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Chiang MC, Huang CC, Hu TH, Chou WC, Chuang LP, Tang ST. Factors associated with bereaved family surrogates' satisfaction with end-of-life care in intensive care units. Intensive Crit Care Nurs 2022; 71:103243. [PMID: 35396097 DOI: 10.1016/j.iccn.2022.103243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Family satisfaction with end-of-life care in the intensive care unit constitutes an important outcome for evaluating end-of-life care quality. Research on this topic focuses on linking end-of-life care processes to family-surrogate satisfaction with the patient's end-of-life care but has seldom examined patient- and family-surrogate-based factors. We aimed to comprehensively and simultaneously examine factors facilitating or deterring family satisfaction with end-of-life care in the intensive care unit from patient- and family-surrogate perspectives. METHODS For this secondary-analysis study, 278 Taiwanese family surrogates were surveyed one-month post-patient death using the Family Satisfaction in the Intensive Care Unit questionnaire (FS-ICU), which measures care and decision-making. Associations between family satisfaction with end-of-life care and patient and family characteristics, patient disease severity, and length of intensive care stay were examined by multivariate, multilevel linear regression models. RESULTS Female family surrogates were more satisfied with patients' end-of-life care than male family surrogates when patients had a higher APACHE II but a lower SOFA score. Adult-child surrogates had lower FS-ICU Care scores than other family surrogates. Higher satisfaction with ICU decision-making was associated with patients' higher APACHE II but lower SOFA scores, longer stay and family socio-demographics, including being unmarried, educational attainment above junior high school and reported financial sufficiency to make ends meet. CONCLUSION Patient disease severity and family-surrogate characteristics are significantly associated with surrogates' satisfaction with patients' end-of-life care in the intensive care unit. Specific interventions should be tailored to the needs of high-risk family surrogates to increase their satisfaction with this care.
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Affiliation(s)
- Ming Chu Chiang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC
| | - Chung-Chi Huang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; Department of Respiratory Therapy, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Tsung-Hui Hu
- Department of Internal Medicine, Division of Hepato-Gastroenterology, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Li-Pang Chuang
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC; Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC; School of Nursing, Medical College, Chang Gung University, Tao-Yuan, Taiwan, ROC.
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Knutsson B, Kadum B, Eneqvist T, Mukka S, Sayed-Noor AS. Patient Satisfaction With Care Is Associated With Better Outcomes in Function and Pain 1 Year After Lumbar Spine Surgery. J Patient Cent Res Rev 2022; 9:7-14. [PMID: 35111878 PMCID: PMC8772612 DOI: 10.17294/2330-0698.1883] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024] Open
Abstract
PURPOSE There has been increasing interest in patient-reported experience measures (PREMs) to evaluate the patient experience and satisfaction with care. We conducted a prospective multicenter cohort study to determine any association between patients' satisfaction of care and their outcomes 1 year after lumbar spine surgery. METHODS Satisfaction with care was recorded through telephone interviews and a standardized questionnaire. Baseline data collection (300 patients) and 1-year follow-up (209 patients) were conducted through The Swedish National Register for Spine Surgery (Swespine). Exposures were patient experiences, health care professional (HCP) attitudes, shared decision-making, and overall satisfaction with care. Associations were evaluated using adjusted analysis of covariance (ANCOVA) models. RESULTS Satisfaction with HCP attitudes was not associated with improvements at 1 year in Oswestry Disability Index (ODI) or back pain; however a significantly greater improvement in leg pain score was reported by patients who were highly satisfied (3.0 points) versus the moderate/low satisfaction group (1.3 points; P=0.008). For shared decision-making, high satisfaction was associated with significantly greater improvements, as compared to moderate/low satisfaction, in ODI (20 vs 11 points; P=0.001), back pain (2.6 vs 1.7 points; P=0.05), and leg pain (3.2 vs 1.9 points, P=0.007). Similarly, high overall satisfaction with care was associated with significantly greater improvements in ODI (18 vs 10 points; P=0.02), back pain (3.2 vs 0.6 points; P<0.001), and leg pain (2.6 vs 1.1 points; P=0.009). CONCLUSIONS Findings indicate that shared decision-making on perioperative care and patients' overall satisfaction with care were associated with better health outcomes 1 year after lumbar spine surgery.
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Affiliation(s)
- Björn Knutsson
- Department of Surgical and Perioperative Sciences, Orthopedics, Umeå University, Umeå, Sweden
| | - Bakir Kadum
- Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Ted Eneqvist
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Sebastian Mukka
- Department of Surgical and Perioperative Sciences, Orthopedics, Umeå University, Umeå, Sweden
| | - Arkan S. Sayed-Noor
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
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Racial/ethnic disparities in patient experiences with care and Gleason score at diagnosis of prostate cancer: a SEER-CAHPS study. Cancer Causes Control 2022; 33:601-612. [PMID: 35032242 DOI: 10.1007/s10552-022-01552-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 12/30/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To determine whether racial/ethnic differences in patient experiences with care, potentially leading to underutilization of necessary care, are associated with disparities in Gleason score at diagnosis. METHODS We used the SEER-CAHPS linked dataset to identify Medicare beneficiaries who completed a Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey prior to diagnosis of prostate cancer. Independent variables included aspects of patient experiences with care captured by CAHPS surveys. We conducted survey weighted multivariable multinomial logistic regression analyses, stratified by patient race/ethnicity, to estimate associations of CAHPS measures with Gleason score at diagnosis. RESULTS Of the 4,245 patients with prostate cancer, most were non-Hispanic white (NHW) (77.6%), followed by non-Hispanic black (NHB) (8.4%), Hispanic (8.4%), and Asian (5.6%). Excellent experience with getting needed prescription drugs was associated with lower odds of Gleason scores of 7 and 8-10 in NHBs (7: OR = 0.19, 95% CI = 0.05-0.67; 8-10: OR = 0.04, 95% CI = 0.01-0.2) and lower odds of 8-10 in NHWs (OR = 0.61, 95% CI = 0.40-0.93). For NHBs, excellent primary physician ratings were associated with greater odds of a Gleason score of 8-10 (OR = 13.28, 95% CI = 1.53-115.21). CONCLUSION Patient experiences with access to care and physician relationships may influence Gleason score in different ways for patients of different racial/ethnic groups. More research, including large observational studies with greater proportions of racial/ethnic minority patients, is necessary to understand these relationships and target interventions to overcome disparities and improve patient outcomes.
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Woodcock EW. Barriers to and Facilitators of Automated Patient Self-scheduling for Health Care Organizations: Scoping Review. J Med Internet Res 2022; 24:e28323. [PMID: 35014968 PMCID: PMC8790681 DOI: 10.2196/28323] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/25/2021] [Accepted: 11/26/2021] [Indexed: 01/26/2023] Open
Abstract
Background Appointment management in the outpatient setting is important for health care organizations, as waits and delays lead to poor outcomes. Automated patient self-scheduling of outpatient appointments has demonstrable advantages in the form of patients’ arrival rates, labor savings, patient satisfaction, and more. Despite evidence of the potential benefits of self-scheduling, the organizational uptake of self-scheduling in health care has been limited. Objective The objective of this scoping review is to identify and to catalog existing evidence of the barriers to and facilitators of self-scheduling for health care organizations. Methods A scoping review was conducted by searching 4 databases (PubMed, CINAHL, Business Source Ultimate, and Scopus) and systematically reviewing peer-reviewed studies. The Consolidated Framework for Implementation Research was used to catalog the studies. Results In total, 30 full-text articles were included in this review. The results demonstrated that self-scheduling initiatives have increased over time, indicating the broadening appeal of self-scheduling. The body of literature regarding intervention characteristics is appreciable. Outer setting factors, including national policy, competition, and the response to patients’ needs and technology access, have played an increasing role in influencing implementation over time. Self-scheduling, compared with using the telephone to schedule an appointment, was most often cited as a relative advantage. Scholarly pursuit lacked recommendations related to the framework’s inner setting, characteristics of individuals, and processes as determinants of implementation. Future discoveries regarding these Consolidated Framework for Implementation Research domains may help detect, categorize, and appreciate organizational-level barriers to and facilitators of self-scheduling to advance knowledge regarding this solution. Conclusions This scoping review cataloged evidence of the existence, advantages, and intervention characteristics of patient self-scheduling. Automated self-scheduling may offer a solution to health care organizations striving to positively affect access. Gaps in knowledge regarding the uptake of self-scheduling by health care organizations were identified to inform future research.
