Telemedicine and patient satisfaction during the COVID-19 pandemic: A case-control study of outpatient pediatric urology patients

The Application of Human Factors Approaches to Improve Safety, Efficiency and Well-being in Urology: A Systematic Scoping Review

OBJECTIVE

To elucidate the application of HF approaches within urology to improve clinical work-system function via a systematic scoping review. Human Factors (HF) plays an integral role to improving safety, efficiency, and well-being by optimizing work-system interactions. Despite its established application across various high-risk industries, the systematic exploration of HF methods applied within urology remains limited.

METHODS

A scoping review of HF interventions implemented within urologic care from 1980 to 2023 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Web of Science, PubMed, and OVID Medline databases were searched. Database searching resulted in 10,850 articles, after systematic review, 22 studies were included.

RESULTS

The included studies predominantly originated from the United States and covered diverse areas of urology, including surgical procedures, diagnostics, and patient care. Interventions varied widely from ergonomic equipment implementations to modifications in clinical processes and team dynamics. Most studies utilized predetermined interventions based on prior literature or experiential anecdotes (15, 65.22%), while a smaller subset employed data-driven strategies to tailor interventions (8, 34.7%). The HF methods employed included questionnaires, retrospective reviews, observations, and physical measurements, targeting improvements in patient experiences, operational efficiencies, and clinical outcomes.

CONCLUSION

This review underscores the emergent role of HF in urology, highlighting a broad spectrum of interventions and methodological approaches that contribute to system optimization. Future endeavors should focus on collaborative efforts to develop standardized HF applications in urology, promoting a safer, more efficient, and clinician-friendly environment.

Routine use of patient-reported experience and outcome measures for children and young people: a scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) measure people's views of their health status whereas patient-reported experience measures (PREMs) are questionnaires measuring perceptions of their experience whilst receiving healthcare. PROMs/PREMs have the potential to enable children and young people (CYP) to be involved in decisions about their care and improve the quality of their care but it is not clear how often PROMs/PREMs are incorporated as part of standard care of CYP in the hospital setting. The aims of this scoping review were to understand the extent of the literature and map available evidence on the use, benefits, barriers and facilitators of PROMs/PREMs as part of standard care and treatment of CYP in hospitals.

METHODS

The Joanna Briggs Institute review process was used to map existing evidence on the use of PROMs/PREMs in routine care of CYP in different hospital settings worldwide. Key search terms were developed and Ovid (Emcare, Embase MEDLINE, APA PsychInfo), Scopus and Web of Science were searched. Data were analysed using frequency counts and basic content analysis for thematic mapping according to the research questions. We undertook an initial search in February 2021 and updated this in April 2023.

RESULTS

The search yielded 68,004 studies, 388 were eligible for full text review and 172 met the inclusion criteria. PROMs were more commonly used than PREMs in routine care of CYP in hospitals; these were mostly collected using electronic collection and concentrated in specific specialities, settings, contexts and countries. The findings mapped the use of PROMs/PREMs, including how data are applied in clinical practice and used for service development, but this was not consistently reported. There are specific challenges in the implementation of PROMs/PREMs in routine care of CYP that need to be considered.

CONCLUSION

PROMs/PREMs have the potential to improve care for CYP in hospital settings contributing to different aspects of care. A better understanding of their use, how results can be applied in clinical practice and contribute to service development will enable meaningful employment. The popularity of electronically collected and captured PROMS/PREMs warrants further investigation to enable their meaningful use in routine care of CYP.

SYSTEMATIC REVIEW REGISTRATION

Not pre-registered.

