality data (NCQD) was understood and interpreted; and 2) identify, compare, and contrast individual and group responses. BACKGROUND: Little evidence exists on how to best disseminate NCQD information. This study explores the outcomes of implementing an NCQD and human-interest information slide show across an inpatient surgery nursing service line using electronic screens. METHODS: Methods included semistructured interviews, qualitative analysis, and diagramming. RESULTS: The human-interest content most often attracted viewers' attention, but they were also exposed to NCQD. Interpretations and understandings differed among groups and between individuals. Among staff members, the human-interest content facilitated team-building, whereas NCQD provided meaningful recognition. Nursing care quality data evidenced the efforts that were being made to improve and provide excellent patient care. CONCLUSIONS: Using innovative dissemination methods can enhance understanding of NCQD among clinical providers. Creating microclimates of change and innovation within complex healthcare environments can benefit staff members and patients.


Assuntos
Disseminação de Informação , Microclima , Cuidados de Enfermagem/normas , Inovação Organizacional , Qualidade da Assistência à Saúde/normas , Adulto , Feminino , Humanos , Entrevistas como Assunto , Recursos Humanos de Enfermagem no Hospital/normas , Televisão
13.
Med Care ; 58(7): 643-650, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32520838

RESUMO

BACKGROUND: Investigating primary care provider (PCP)-team communication can provide insight into how colleagues work together to become high-functioning teams more able to address an increasingly complex set of tasks associated with chronic disease management. OBJECTIVE: To assess how PCP communication with their care team relates to patients' health. RESEARCH DESIGN: Longitudinal study of how 3 aspects of PCP-care team communication-participation, time spent listening, and uninterrupted speaking length-relate to disease management of patients with hypertension or diabetes, and the effect of these team communication behaviors on PCP-patient communication as a pathway by which this relationship might exist. We used multilevel regression models. SUBJECTS: Twenty-seven PCPs and 98 team members, and 18,067 patients with hypertension and 8354 patients with diabetes affiliated with a federally qualified health center with 12 practice sites. MEASURES: Primary data on communication collected using sociometric sensors worn by PCPs and team members, patient-PCP communication data collected with surveys, and patient health, PCP and patient characteristics extracted from electronic records. RESULTS: PCPs participated in 75% of care team conversations, spent 56% of conversation time listening, and had an average uninterrupted speaking length of 2.42 seconds. PCP participation, listening, and length of uninterrupted speaking time were associated with significantly higher odds that their patients had controlled hypertension and diabetes and improvements in disease control over time. PCP-patient communication mediates this relationship. CONCLUSIONS: PCP-team communication is associated with patient health management. How team members speak with one another may be as important as the content of their communication.


Assuntos
Gerenciamento Clínico , Comunicação Interdisciplinar , Equipe de Assistência ao Paciente/normas , Atenção Primária à Saúde/métodos , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente/estatística & dados numéricos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Inquéritos e Questionários
14.
Med Care ; 58(7): 658-662, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32520839

RESUMO

BACKGROUND: Single-center comparative effectiveness studies evaluating outcomes that can occur posthospitalization may become biased if outcomes diagnosed at other facilities are not ascertained. Administrative datasets that link patients' records across facilities may improve outcome ascertainment. OBJECTIVE: To determine whether use of linked administrative data significantly augments thromboembolic outcome ascertainment. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: Patients with an acute isolated calf deep vein thrombosis (DVT) diagnosed at 1 Californian center during 2010-2013. MEASURES: Proximal DVT or pulmonary embolism (PE) within 180 days. We ascertained outcomes from linked California hospitalization, emergency department, and ambulatory surgery data and compared this information to outcomes previously identified from review of the center's medical records. RESULTS: Among 384 patients with an isolated calf DVT, 333 could be linked to longitudinal administrative data records. Ten patients had a possible proximal DVT or PE (4 more clearly so) from administrative data; all were unknown from medical record review. Eleven patients with known outcomes from medical record review had no outcome from administrative data. The adjusted odds ratio of proximal DVT or PE with therapeutic anticoagulation attenuated from 0.33 [95% confidence interval (CI), 0.12-0.87] using only medical record review to 0.64 (95% CI, 0.29-1.40) using both medical record review and possible outcomes from administrative data. Restricting the outcome to diagnoses clearly involving proximal DVT or PE, the adjusted odds ratio was 0.46 (95% CI, 0.19-1.10). CONCLUSIONS: Use of linked hospital administrative data augmented detection of outcomes but imperfect linkage, nonspecific diagnoses, and documentation/coding errors introduced uncertainty regarding the accuracy of outcome ascertainment.


Assuntos
Anticoagulantes/uso terapêutico , Organização e Administração/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/normas , Tromboembolia Venosa/tratamento farmacológico , Adulto , Idoso , California , Estudos de Coortes , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/fisiopatologia , Masculino , Pessoa de Meia-Idade , Razão de Chances , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Tromboembolia Venosa/prevenção & controle
15.
Br J Radiol ; 93(1113): 20200082, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32584595

RESUMO

OBJECTIVE: To understand the status of pre-procedural safety practices in radiological examinations at radiology residency training institutions in various Asian regions. METHODS: A questionnaire based on the Joint Commission International Accreditation Standards was electronically sent to 3 institutions each in 10 geographical regions across 9 Asian countries. Questions addressing 45 practices were divided into 3 categories. A five-tier scale with numerical scores was used to evaluate safety practices in each institution. Responses obtained from three institutions in the United States were used to validate the execution rate of each surveyed safety practice. RESULTS: The institutional response rate was 70.0% (7 Asian regions, 21 institutions). 44 practices (all those surveyed except for the application of wrist tags for identifying patients with fall risks) were validated using the US participants. Overall, the Asian participants reached a consensus on 89% of the safety practices. Comparatively, most Asian participants did not routinely perform three pre-procedural practices in the examination appropriateness topic. CONCLUSION: Based on the responses from 21 participating Asian institutions, most routinely perform standard practices during radiological examinations except when it comes to examination appropriateness. This study can provide direction for safety policymakers scrutinizing and improving regional standards of care. ADVANCES IN KNOWLEDGE: This is the first multicenter survey study to elucidate pre-procedural safety practices in radiological examinations in seven Asian regions.