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Affiliation(s)
- Elizabeth W Woodcock
- Department of Health Policy & Management, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Patient-Reported Care Coordination is Associated with Better Performance on Clinical Care Measures. J Gen Intern Med 2021; 36:3665-3671. [PMID: 34545472 PMCID: PMC8642573 DOI: 10.1007/s11606-021-07122-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 08/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prior studies using aggregated data suggest that better care coordination is associated with higher performance on measures of clinical care process; it is unclear whether this relationship reflects care coordination activities of health plans or physician practices. OBJECTIVE Estimate within-plan relationships between beneficiary-reported care coordination measures and HEDIS measures of clinical process for the same individuals. DESIGN Mixed-effect regression models in cross-sectional data. PARTICIPANTS 2013 Medicare Advantage CAHPS respondents (n=152,069) with care coordination items linked to independently collected HEDIS data on clinical processes. MAIN MEASURES Care coordination measures assessed follow-up, whether doctors had medical records during visits, whether doctors discussed medicines being taken, how informed doctors seemed about specialist care, and help received with managing care among different providers. HEDIS measures included mammography, colorectal cancer screening, cardiovascular LDL-C screening, controlling blood pressure, 5 diabetes care measures (LDL-C screening, retinal eye exam, nephropathy, blood sugar/HbA1c <9%, LCL-C<100 mg/dL), glaucoma screening in older adults, BMI assessment, osteoporosis management for women with a fracture, and rheumatoid arthritis therapy. KEY RESULTS For 9 of the 13 HEDIS measures, within health plans, beneficiaries who reported better care coordination also received better clinical care (p<0.05) and none of the associations went in the opposite direction; HEDIS differences between those with excellent and poor coordination exceeded 5 percentage points for 7 measures. Nine measures had positive associations (breast cancer screening, colorectal cancer screening, cardiovascular care LDL-C screening, 4 of 5 diabetes care measures, osteoporosis management, and rheumatoid arthritis therapy). CONCLUSIONS Within health plans, beneficiaries who report better care coordination also received higher-quality clinical care, particularly for care processes that entail organizing patient care activities and sharing information among different healthcare providers. These results extend prior research showing that health plans with better beneficiary-reported care coordination achieved higher HEDIS performance scores.
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Feng Y, Gravelle H. Patient Self-Reported Health, Clinical Quality, and Patient Satisfaction in English Primary Care: Practice-Level Longitudinal Observational Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1660-1666. [PMID: 34711367 DOI: 10.1016/j.jval.2021.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/20/2021] [Accepted: 05/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To examine the association of self-reported health of patients in general practices, as measured by the EQ-5D-5L, with practice clinical quality and patient-reported satisfaction with accessibility and consultations. METHODS We used data from the General Practitioner (GP) Patient Survey to construct a practice-level EQ-5D-5L index as the health outcome. Key explanatories were patient-reported measures of satisfaction with access and consultations (also derived from the GP Patient Survey) and clinical quality measured by the achievement of clinical quality indicators reported in the Quality and Outcomes Framework. We estimated practice-level linear panel data models with random and fixed practice effects and practice and patient covariates using 2012/13 to 2016/17 data on more than 7500 English general practices. RESULTS Bivariate correlations of the EQ-5D-5L index with quality measures were 0.048 for clinical quality, 0.071 for satisfaction with access, and 0.107 for satisfaction with GP consultations (all with P<.001). In both fixed effects regressions, which allow for unobserved time invariant practice characteristics, and random effects regressions which do not, the EQ-5D-5L index was positively associated with 1-year lags of patient satisfaction with access and GP consultations. Patient-reported health was positively associated with clinical quality in the fixed effects regressions. The implied effects were small in all cases. CONCLUSION Practice-level EQ-5D-5L is positively associated with clinical quality and with 1-year lags of patient-reported satisfaction with access and GP consultations.
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Affiliation(s)
- Yan Feng
- Institute of Population Health Sciences, Queen Mary University of London, England, UK.
| | - Hugh Gravelle
- Centre for Health Economics, University of York, England, UK
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Gliedt JA, Walker RJ, Lu K, Dawson AZ, Egede LE. The Relationship Between Patient Satisfaction and Healthcare Expenditures in Adults with Spine Related Disorders: An Analysis of the 2008 to 2015 Medical Expenditures Panel Survey (MEPS). Spine (Phila Pa 1976) 2021; 46:1409-1417. [PMID: 33826590 PMCID: PMC8463412 DOI: 10.1097/brs.0000000000004047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE The aim of this study was to investigate the relationship between patient satisfaction (PS) and healthcare expenditures (HCE) in adults with spine related disorders (SRDs). SUMMARY OF BACKGROUND DATA SRDs are widespread and pose a high cost to society. PS and HCE have yet to be studied in this population. METHODS Fifteen thousand eight hundred fifty adults with SRDs from the Medical Expenditures Panel Survey (MEPS) (2008-2015) were analyzed. The MEPS medical conditions files were used to identify SRDs based on International Classification of Diseases-9 codes. Frequencies and percentages of sample demographics were calculated. HCE was measured as total direct payments for care provided during the survey year. A composite PS score was constructed using a 0 to 10 rating of their healthcare providers combined with the frequency in which patients felt they were listened to, were given understandable explanations, were respected, and were given enough time. Mean unadjusted HCE were calculated for each year and by quartile of PS. A two-part model consisting of a probit model and subsequent generalized linear model with gamma distribution was performed, adjusting for relevant covariates. Margins command was used to calculate incremental estimates of HCE. RESULTS Mean unadjusted HCE increased annually from $7057 (95% confidence interval [CI], $6516, $7597) in 2008 to $9820 (95% CI, $8811, $10,830) in 2015 for adults with SRDs. Adjusting for predisposing factors, individuals in second, third, and fourth quartiles of PS were significantly different from the first quartile. Adjusting for predisposing and enabling factors, only fourth quartile was significantly different from first quartile. After adjusting for predisposing, enabling and need factors, second, third, and fourth quartiles were no longer significantly different from the first quartile. CONCLUSION Expenditures have increased over time in adults with SRDs. PS is significantly associated with expenditures after controlling for predisposing and enabling factors, but not significant after controlling for need factors. Need factors appear to explain the relationship between lower levels of PS and higher HCE in adults with SRDs.Level of Evidence: 2.
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Affiliation(s)
- Jordan A. Gliedt
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rebekah J. Walker
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kaiwei Lu
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Aprill Z. Dawson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E. Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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Navarro S, Ochoa CY, Chan E, Du S, Farias AJ. Will Improvements in Patient Experience With Care Impact Clinical and Quality of Care Outcomes?: A Systematic Review. Med Care 2021; 59:843-856. [PMID: 34166268 DOI: 10.1097/mlr.0000000000001598] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patient experiences with health care have been widely used as benchmark indicators of quality for providers, health care practices, and health plans. OBJECTIVE The objective of this study was to summarize the literature regarding the associations between Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experiences and clinical and quality outcomes. RESEARCH DESIGN A systematic review of the literature was completed using PubMed, Embase, and Cumulative Index to Nursing and Allied Health Literature on December 14, 2019. Separate searches were conducted to query terms identifying CAHPS surveys with clinical and quality outcomes of care. Two reviewers completed all components of the search process. STUDY SELECTION Studies investigating associations between CAHPS composite ratings and health care sensitive clinical outcomes or quality measures of care were included in this review. Studies were excluded if they did not investigate patient experiences using CAHPS composite ratings or if CAHPS composites were not treated as the independent variable. RESULTS Nineteen studies met inclusion criteria, 10 investigating associations of CAHPS composite ratings with clinical outcomes and 9 investigating these associations with quality measures. Patient-provider communication was the most studied CAHPS composite rating and was significantly associated with self-reported physical and mental health, frequency of emergency room visits and inpatient hospital stays, hospitalization length, and CAHPS personal physician global ratings. CONCLUSIONS Ratings of patient experience with care may influence clinical and quality outcomes of care. However, key inconsistencies between studies affirm that more research is needed to solidify this conclusion and investigate how patient experiences differentially relate to outcomes for various patient groups.
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Affiliation(s)
- Stephanie Navarro
- Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA
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Association of Follow-Up After an Emergency Department Visit for Mental Illness with Utilization Based Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:718-728. [PMID: 33438094 DOI: 10.1007/s10488-020-01106-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Follow-up within 30 days of an emergency department (ED) visit for mental illness is a new and widely-used quality measure. However, no empirical evidence validates associations between follow-up and subsequent utilization based outcomes. Using Massachusetts all payer claims data, we identified insured individuals with an ED visit for mental illness. Multivariate regression analysis estimated associations between follow-up within 30 days after an ED visit for mental illness with costs, hospitalizations, and additional ED visits in 180 days following the index visit. 63,814 index ED visits were included (56.5% female, mean [SD] age 38.0 [12.1] years, 48% Medicaid covered). 31% of index ED principal diagnoses were for major depressive disorder, 3% schizophrenia, 5% bipolar disorder, 34% anxiety disorder, 0.6% post-traumatic stress disorder, 8% other psychoses, and 19% other mental illness diagnoses. Only 33% of patients had a follow-up visit for mental illness within 30 days. Adjusted regression analyses show timely follow-up is associated with increased costs in the 180 days after (average marginal effect = $1622; 95% confidence interval [CI] 1459, 1786), an increased probability of inpatient hospitalization (2.7 percentage points; 95% CI 0.021, 0.032), and a small reduction in the probability of at least one additional ED visit (- 1.7 percentage points; 95% CI - 0.026 to 0.009). Overall follow-up rates are low; follow-up within 30 days of an ED visit for mental illness is associated with increased costs and increased probability of hospitalization in the follow-up period. It is not known whether increased rates of utilization improve patient outcomes, potentially by receiving appropriate more intensive care.
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Borrelli M, Ting JY, Rabbani CC, Tan BK, Higgins TS, Walgama ES, Liu GC, Chen HH, Lee MK, Hopp ML, Illing EA, Mirocha J, Wu AW. Patient satisfaction survey experience among American otolaryngologists. Am J Otolaryngol 2020; 41:102656. [PMID: 32836038 DOI: 10.1016/j.amjoto.2020.102656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patient Satisfaction (PS) is a commonly used metric in health care settings to assess the quality of care given by physicians. Monitoring physicians in this way may impact physician quality of life. Studies evaluating this impact are not available. This study sought to examine the physician experience of measuring PS among practicing otolaryngologists. METHODS Using an online survey platform, a 34-item survey was given to practicing otolaryngologists through email distribution. The survey included questions about physician, practice and patient demographics, as well as inquiries regarding the way in which PS was measured and how it affected physician work and personal life. Data from these questions were reviewed and analyzed. RESULTS 174 otolaryngologists responded to the survey. A majority of physicians' (55.3%) PS scores had been tracked with 89.9% reporting being tracked for a length of at least 1 year. PS scores for individual physicians were noted to be inconsistent and vary significantly between reports. Measuring patient satisfaction led to increased occupational stress, yet most physicians (63.8%) felt the monitoring did not lead to improvements in their practice. Some physicians (36.2%) reported that the collection of patient satisfaction scores had negatively influenced the way they practiced medicine, including the pressure to order superfluous tests or to prescribe unnecessary medications. CONCLUSION Overall, physicians are negatively affected by the tracking of patient satisfaction scores. Occupational stress caused by the collection of patient satisfaction scores may contribute to physician burnout.
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Early Postoperative Radiographs Have No Effect on Orthopaedic Trauma Patient's Satisfaction With Their Clinic Visit. J Am Acad Orthop Surg 2020; 28:e125-e130. [PMID: 31977614 DOI: 10.5435/jaaos-d-18-00697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Patient satisfaction plays a prominent role in modern orthopaedic care, reimbursement, and quality assessment, even if it runs contrary to the "standard of care." The literature shows that routine early radiographs after acute fracture care have no impact on clinical decision-making or patient outcomes, but little is known about their effect on patient satisfaction and understanding of their injuries. We hypothesized that eliminating these radiographs would negatively influence patient satisfaction scores with their clinic visit. METHODS One hundred patients were prospectively enrolled after acute fracture fixation. Half the patients obtained radiographs at the 2-week follow-up visit, whereas the other half did not. All patients completed a satisfaction survey about their clinic visit. RESULTS No difference was observed between the groups in overall satisfaction with the clinic visit (P = 0.62) or complications. However, patients with radiographs were more satisfied with the surgeon's explanations of their injury and progression (P = 0.03). CONCLUSION Eliminating routine early postoperative radiographs had no effect on overall patient satisfaction with the clinic visit, but it did affect satisfaction with the surgeon's explanation of their injury. This could save time, money, and radiation exposure without adversely affecting patient outcome or satisfaction, but an equivalent educational tool should be identified for clinic visits.
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12
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Doubova SV, Infante-Castañeda C, Roder-DeWan S, Pérez-Cuevas R. User experience and satisfaction with specialty consultations and surgical care in secondary and tertiary level hospitals in Mexico. BMC Health Serv Res 2019; 19:872. [PMID: 31752851 PMCID: PMC6873740 DOI: 10.1186/s12913-019-4706-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the association between user experience and satisfaction with specialty consultations and surgical care at the Mexican Institute of Social Security (IMSS) secondary and tertiary level hospitals. METHODS We conducted secondary data analysis of the cross-sectional 2017 IMSS National Satisfaction Survey. The dependent variables were user satisfaction with outpatient consultation and with surgery. The study's independent variables were user experience with these services. The Lancet Global Health Commission on High Quality Health Systems in the Sustainable Development Era framework was used to guide the analysis. For each dependent variable a double-weighted Poisson regression model with robust variance was performed and considered clustering of the observations within 111 secondary level and 25 tertiary level hospitals. RESULTS The study included 6713 outpatient consultation users and 528 surgery users. 83% of users attending outpatient consultations and 86.6% of users who underwent inpatient surgery at IMSS hospitals were satisfied with the service received. The common patient negative experiences with specialty consultations and surgical care were long waiting time (40%) and lack of hospital cleanliness (20%). An additional concern was the lack of clinical examination during the consultation (25%). Shorter waiting times, health provider courtesy, good communication, clinical examination, and hospital cleanliness were associated with patient satisfaction with specialty consultations. Having the surgery without prior postponement(s) and without complications increased the probability of patient satisfaction. CONCLUSION Patient satisfaction with hospital outpatient consultations and surgical care may be raised by focusing on improvement strategies to enhance positive patient experiences with care.
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Affiliation(s)
- Svetlana V Doubova
- Epidemiology and Health Services Research Unit CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Zip Code: 06720, Mexico City, Mexico.
| | | | - Sanam Roder-DeWan
- Ifakara Health Institute, Dar es Salaam, Tanzania.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA
| | - Ricardo Pérez-Cuevas
- Center for Health Systems Research, National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, Zip Code: 62100, CuernavacaCity, Mexico.,Division of Social Protection and Health, Jamaica Country Office, InterAmerican Development Bank, 6 Montrose road, Kingston, Jamaica
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Khanna K, Diab M. Patient Satisfaction: Inception, Impact, and Correlation with Outcomes. J Bone Joint Surg Am 2019; 101:e115. [PMID: 31567669 DOI: 10.2106/jbjs.18.01499] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Krishn Khanna
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California
| | - Mohammad Diab
- Department of Orthopaedic Surgery, University of California-San Francisco, San Francisco, California
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Abstract
BACKGROUND Having a "personal" physician is a critical element to care continuity. Little is known about which older adults are more likely to lack personal physicians and if their care experiences differ from those with a personal physician. OBJECTIVE The objective of this study was to describe care experiences and characteristics associated with not having a personal physician. RESEARCH DESIGN We compare rates of lacking a personal physician across subgroups. Using doubly robust propensity-score-weighted regression, we compare patient experience among beneficiaries with and without a personal physician. SUBJECTS A total of 272,463 nationally representative beneficiaries age 65+ responding to the 2012 Medicare CAHPS survey. MEASURES Beneficiary characteristics, having a personal physician, 4 patient experience measures. RESULTS Five percent of respondents reported no personal physician. Lacking a personal physician was more common for men, racial/ethnic minorities (eg, 16% of American Indian/Alaska Natives), and the younger and less educated. Those without a personal physician reported substantially poorer experiences on 4 measures (P<0.001); these differences are larger than those observed by key demographic characteristics. Beneficiaries without a personal physician were more than 3 times as likely to have not seen any health care provider in the last 6 months. CONCLUSIONS Even with the access provided by Medicare, a small but nontrivial proportion of seniors report having no personal physician. Those without a personal physician report substantially worse patient experiences and lacking a personal physician is more common for some vulnerable groups. This may underlie some previously observed disparities. Efforts should be made to encourage and help seniors without personal physicians to select one.
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Tuot DS. Better Patient Ambulatory Care Experience: Does It Translate into Improved Outcomes among Patients with CKD? Clin J Am Soc Nephrol 2018; 13:1619-1620. [PMID: 30337325 PMCID: PMC6237056 DOI: 10.2215/cjn.11260918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Delphine S Tuot
- Division of Nephrology, University of California, San Francisco, California; and
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
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Cefalu MS, Elliott MN, Setodji CM, Cleary PD, Hays RD. Hospital quality indicators are not unidimensional: A reanalysis of Lieberthal and Comer. Health Serv Res 2018; 54:502-508. [PMID: 30259508 DOI: 10.1111/1475-6773.13056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To evaluate the dimensionality of hospital quality indicators treated as unidimensional in a prior publication. DATA SOURCE/STUDY DESIGN Pooled cross-sectional 2010-2011 Hospital Compare data (10/1/10 and 10/1/11 archives) and the 2012 American Hospital Association Annual Survey. DATA EXTRACTION We used 71 indicators of structure, process, and outcomes of hospital care in a principal component analysis of Ridit scores to evaluate the dimensionality of the indicators. We conducted an exploratory factor analysis using only the indicators in the Centers for Medicare & Medicaid Services' Hospital Value-Based Purchasing. PRINCIPAL FINDINGS There were four underlying dimensions of hospital quality: patient experience, mortality, and two clinical process dimensions. CONCLUSIONS Hospital quality should be measured using a variety of indicators reflecting different dimensions of quality. Treating hospital quality as unidimensional leads to erroneous conclusions about the performance of different hospitals.