Assuntos
Consenso , Pesquisas sobre Serviços de Saúde , Segurança do Paciente/normas , Qualidade da Assistência à Saúde/normas , Radiografia/normas , Ásia , China , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Internato e Residência , Japão , Imagem por Ressonância Magnética/normas , Malásia , Tomografia por Emissão de Pósitrons , Radiologia/educação , República da Coreia , Gestão da Segurança/normas , Singapura , Taiwan , Tomografia Computadorizada por Raios X/normas
17.
PLoS One ; 15(6): e0234988, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559256

RESUMO

BACKGROUND: Even though there are different tuberculosis (TB) prevention and control measures implemented globally including Ethiopia, TB is still major public health problem. This is partly due to compromised quality of care delivered for tuberculosis patients in health facilities (HFs) during diagnosis, treatment and follows-up. Thus this study is intended to determine the quality of care delivered for TB patients in all public HFs of Debre Tabor town, Northwest Ethiopia. METHODS: Cross sectional study was conducted from January to May 2018. Data were collected with face-to-face interview and TB registration book review using structured questionnaire and checklist respectively. Collected data was entered and processed using SPSS and P value <0.05 was considered statistically significant. The quality of care for each HF was graded as very good, good, moderate, poor and very poor if HFs achieve [90-100%], [80-90%), [70-80%), [60-70%) and <60% of performance indicators respectively using Donabedian structure, process and outcome model of health care quality. RESULTS: All HFs have sputum collection area, enough microscopic slide, at least one functional microscope and sufficient anti TB drug supply. But HFs lack backup laboratory stains. Overall structural aspects of quality of care in all HFs were very poor achieving 42.5-52.9% structural performance indicators out of 100%. Similarly the overall process aspects of quality of care was poor in all public HFs which achieved 60-68.9% of the scores out of 100%. In the study; 68.9%, 54.5% and 80.6% of Medical Laboratory, pharmacy and other healthcare workers (HWs) provided correct response respectively on TB causative agent, risk factor, transmission, treatment, prevention, case management and case finding strategies. HWs who knew at least two TB case finding strategies in DTH was significantly higher than those HWs working in Health Centers (P = 0.004). On the other hand, except Ginbot 20 HC, HFs was graded as good by scoring 86.6-89.3% of performance indicators on the outcome aspects of quality of care. In all HFs studied, all TB patients' unit TB registration number, sex, age, TB category, treatment initiation date and intensive phase treatment start year were properly registered. Moreover 110 (78%) and 147 (69%) contact person address in DTH and HCs was properly registered on TB unit register book respectively with no statistical difference in hospital and HCs (P = 0.063). There was proper TB patients' address registration in hospital than HCs studied (P< 0.001). CONCLUSIONS: The outcome aspects of quality of care for TB patients in all HFs were promising. But structural & process aspects of quality of care was compromised which necessitate different corrective actions to be taken by different stakeholders to enhance quality of care for TB patients in public HFs studied. Moreover based on the study findings, continuous supply of drugs, laboratory equipment and reagents, availing current guideline/s in HFs, providing up-to-date training for HWs on TB and proper documentation are important to improve quality of care provided for TB patients.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Tuberculose Pulmonar/terapia , Adulto , Etiópia , Feminino , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários , Tuberculose Pulmonar/epidemiologia
20.
Clin Orthop Surg ; 12(2): 238-244, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32489547

RESUMO

Backgroud: Physician-rating websites (PRWs) are designed to publicly report physician quality information while bringing forth a sense of transparency. This study looks to identify the influence PRWs have on a patient's choice of orthopedic hand surgeon while stratifying patient physician preference by various demographic characteristics. Methods: This survey-based study was conducted in a suburban outpatient orthopedic hand practice. All patients between 18 to 89 years of age who presented for an appointment were asked to participate. Survey questions aimed to identify patient demographics and the sources patients used to choose their hand surgeon. Results: Overall, 104 patients completed our survey. Our study population was predominantly between 51 and 70 years of age (50.0%), women (60.6%), and Caucasian (84.6%), received a general education degree or high school diploma (36.5%), was employed (49.0%), and owned private health insurance (59.6%). One hundred and two patients (98.1%) answered that their physician's reputation is important. Seventy-five patients (72.1%) reported that they heard about their surgeon by physician referral, while only two (1.9%) used online search engines. Sixty-six patients (63.5%) noted that physician referrals were most trustworthy. Only 10 patients (9.6%) consulted PRWs to choose their surgeon, most of whom were younger than 50 years (n = 6), Caucasian (n = 8), and employed (n = 7) and had schooling after high school (n = 8). Conclusions: Despite increases in digital information exchange platforms, PRWs are not commonly used by suburban orthopedic hand patients to exchange information about or choose their hand surgeon. Patients still primarily rely on physician referrals and word of mouth from family and friends to choose their surgeon.


Assuntos
Disseminação de Informação , Internet , Cirurgiões Ortopédicos/normas , Preferência do Paciente , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
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