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Affiliation(s)
| | | | | | - Paul D Cleary
- School of Public Health, Yale University, New Haven, Connecticut
| | - Ron D Hays
- Division of General Internal Medicine & Health Services Research, University of California, Los Angeles, California
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Garner BR, Lwin AK, Strickler GK, Hunter BD, Shepard DS. Pay-for-performance as a cost-effective implementation strategy: results from a cluster randomized trial. Implement Sci 2018; 13:92. [PMID: 29973280 PMCID: PMC6033288 DOI: 10.1186/s13012-018-0774-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 05/31/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Pay-for-performance (P4P) has been recommended as a promising strategy to improve implementation of high-quality care. This study examined the incremental cost-effectiveness of a P4P strategy found to be highly effective in improving the implementation and effectiveness of the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based treatment (EBT) for adolescent substance use disorders (SUDs). METHODS Building on a $30 million national initiative to implement A-CRA in SUD treatment settings, urn randomization was used to assign 29 organizations and their 105 therapists and 1173 patients to one of two conditions (implementation-as-usual (IAU) control condition or IAU+P4P experimental condition). It was not possible to blind organizations, therapists, or all research staff to condition assignment. All treatment organizations and their therapists received a multifaceted implementation strategy. In addition to those IAU strategies, therapists in the IAU+P4P condition received US $50 for each month that they demonstrated competence in treatment delivery (A-CRA competence) and US $200 for each patient who received a specified number of treatment procedures and sessions found to be associated with significantly improved patient outcomes (target A-CRA). Incremental cost-effectiveness ratios (ICERs), which represent the difference between the two conditions in average cost per treatment organization divided by the corresponding average difference in effectiveness per organization, and quality-adjusted life years (QALYs) were the primary outcomes. RESULTS At trial completion, 15 organizations were randomized to the IAU condition and 14 organizations were randomized to the IAU+P4P condition. Data from all 29 organizations were analyzed. Cluster-level analyses suggested the P4P strategy led to significantly higher average total costs compared to the IAU control condition, yet this average increase of 5% resulted in a 116% increase in the average number of months therapists demonstrated competence in treatment delivery (ICER = $333), a 325% increase in the average number of patients who received the targeted dosage of treatment (ICER = $453), and a 325% increase in the number of days of abstinence per patient in treatment (ICER = $8.134). Further supporting P4P as a cost-effective implementation strategy, the cost per QALY was only $8681 (95% confidence interval $1191-$16,171). CONCLUSION This study provides experimental evidence supporting P4P as a cost-effective implementation strategy. TRIAL REGISTRATION NCT01016704 .
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Affiliation(s)
- Bryan R. Garner
- RTI International, P. O. Box 12194, Research Triangle Park, Raleigh, NC 27709-2194 USA
| | - Aung K. Lwin
- Schneider Institutes for Health Policy, The Heller School, MS035, Brandeis University, Waltham, MA USA
| | - Gail K. Strickler
- Schneider Institutes for Health Policy, The Heller School, MS035, Brandeis University, Waltham, MA USA
| | | | - Donald S. Shepard
- Schneider Institutes for Health Policy, The Heller School, MS035, Brandeis University, Waltham, MA USA
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Garner BR, Zehner M, Roosa MR, Martino S, Gotham HJ, Ball EL, Stilen P, Speck K, Vandersloot D, Rieckmann TR, Chaple M, Martin EG, Kaiser D, Ford JH. Testing the implementation and sustainment facilitation (ISF) strategy as an effective adjunct to the Addiction Technology Transfer Center (ATTC) strategy: study protocol for a cluster randomized trial. Addict Sci Clin Pract 2017; 12:32. [PMID: 29149909 PMCID: PMC5693537 DOI: 10.1186/s13722-017-0096-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the extent to which evidence-based practices (EBPs)-treatments that have been empirically shown to be efficacious or effective-are integrated within routine practice is a well-documented challenge across numerous areas of health. In 2014, the National Institute on Drug Abuse funded a type 2 effectiveness-implementation hybrid trial titled the substance abuse treatment to HIV Care (SAT2HIV) Project. Aim 1 of the SAT2HIV Project tests the effectiveness of a motivational interviewing-based brief intervention (MIBI) for substance use as an adjunct to usual care within AIDS service organizations (ASOs) as part of its MIBI Experiment. Aim 2 of the SAT2HIV Project tests the effectiveness of implementation and sustainment facilitation (ISF) as an adjunct to the Addiction Technology Transfer Center (ATTC) model for training staff in motivational interviewing as part of its ISF Experiment. The current paper describes the study protocol for the ISF Experiment. METHODS Using a cluster randomized design, case management and leadership staff from 39 ASOs across the United States were randomized to receive either the ATTC strategy (control condition) or the ATTC + ISF strategy (experimental condition). The ATTC strategy is staff-focused and includes 10 discrete strategies (e.g., provide centralized technical assistance, conduct educational meetings, provide ongoing consultation). The ISF strategy is organization-focused and includes seven discrete strategies (e.g., use an implementation advisor, organize implementation team meetings, conduct cyclical small tests of change). Building upon the exploration-preparation-implementation-sustainment (EPIS) framework, the effectiveness of the ISF strategy is examined via three staff-level measures: (1) time-to-proficiency (i.e., preparation phase outcome), (2) implementation effectiveness (i.e., implementation phase outcome), and (3) level of sustainment (i.e., sustainment phase outcome). DISCUSSION Although not without limitations, the ISF experiment has several strengths: a highly rigorous design (randomized, hypothesis-driven), high-need setting (ASOs), large sample size (39 ASOs), large geographic representation (23 states and the District of Columbia), and testing along multiple phases of the EPIS continuum (preparation, implementation, and sustainment). Thus, study findings will significantly improve generalizable knowledge regarding the best preparation, implementation, and sustainment strategies for advancing EBPs along the EPIS continuum. Moreover, increasing ASO's capacity to address substance use may improve the HIV Care Continuum. Trial registration ClinicalTrials.gov: NCT03120598.
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Affiliation(s)
- Bryan R. Garner
- RTI International, 3040 E. Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Mark Zehner
- School of Medicine and Public Health, University of Wisconsin–Madison, 1930 Monroe St., Madison, WI 53711-2027 USA
| | | | - Steve Martino
- Department of Psychiatry, VA Connecticut Healthcare System, Yale University, 950 Campbell Avenue (116B), West Haven, CT 06516 USA
| | - Heather J. Gotham
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO 64108 USA
| | - Elizabeth L. Ball
- RTI International, 3040 E. Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - Patricia Stilen
- School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St., Kansas City, MO 64108 USA
| | - Kathryn Speck
- University of Nebraska Public Policy Center, 215 Centennial Mall South, Suite 401, Lincoln, NE 68588 USA
| | - Denna Vandersloot
- Vandersloot Training & Consulting, 11845 NW Stone Mt. Lane, #108, Portland, OR 97229 USA
| | - Traci R. Rieckmann
- School of Medicine Psychiatry, and Greenfield Health Medicine, Oregon Health & Science University, 9450 SW Barnes Road St. 100, Portland, OR 97225 USA
| | - Michael Chaple
- National Development and Research Institutes, Inc, 71 West 23rd Street, New York, NY 10010 USA
| | - Erika G. Martin
- Rockefeller Institute of Government, State University of New York, New York, USA
- Department of Public Administration and Policy, Rockefeller College of Public Affairs and Policy, University at Albany, 1400 Washington Avenue, Milne 300E, Albany, NY 12222 USA
| | - David Kaiser
- RTI International, 3040 E. Cornwallis Rd., P.O. Box 12194, Research Triangle Park, NC 27709-2194 USA
| | - James H. Ford
- School of Medicine and Public Health, University of Wisconsin–Madison, 1930 Monroe St., Madison, WI 53711-2027 USA
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Ricci-Cabello I, Stevens S, Dalton ARH, Griffiths RI, Campbell JL, Valderas JM. Identifying Primary Care Pathways from Quality of Care to Outcomes and Satisfaction Using Structural Equation Modeling. Health Serv Res 2017; 53:430-449. [PMID: 28217876 DOI: 10.1111/1475-6773.12666] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To study the relationships between the different domains of quality of primary health care for the evaluation of health system performance and for informing policy decision making. DATA SOURCES A total of 137 quality indicators collected from 7,607 English practices between 2011 and 2012. STUDY DESIGN Cross-sectional study at the practice level. Indicators were allocated to subdomains of processes of care ("quality assurance," "education and training," "medicine management," "access," "clinical management," and "patient-centered care"), health outcomes ("intermediate outcomes" and "patient-reported health status"), and patient satisfaction. The relationships between the subdomains were hypothesized in a conceptual model and subsequently tested using structural equation modeling. PRINCIPAL FINDINGS The model supported two independent paths. In the first path, "access" was associated with "patient-centered care" (β = 0.63), which in turn was strongly associated with "patient satisfaction" (β = 0.88). In the second path, "education and training" was associated with "clinical management" (β = 0.32), which in turn was associated with "intermediate outcomes" (β = 0.69). "Patient-reported health status" was weakly associated with "patient-centered care" (β = -0.05) and "patient satisfaction" (β = 0.09), and not associated with "clinical management" or "intermediate outcomes." CONCLUSIONS This is the first empirical model to simultaneously provide evidence on the independence of intermediate health care outcomes, patient satisfaction, and health status. The explanatory paths via technical quality clinical management and patient centeredness offer specific opportunities for the development of quality improvement initiatives.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Stevens
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Robert I Griffiths
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - John L Campbell
- APEx Collaboration for Academic Primary Care, Institute for Health Services Research, University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Jose M Valderas
- APEx Collaboration for Academic Primary Care, Institute for Health Services Research, University of Exeter Medical School, University of Exeter, Exeter, UK
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Bosko T, Wilson K. Assessing the relationship between patient satisfaction and clinical quality in an ambulatory setting. J Health Organ Manag 2016; 30:1063-1080. [PMID: 27700474 DOI: 10.1108/jhom-11-2015-0181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this paper is to assess the relationship between patient satisfaction and a variety of clinical quality measures in an ambulatory setting to determine if there is significant overlap between patient satisfaction and clinical quality or if they are separate domains of overall physician quality. Assessing this relationship will help to determine whether there is congruence between different types of clinical quality performance and patient satisfaction and therefore provide insight to appropriate financial structures for physicians. Design/methodology/approach Ordered probit regression analysis is conducted with overall rating of physician from patient satisfaction responses to the Clinician and Groups Consumer Assessment of Healthcare Providers and Systems survey as the dependent variable. Physician clinical quality is measured across five composite groups based on 26 Healthcare Effectiveness Data and Information Set (HEDIS) measures aggregated from patient electronic health records. Physician and patient demographic variables are also included in the model. Findings Better physician performance on HEDIS measures are correlated with increases in patient satisfaction for three composite measures: antibiotics, generics, and vaccination; it has no relationship for chronic conditions and is correlated with decrease in patient satisfaction for preventative measures, although the negative relationship for preventative measures is not robust in sensitivity analysis. In addition, younger physicians and male physicians have higher satisfaction scores even with the HEDIS quality measures in the regression. Research limitations/implications There are four primary limitations to this study. First, the data for the study come from a single hospital provider organization. Second, the survey response rate for the satisfaction measure is low. Third, the physician clinical quality measure is the percent of the physician's relevant patient population that met the HEDIS measure rather than if the measure was met for the individual patient. Finally, it is not possible to distinguish if the significant coefficient estimates on the physician age and gender variables are capturing systematic differences in physician behavior or capturing patient bias. Practical implications The results suggest patient satisfaction and physician clinical quality may be complementary, capturing similar aspects of overall physician quality, across some clinical quality measures but for other measures satisfaction and clinical quality are unrelated or negatively related. Therefore, for some clinical quality metrics, it will be important to separately compensate clinical quality and satisfaction and understand the relationship between metrics. Finally, the strong relationship between the level of patient satisfaction and physician age, physician gender, and patient age are important to consider when designing a physician compensation package based on patient satisfaction; if these differences reflect patient bias they could increase inequality among medical staff if compensation is based on patient satisfaction. Originality/value This study is the first to use physician organization data to examine patient satisfaction and physician performance on a variety of HEDIS quality metrics.
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Affiliation(s)
| | - Kathryn Wilson
- Department of Economics, Kent State University , Kent, Ohio, USA
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Achieving a 5-star rating: Analysis of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores among patients undergoing elective colorectal operations. Surgery 2016; 160:902-914. [PMID: 27475815 DOI: 10.1016/j.surg.2016.04.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/21/2016] [Accepted: 04/23/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a publicly reported survey of patients' hospital experience. METHODS All inpatient, elective colorectal resections with completed HCAHPS surveys at a single institution between June 2012 and April 2015 were identified. HCAHPS measures were analyzed according to published methodologies. Univariate logistic regression evaluated associations of various HCAHPS measures with age, sex, ostomy, approach, diagnosis, and prolonged length of stay (PLOS; ≥7 days). Key driver analysis demonstrated associations between the individual HCAHPS measures and the global hospital rating measure. RESULTS We identified 755 patients. Younger age, inflammatory bowel disease, open approach, ostomy construction, and PLOS were associated with low quality of pain management. Patients with inflammatory bowel disease, open approach, and PLOS had a low overall star score (all P < .05). Care transitions and communication about medications received low scores but were associated highly with the global hospital rating measure. CONCLUSION Efforts aimed at improving pain management among patients with colorectal resection should focus on patients with inflammatory bowel disease, open operations, ostomies, and PLOS. Improving care transitions and communication about medications are important targets for improvement to increase the overall hospital score. Considering the importance of improving patient-centered outcomes, we suggest that all institutions utilize their existing HCAHPS data in this manner.
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Lepnurm R, Nesdole R, Dobson RT, Peña-Sánchez JN. The effects of distress and the dimensions of coping strategies on physicians' satisfaction with competence. SAGE Open Med 2016; 4:2050312116643907. [PMID: 27127629 PMCID: PMC4834470 DOI: 10.1177/2050312116643907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/15/2016] [Indexed: 11/28/2022] Open
Abstract
Objectives: The purposes of this study were to (1) articulate the dimensions of Coping strategies used by physicians, and (2) determine whether Coping strategies alleviated Distress and enhanced Satisfaction with Competence. Methods: Comprehensive questionnaires on factors associated with Satisfaction with Competence were sent to a stratified sample of 5300 physicians across Canada. The response rate was 57% with negligible bias. Factor analysis was used to articulate the dimensions of Coping strategies. The classic Baron and Kenny regression series was used to establish whether Coping mediates the effects of Distress on Satisfaction with Competence. Years in Practice, Self-Reported Health, and Duties of Physicians were control factors. Results: A reliable 15-item measure of Coping was confirmed (α = .76) with four reasonably reliable dimensions: Collegiality (α = .80), Attitude (α = .63), Managing Work (α = .60), and Self-Care (α = .62). Physicians reported a mean Satisfaction with Competence of (M = 4.26 out of 6.0, standard deviation (SD) = 0.64) with General practitioners reporting slightly lower levels of Satisfaction with Competence than average. Conversely, chronic disease, clinical, and procedural specialists reported higher levels of Satisfaction with Competence. The mean Distress level for all physicians was (M = 3.66 out of 7.0, SD = 0.93). The highest levels of distress were reported by emergency physicians, general practitioners, and surgeons. Clinical specialists, anesthesiologists, and psychiatrists reported the lowest levels of distress. Physicians reported (M = 4.48 out of 7.0, SD = 0.78) as the mean level of Coping ability with clinical specialists and general practitioners reporting lower than average abilities to cope. Laboratory and chronic care specialists reported greater than average coping abilities. Regression analyses established Coping as a mediator of Distress which predicted physicians’ Satisfaction with Competence. Conclusion: Four groups of coping strategies were significant in relieving the pressures of work: (1) Collegiality, (2) Self-Care, (3) Managing Work, and (4) Positive Attitude.
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Affiliation(s)
- Rein Lepnurm
- MERCURi Research Group, School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
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Lepnurm R, Dobson RT, Peña-Sánchez JN, Nesdole R. Modeling factors explaining physicians' satisfaction with competence. SAGE Open Med 2015; 3:2050312115613352. [PMID: 27092256 PMCID: PMC4821212 DOI: 10.1177/2050312115613352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/24/2015] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE Attention to physician wellness has increased as medical practice gains in complexity. Physician satisfaction with practice is critical for quality of care and practice growth. The purpose of this study was to model physicians' self-reported Satisfaction with Competence as a function of their perceptions of the Quality of Health Services, Distress, Coping, Practice Management, Personal Satisfaction and Professional Equity. METHODS Comprehensive questionnaires were sent to a stratified sample of 5300 physicians across Canada. This cross-sectional study focused on physicians who examined and treated individual patients for a final study population of 2639 physicians. Response bias was negligible. The questionnaires contained measures of Satisfaction with Competence, Quality of Health Services, Distress, Coping, Personal Satisfaction, Practice Management and Professional Equity. Exploring relationships was done using Pearson correlations and one-way analysis of variance. Modeling was by hierarchical regressions. RESULTS The measures were reliable: Satisfaction with Competence (α = .86), Quality (α = .86), Access (α = .82), Distress (α = .82), Coping (α = .76), Personal Satisfaction (α = .78), Practice Management (α = .89) and the dimensions of Professional Equity (Fulfillment, α = .81; Financial, α = .93; and Recognition, α = .75) with comparative validity. Satisfaction with Competence was positively correlated with Quality (r = .32), Efficiency (r = .37) and Access (r = .32); negatively correlated with Distress (r = -.54); and positively correlated with Coping strategies (r = .43), Personal Satisfaction (r = .57), Practice Management (r = .17), Fulfillment (r = .53), Financial (r = .36) and Recognition (r = .54). Physicians' perceptions on Quality, Efficiency, Access, Distress, Coping, Personal Satisfaction, Practice Management, Fulfillment, Pay and Recognition explained 60.2% of the variation in Satisfaction with Competence, controlling for years in practice, self-reported health and duties of physicians. CONCLUSION Satisfaction with Competence could be affected by excessive accumulation of duties, concerns about quality, efficiency, access, excessive distress, inadequate coping abilities, personal satisfaction with life as a physician, challenges in managing practices and persistent inequities among physicians.
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Affiliation(s)
- Rein Lepnurm
- MERCURi Research Group, School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Roy Thomas Dobson
- MERCURi Research Group, School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
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Abstract
OBJECTIVE Although misperceptions about prognosis by surrogates in ICUs are common and influence treatment decisions, there is no validated, practical way to measure the effectiveness of prognostic communication. Surrogates' subjective ratings of quality of communication have been used in other domains as markers of effectiveness of communication. We sought to determine whether surrogates' subjective ratings of the quality of prognostic communication predict accurate expectation about prognosis by surrogates. DESIGN We performed a cross-sectional cohort study. Surrogates rated the quality of prognostic communication by survey. Physicians and surrogates gave their percentage estimate of patient survival on ICU day 3 on a 0-100 probability scale. We defined discordance about prognosis as a difference in the physician's and surrogate's estimates of greater than or equal to ±20%. We used multilevel logistic regression modeling to account for clustering under physicians and patients and adjust for confounders. SETTING Medical-surgical, trauma, cardiac, and neurologic ICUs of five U.S. academic medical centers located in California, Pennsylvania, Washington, North Carolina, and Massachusetts. PATIENTS Two hundred seventy-five patients with acute respiratory distress syndrome at high risk of death or severe functional impairment, their 546 surrogate decision makers, and their 150 physicians. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS There was no predictive utility of surrogates' ratings of the quality of communication about prognosis to identify inaccurate expectations about prognosis (odds ratio, 1.04 ± 0.07; p = 0.54). Surrogates' subjective ratings of the quality of communication about prognosis were high, as assessed with a variety of questions. Discordant prognostic estimates were present in 63.5% (95% CI, 59.0-67.9) of physician-surrogate pairs. CONCLUSIONS Although most surrogates rate the quality of prognostic communication high, inaccurate expectations about prognosis are common among surrogates. Surrogates' ratings of the quality of prognostic communication do not reliably predict an accurate expectation about prognosis.
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Abstract
BACKGROUND The aims of this study were to describe guardian perceptions of the experiences of a sample of youth with sickle cell disease (SCD) in rural emergency departments (EDs) with a focus on overall patient satisfaction and characteristics of care. PROCEDURE Guardians of 139 children with SCD (0 to 17 y) seen at a rural pediatric SCD clinic completed a survey concerning their children's ED experiences in the past 6 months, including information about ED wait times, quality of communications and interactions with the ED health care providers, pain management, perceptions of speed of care, and overall satisfaction. RESULTS About 41% of guardians reported that their child visited the ED in the past 6 months. Guardians reported moderate satisfaction with ED care. About 25% of those who visited the ED indicated that health care providers did not spend enough time with them and their children did not receive speedy care. Shorter ED wait times and higher ratings of speed of care predicted higher satisfaction. CONCLUSIONS Families of youth with SCD are experiencing longer wait times in rural EDs which contribute to dissatisfaction with care. Efforts are needed to develop strategies to reduce ED wait times and improve speed of care which may improve outcomes following ED care.
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Do Hospital-Acquired Condition Scores Correlate With Patients' Perspectives of Care? Qual Manag Health Care 2015; 24:69-73. [DOI: 10.1097/qmh.0000000000000056] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Goloback M, McCarthy DM, Schmidt M, Adams JG, Pang PS. ED operational factors associated with patient satisfaction. Am J Emerg Med 2014; 33:111-2. [PMID: 25445872 DOI: 10.1016/j.ajem.2014.09.051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Revised: 09/29/2014] [Accepted: 09/30/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Molly Goloback
- Department of Emergency Medicine, Colorado Permanente Medical Group, Denver, CO
| | - Danielle M McCarthy
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael Schmidt
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - James G Adams
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Peter S Pang
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN.
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Anhang Price R, Elliott MN, Zaslavsky AM, Hays RD, Lehrman WG, Rybowski L, Edgman-Levitan S, Cleary PD. Examining the role of patient experience surveys in measuring health care quality. Med Care Res Rev 2014; 71:522-54. [PMID: 25027409 DOI: 10.1177/1077558714541480] [Citation(s) in RCA: 485] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs.
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Affiliation(s)
| | | | | | - Ron D Hays
- UCLA Department of Medicine, Los Angeles, CA, USA
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Tevis SE, Schmocker RK, Kennedy GD. Can patients reliably identify safe, high quality care? ACTA ACUST UNITED AC 2014; 3:150-160. [PMID: 26413179 DOI: 10.5430/jha.v3n5p150] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publicly reported tool that measures patient satisfaction. As both patients and Centers for Medicare & Medicaid Services (CMS) reimbursement rely on survey results as a metric of quality of care, we reviewed the current literature to determine if patient satisfaction correlates with quality, safety, or patient outcomes. We found varying associations between safety culture, process of care measure compliance, and patient outcomes with patient satisfaction on the HCAHPS survey. Some studies found inverse relationships between quality and safety metrics and patient satisfaction. The measure that most reliably correlated with high patient satisfaction was low readmission rate. Future studies using patient specific data are needed to better identify which factors most influence patient satisfaction and to determine if patient satisfaction is a marker of safer and better quality care. Furthermore, the HCAHPS survey should continue to undergo evaluations to assure it generates predictable results.
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Affiliation(s)
- Sarah E Tevis
- Department of Surgery, University of Wisconsin, Wisconsin, United States
| | - Ryan K Schmocker
- Department of Surgery, University of Wisconsin, Wisconsin, United States
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin, Wisconsin, United States
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Wallace BC, Paul MJ, Sarkar U, Trikalinos TA, Dredze M. A large-scale quantitative analysis of latent factors and sentiment in online doctor reviews. J Am Med Inform Assoc 2014; 21:1098-103. [PMID: 24918109 DOI: 10.1136/amiajnl-2014-002711] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Online physician reviews are a massive and potentially rich source of information capturing patient sentiment regarding healthcare. We analyze a corpus comprising nearly 60,000 such reviews with a state-of-the-art probabilistic model of text. We describe a probabilistic generative model that captures latent sentiment across aspects of care (eg, interpersonal manner). We target specific aspects by leveraging a small set of manually annotated reviews. We perform regression analysis to assess whether model output improves correlation with state-level measures of healthcare. We report both qualitative and quantitative results. Model output correlates with state-level measures of quality healthcare, including patient likelihood of visiting their primary care physician within 14 days of discharge (p=0.03), and using the proposed model better predicts this outcome (p=0.10). We find similar results for healthcare expenditure. Generative models of text can recover important information from online physician reviews, facilitating large-scale analyses of such reviews.
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Affiliation(s)
- Byron C Wallace
- Department of Health Services Policy & Practice, Brown University, Providence, Rhode Island, USA
| | - Michael J Paul
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Urmimala Sarkar
- Department of Medicine, UCSF, San Francisco, California, USA
| | - Thomas A Trikalinos
- Department of Health Services Policy & Practice, Brown University, Providence, Rhode Island, USA
| | - Mark Dredze
- Johns Hopkins University, Human Language Technology Center of Excellence, Baltimore, Maryland, USA
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Zgierska A, Rabago D, Miller MM. Impact of patient satisfaction ratings on physicians and clinical care. Patient Prefer Adherence 2014; 8:437-46. [PMID: 24729691 PMCID: PMC3979780 DOI: 10.2147/ppa.s59077] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Although patient satisfaction ratings often drive positive changes, they may have unintended consequences. OBJECTIVE The study reported here aimed to evaluate the clinician-perceived effects of patient satisfaction ratings on job satisfaction and clinical care. METHODS A 26-item survey, developed by a state medical society in 2012 to assess the effects of patient satisfaction surveys, was administered online to physician members of a state-level medical society. Respondents remained anonymous. RESULTS One hundred fifty five physicians provided responses (3.9% of the estimated 4,000 physician members of the state-level medical society, or approximately 16% of the state's emergency department [ED] physicians). The respondents were predominantly male (85%) and practicing in solo or private practice (45%), hospital (43%), or academia (15%). The majority were ED (57%), followed by primary care (16%) physicians. Fifty-nine percent reported that their compensation was linked to patient satisfaction ratings. Seventy-eight percent reported that patient satisfaction surveys moderately or severely affected their job satisfaction; 28% had considered quitting their job or leaving the medical profession. Twenty percent reported their employment being threatened because of patient satisfaction data. Almost half believed that pressure to obtain better scores promoted inappropriate care, including unnecessary antibiotic and opioid prescriptions, tests, procedures, and hospital admissions. Among 52 qualitative responses, only three were positive. CONCLUSION These pilot-level data suggest that patient satisfaction survey utilization may promote, under certain circumstances, job dissatisfaction, attrition, and inappropriate clinical care among some physicians. This is concerning, especially in the context of the progressive incorporation of patient satisfaction ratings as a quality-of-care metric, and highlights the need for a rigorous evaluation of the optimal methods for survey implementation and utilization.
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Affiliation(s)
- Aleksandra Zgierska
- Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI
| | - David Rabago
- Department of Family Medicine, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI
| | - Michael M Miller
- American Society of Addiction Medicine, Chevy Chase, MD
- Department of Psychiatry, University of Wisconsin-Madison, School of Medicine and Public Health, Oconomowoc, WI, USA
- Herrington Recovery Center, Rogers Memorial Hospital, Oconomowoc, WI, USA
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Farley H, Enguidanos ER, Coletti CM, Honigman L, Mazzeo A, Pinson TB, Reed K, Wiler JL. Patient satisfaction surveys and quality of care: an information paper. Ann Emerg Med 2014; 64:351-7. [PMID: 24656761 DOI: 10.1016/j.annemergmed.2014.02.021] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/31/2014] [Accepted: 02/21/2014] [Indexed: 11/17/2022]
Abstract
With passage of the Patient Protection and Affordable Care Act of 2010, payment incentives were created to improve the "value" of health care delivery. Because physicians and physician practices aim to deliver care that is both clinically effective and patient centered, it is important to understand the association between the patient experience and quality health outcomes. Surveys have become a tool with which to quantify the consumer experience. In addition, results of these surveys are playing an increasingly important role in determining hospital payment. Given that the patient experience is being used as a surrogate marker for quality and value of health care delivery, we will review the patient experience-related pay-for-performance programs and effect on emergency medicine, discuss the literature describing the association between quality and the patient-reported experience, and discuss future opportunities for emergency medicine.
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Affiliation(s)
- Heather Farley
- Department of Emergency Medicine, Christiana Care Health System, Newark, DE.
| | - Enrique R Enguidanos
- Department of Emergency Medicine, Providence Regional Medical Center, Everett, WA
| | | | - Leah Honigman
- Department of Emergency Medicine, the George Washington University Hospital, Washington, DC
| | - Anthony Mazzeo
- Department of Emergency Medicine, Mercy Fitzgerald Hospital, Darby, PA
| | - Thomas B Pinson
- Department of Emergency Medicine, Mayes County Medical Center, Pryor, OK
| | - Kevin Reed
- Department of Emergency Medicine, MedStar Harbor Hospital, Baltimore, MD
| | - Jennifer L Wiler
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO
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Black N, Varaganum M, Hutchings A. Relationship between patient reported experience (PREMs) and patient reported outcomes (PROMs) in elective surgery. BMJ Qual Saf 2014; 23:534-42. [DOI: 10.1136/bmjqs-2013-002707] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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35
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Development and validation of the functional assessment of chronic illness therapy treatment satisfaction (FACIT TS) measures. Qual Life Res 2013; 23:815-24. [DOI: 10.1007/s11136-013-0520-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2013] [Indexed: 10/26/2022]
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36
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Cleary PD. Expanding the use of patient reports about patient-centered care. Isr J Health Policy Res 2013; 2:36. [PMID: 24044702 PMCID: PMC3848602 DOI: 10.1186/2045-4015-2-36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 09/11/2013] [Indexed: 11/29/2022] Open
Abstract
In an informative article on the assessment of patient care experiences, Zimlichman, Rozenblum, and Millenson describe the evolving use of surveys that elicit patient reports about medical care experiences in Israel, a trend that parallels developments in the U.S. This commentary summarizes some of experiences in the U.S. that might inform the development of more consistent and extensive strategies for assessing and promoting patient-centered care in Israel. More comprehensive patient experience surveys, the results of which would be publicly available, as Zimlichman and colleagues advocate, would facilitate quality improvements, especially if users are provided with support for the use and interpretation of the data. Developing more efficient survey methods will facilitate the broader use of such surveys, although it is important to use methods that yield results that are as representative of the target population as possible and to account for survey mode effects when data are reported. Although the surveys need to be appropriate for the Israeli context, the use of standard questions used in other countries would facilitate comparisons that could help to identify best practices that can be adopted in different settings. Those who work on assessing patient-centered care in the U.S. look forward to learning from the work of their Israeli colleagues. This is a commentary on http://www.ijhpr.org/content/2/1/35/.
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Affiliation(s)
- Paul D Cleary
- Yale School of Public Health, 60 College Street, New Haven, CT 06520, USA.
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Llanwarne NR, Abel GA, Elliott MN, Paddison CAM, Lyratzopoulos G, Campbell JL, Roland M. Relationship between clinical quality and patient experience: analysis of data from the english quality and outcomes framework and the National GP Patient Survey. Ann Fam Med 2013; 11:467-72. [PMID: 24019279 PMCID: PMC3767716 DOI: 10.1370/afm.1514] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England. METHODS Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-for-performance scheme (Quality and Outcomes Framework). Spearman's rank correlation and multiple linear regression were used on practice-level estimates. RESULTS Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15). CONCLUSION Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.
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Schleyer AM, Curtis JR. Family satisfaction in the ICU: why should ICU clinicians care? Intensive Care Med 2013; 39:1143-5. [PMID: 23612761 DOI: 10.1007/s00134-013-2939-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 04/17/2013] [Indexed: 11/28/2022]
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Browne K, Roseman D, Shaller D, Edgman-Levitan S. Analysis & commentary. Measuring patient experience as a strategy for improving primary care. Health Aff (Millwood) 2013; 29:921-5. [PMID: 20439881 DOI: 10.1377/hlthaff.2010.0238] [Citation(s) in RCA: 186] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients value the interpersonal aspects of their health care experiences. However, faced with multiple resource demands, primary care practices may question the value of collecting and acting upon survey data that measure patients' experiences of care. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) suite of surveys and quality improvement tools supports the systematic collection of data on patient experience. Collecting and reporting CAHPS data can improve patients' experiences, along with producing tangible benefits to primary care practices and the health care system. We also argue that the use of patient experience information can be an important strategy for transforming practices as well as to drive overall system transformation.
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Affiliation(s)
- Katherine Browne
- Center for Health Care Quality, Department of Health Policy, George Washington University, Washington, DC, USA.
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Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open 2013; 3:e001570. [PMID: 23293244 PMCID: PMC3549241 DOI: 10.1136/bmjopen-2012-001570] [Citation(s) in RCA: 1207] [Impact Index Per Article: 109.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 11/02/2012] [Accepted: 11/12/2012] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore evidence on the links between patient experience and clinical safety and effectiveness outcomes. DESIGN Systematic review. SETTING A wide range of settings within primary and secondary care including hospitals and primary care centres. PARTICIPANTS A wide range of demographic groups and age groups. PRIMARY AND SECONDARY OUTCOME MEASURES A broad range of patient safety and clinical effectiveness outcomes including mortality, physical symptoms, length of stay and adherence to treatment. RESULTS This study, summarising evidence from 55 studies, indicates consistent positive associations between patient experience, patient safety and clinical effectiveness for a wide range of disease areas, settings, outcome measures and study designs. It demonstrates positive associations between patient experience and self-rated and objectively measured health outcomes; adherence to recommended clinical practice and medication; preventive care (such as health-promoting behaviour, use of screening services and immunisation); and resource use (such as hospitalisation, length of stay and primary-care visits). There is some evidence of positive associations between patient experience and measures of the technical quality of care and adverse events. Overall, it was more common to find positive associations between patient experience and patient safety and clinical effectiveness than no associations. CONCLUSIONS The data presented display that patient experience is positively associated with clinical effectiveness and patient safety, and support the case for the inclusion of patient experience as one of the central pillars of quality in healthcare. It supports the argument that the three dimensions of quality should be looked at as a group and not in isolation. Clinicians should resist sidelining patient experience as too subjective or mood-oriented, divorced from the 'real' clinical work of measuring safety and effectiveness.
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Affiliation(s)
- Cathal Doyle
- NIHR CLAHRC for North West London, Chelsea and Westminster Hospital, London, UK
| | - Laura Lennox
- NIHR CLAHRC for North West London, Chelsea and Westminster Hospital, London, UK
- Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
| | - Derek Bell
- NIHR CLAHRC for North West London, Chelsea and Westminster Hospital, London, UK
- Department of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, UK
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Yang H, Shi L, Lebrun LA, Zhou X, Liu J, Wang H. Development of the Chinese primary care assessment tool: data quality and measurement properties. Int J Qual Health Care 2012; 25:92-105. [PMID: 23175535 DOI: 10.1093/intqhc/mzs072] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE The aim of this study was to translate and adapt the Primary Care Assessment Tool to assess the perceptions of the quality of primary care among patients in China and to examine the psychometric properties of the adapted Primary Care Assessment Tool Chinese version (PCAT-C). DESIGN A cross-sectional survey to assess the validity and reliability of PCAT-C using standard psychometric techniques. SETTING Outpatient departments of five state-level and provincial-level hospitals and four municipal-level hospitals as well as nine community health centers in Changsha, China. PARTICIPANTS A total of 2532 patients visiting primary care providers. RESULTS The PCAT-C was acceptable to patients, as evidenced by low proportions of missing data and a full range of possible scores for all items. Two items were eliminated following principal component analysis and reliability testing. The principal component analysis extracted eight multiple-item scales and one single-item scale. Multiple-item scales had reasonable internal consistency and high item-scale correlations. CONCLUSIONS This study represents the first attempt to construct an instrument for assessing patient reports on the quality of primary care, which is applicable to the Chinese context. Psychometric assessments indicated that the PCAT-C is a useful instrument for assessing the core attributes of primary care in China.
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Affiliation(s)
- Hui Yang
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD 21205, USA
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Advances in measuring culturally competent care: a confirmatory factor analysis of CAHPS-CC in a safety-net population. Med Care 2012; 50:S49-55. [PMID: 22895231 DOI: 10.1097/mlr.0b013e31826410fb] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Providing culturally competent care shows promise as a mechanism to reduce health care inequalities. Until the recent development of the Consumer Assessment of Healthcare Providers and Systems Cultural Competency Item Set (CAHPS-CC), no measures capturing patient-level experiences with culturally competent care have been suitable for broad-scale administration. METHODS We performed confirmatory factor analysis and internal consistency reliability analysis of CAHPS-CC among patients with type 2 diabetes (n=600) receiving primary care in safety-net clinics. CAHPS-CC domains were also correlated with global physician ratings. RESULTS A 7-factor model demonstrated satisfactory fit (χ²₂₃₁=484.34, P<0.0001) with significant factor loadings at P<0.05. Three domains showed excellent reliability-Doctor Communication-Positive Behaviors (α=0.82), Trust (α=0.77), and Doctor Communication-Health Promotion (α=0.72). Four domains showed inadequate reliability either among Spanish speakers or overall (overall reliabilities listed): Doctor Communication-Negative Behaviors (α=0.54), Equitable Treatment (α=0.69), Doctor Communication-Alternative Medicine (α=0.52), and Shared Decision-Making (α=0.51). CAHPS-CC domains were positively and significantly correlated with global physician rating. CONCLUSIONS Select CAHPS-CC domains are suitable for broad-scale administration among safety-net patients. Those domains may be used to target quality-improvement efforts focused on providing culturally competent care in safety-net settings.
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Abstract
The recent focus on patient engagement acknowledges that patients have an important role to play in their own health care. This includes reading, understanding and acting on health information (health literacy), working together with clinicians to select appropriate treatments or management options (shared decision making), and providing feedback on health care processes and outcomes (quality improvement). Various interventions designed to help patients play an effective role have been evaluated in trials and systematic reviews. This article outlines the evidence in support of the most promising interventions.
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Sequist TD, Von Glahn T, Li A, Rogers WH, Safran DG. Measuring chronic care delivery: patient experiences and clinical performance. Int J Qual Health Care 2012; 24:206-13. [PMID: 22490300 DOI: 10.1093/intqhc/mzs018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To assess the relationship between clinical care metrics and patient experiences of care among patients with chronic disease. DESIGN Cross-sectional survey and clinical performance data. SETTING Eighty-nine medical groups across California caring for patients with chronic disease. PARTICIPANTS Using patient surveys, we identified 51 129 patients with a chronic disease. MAIN OUTCOME MEASURES Using patient surveys, we produced five composite measures of patient experiences of care and self-management support (scale 0-100). Using Health Plan Employer Data and Information Set data, we analyzed care for asthma, diabetes and cardiovascular disease, producing one composite summarizing clinical processes of care and one composite summarizing outcomes of care. We calculated adjusted Spearman's correlation coefficients to assess the relationship between patient experiences of care, clinical processes and clinical outcomes. RESULTS Clinical performance was higher for process measures compared with outcomes measures, ranging from 91% for appropriate asthma medication use to 59% for controlling low-density lipoprotein cholesterol in the presence of diabetes. Performance on patient experiences of care measures was the highest for the quality of clinical interactions (88.5) and the lowest for delivery of self-management support (68.8). Three of the 10 patient experience-clinical performance composite correlations were statistically significant. These three correlations involved composites summarizing integration of care and quality of clinical interactions, and ranged from a low of 0.30 to a high of 0.39. CONCLUSIONS Chronic care delivery is variable across diseases and domains of care. Improving care integration processes and communication between health-care providers and their patients may lead to improved clinical outcomes.
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Affiliation(s)
- Thomas D Sequist
- Division of General Medicine and Primary Care, Brigham and Women’s Hospital, Boston, MA, USA.
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Federman AD, Keyhani S. Physicians’ participation in the Physicians’ Quality Reporting Initiative and their perceptions of its impact on quality of care. Health Policy 2011; 102:229-34. [DOI: 10.1016/j.healthpol.2011.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Revised: 05/03/2011] [Accepted: 05/05/2011] [Indexed: 10/18/2022]
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Çalıkoğlu Ş, Christmyer CS, Kozlowski BU. My eyes, your eyes--the relationship between CMS five-star rating of nursing homes and family rating of experience of care in Maryland. J Healthc Qual 2011; 34:5-12. [PMID: 22092877 DOI: 10.1111/j.1945-1474.2011.00159.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In 2008, the Centers for Medicaid and Medicare Services (CMS) launched the Five-Star Quality Rating System to help consumers compare nursing homes. The quality rating system consists of three domains: nursing home inspection results, staffing, and quality measures (QMs) and an overall rating calculated from the three domains. The Five-Star System has both advocates and detractors. One source of criticism about the rating system is its lack of input from consumer surveys. Although different dimensions of quality have been recognized as important by the experts and studied in the literature, how these dimensions are linked with each other is largely unknown. This article describes an analysis of the relationship between overall experience of care ratings from a family survey and ratings obtained on the CMS Five-Star Quality Rating for Maryland nursing homes. The results indicated a strong positive correlation between family experience of care score and two five-star domains, namely health inspections and nurse staffing, and no relationship with the quality domain. The lack of relationship between the quality domain and the family score may be due to inadequate risk adjustment or that each rating system measures different aspects of quality.
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Affiliation(s)
- Şule Çalıkoğlu
- Maryland Health Services Cost Review Commission, Baltimore, Maryland, USA.
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48
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Co JPT, Sternberg SB, Homer CJ. Measuring patient and family experiences of health care for children. Acad Pediatr 2011; 11:S59-67. [PMID: 21570018 DOI: 10.1016/j.acap.2011.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 01/21/2011] [Accepted: 01/24/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND The Institute of Medicine considers patient centeredness a core dimension of quality. Several patient/family surveys exist to assess pediatric health care. The Children's Health Insurance Program Reauthorization Act mandates strengthening quality measurement for children, including for patient/family experience of care. OBJECTIVES The aim of this study was to determine what instruments exist for measuring patient/family experience of pediatric health care and which should be included in the core measurement set for assessing Medicaid and the Children's Health Insurance Program (CHIP) programs; to identify gaps in measurement; and to provide recommendations for measure development. METHODS We developed a conceptual framework for measuring patient/family experience of care. We conducted a review of national measure clearinghouses and of the literature to assess validity, reliability, and feasibility of existing measures, and how these measures address the conceptual framework. RESULTS We found valid and reliable instruments for measuring patient/family experience of care include the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) instruments, Promoting Healthy Development Survey (PHDS), Young Adult Health Care Survey (YAHCS), and the National Research Corporation Picker Pediatric Inpatient Survey (NRC Picker). We identified the need for matching patients with providers and groups as a barrier for widespread use of the CAHPS® pediatric clinician & group instrument. CONCLUSIONS We recommended to the National Advisory Council for Healthcare Research and Quality Subcommittee on Children's Healthcare Quality Measures for Medicaid and Child Health Insurance Programs (SNAC) the CAHPS® Child Medicaid 4.0 and pediatric Clinician & Group Survey for inclusion in the initial recommended list of core measures for voluntary use by Medicaid and CHIP. The Clinician and Group Survey was not included in the list posted for public comment due to concerns at that time (December 2009) about feasibility. We also recommended that development of a child version of the CAHPS® behavioral and mental health survey now used in the adult population and of a pediatric hospital CAHPS® measure be considered high priorities for development in the next phase of Children's Health Insurance Program Reauthorization Act measurement activity. This phase should also explore methods to increase response rates and lower costs of obtaining consumer feedback.
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Affiliation(s)
- John Patrick T Co
- MGH Center for Child and Adolescent Health Policy, 50 Staniford Street, Suite 901, Boston, Massachusetts 02114, USA.
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Burgers JS, Voerman GE, Grol R, Faber MJ, Schneider EC. Quality and coordination of care for patients with multiple conditions: results from an international survey of patient experience. Eval Health Prof 2011; 33:343-64. [PMID: 20801976 DOI: 10.1177/0163278710375695] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Previous studies using clinical performance measures suggest that quality of care for patients with multiple chronic conditions is not worse than that for others. This article presents patient-reported experiences of health care among 8,973 of chronically ill adults from eight countries, using telephone survey data. We designed a ''morbidity score'' combining the number of conditions and reported health status. Respondents with high morbidity scores reported less favorable experience with coordination of care compared to those with low morbidity scores. They also reported lower ratings of overall quality of care. There were no differences in reported experience with the individual physicians. Comparing type of comorbidity, chronic lung, and mental health problems were associated with lower ratings than hypertension, heart disease, diabetes, arthritis, and cancer. The implications and limitations of this study are discussed in the context of health care reform. Pay-for-performance programs need to account for chronic conditions to avoid penalizing physicians who care for larger shares of such patients.
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Affiliation(s)
- Jako S Burgers
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.
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50
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Scott IA, Phelps G, Brand C. Assessing individual clinical performance: a primer for physicians. Intern Med J 2011; 41:144-55. [DOI: 10.1111/j.1445-5994.2010.02225.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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