Patient Satisfaction with the Hybrid Telemedicine Model for Ophthalmology

Background: The purpose of this research was to compare patient satisfaction between hybrid ophthalmology telemedicine and standard-of-care in-person visits. A retrospective, cross-sectional, case-control analysis of patient satisfaction based on survey data was used. Methods: Responses to the National Research Council Health Patient Survey were retrieved for randomly sampled hybrid ophthalmology telemedicine and in-person visits between March 11, 2020 and December 31, 2021 at a hospital-based eye clinic in Boston, Massachusetts. The primary outcome was based on the question "How likely would you be to recommend this provider to your family and friends?" (0-10 scale) with a score of 9 or 10 coded as satisfied. Two-sample t-tests, Pearson's chi-square tests, and bivariate logistic regressions were used to compare patient satisfaction scores between the hybrid and in-person cohorts. Demographic data, including age, sex, language, and self-reported race and ethnicity, were used as potential predictors of patient satisfaction in a multivariable logistic regression model. Results: There were 49 surveys from hybrid visits and 3,390 surveys from in-person visits. Hybrid visit patients reported high satisfaction scores without significant differences compared to in-person visit patients (hybrid 79% satisfied, in-person 82% satisfied, p = 0.728). Age was significantly associated with satisfaction in the hybrid cohort with the 65+ age group reporting lower satisfaction (below 65 years 100% satisfied, 65+ years 60% satisfied, p = 0.003). No association with age was observed in the in-person cohort. Conclusions: The hybrid ophthalmology telemedicine model can provide effective care without sacrificing patient satisfaction. Older patients may benefit from targeted interventions in future telemedicine models.

Factors Associated with the Digital Patient Experience of Virtual Care Across Specialties

Background

We aimed to characterize patient experience with virtual care across medical specialties using validated survey data. Primary objective: to determine whether experience varied by visit modality (virtual vs. in-person) and whether relationships persisted after adjusting for patient and provider characteristics. Secondarily, among physicians with sufficient data, we compared virtual versus in-person patient experience scores at the physician level and identified characteristics associated with better experience scores for virtual care.

Methods

This was a retrospective analysis of administrative databases from a large New England health care system, including all ambulatory visits from October 1, 2020 to September 30, 2021 with patient experience scores recorded. We compared experience between virtual and in-person at the visit level (score: 0-10) and the physician level for likelihood of recommending the physician to friends or family. We used a series of cross-classified hierarchical models with visits grouped by patient and by physician to decompose sources of variation. Among physicians with sufficient data, we compared physicians with higher virtual versus higher in-person net promoter score (NPS).

Results

Of 378,472 visits performed by 3368 physicians, 86,878 (23%) were conducted virtually. Most scored ≥9 for either modality, with a small preference for virtual versus in-person care (9.6 vs. 9.5, p < 0.001). We found that more variation in scores was explained by patient than by physician (22.9% vs. 3%). Visit modality was of minimal explanatory value. Most physicians' virtual and in-person NPS were similar, and virtual visit volume was not associated.

Conclusions

We found robust evidence for the parity of patient experience between virtual and in-person modalities across specialties.

Patient Satisfaction with Care Providers During the COVID-19 Pandemic: An Analysis of Consumer Assessment of Healthcare Providers and Systems Survey Scores for In-Person and Telehealth Encounters at an Academic Medical Center

Background: Previous research has demonstrated high patient satisfaction with telehealth encounters. The objective of this study was to compare patient satisfaction scores regarding their physician using the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) surveys between in-person and telehealth outpatient encounters during the pandemic at a large academic health center. Methods: We analyzed CAHPS patient satisfaction survey data within the UC Davis Health system between August 2020 and February 2022. The questions analyzed pertained to patients' satisfaction with their care provider; whether they felt included in discussions, would recommend their physician, received clear explanations, and that their concerns were heard. Using logistic regression models adjusting for confounders, we compared CAHPS care provider top box scores-a score of 4 or 5 on the 5-point scale-for 5 survey items. Results: Survey results from 76,687 (84.2%) in-person encounters and 14,404 (15.8%) telehealth encounters were evaluated. The odds of a telehealth patient giving a top box score for whether they would recommend their care provider to others were 0.97 those of an in-person patient (95% confidence interval [0.87-1.06]; p = 0.494). Similarly, there was no significant difference in odds of giving a top box score between telehealth and in-person patients for the other four questions analyzed. Discussion: Our findings indicate that patient experience and care provider rankings for in-person care and telehealth care are comparable across a variety of specialties and conditions at a large academic health center. Future studies should investigate patient satisfaction with in-person and telehealth encounters by diagnosis and specialty.

Telehealth Use in Pediatric Care during the COVID-19 Pandemic: A Qualitative Study on the Perspectives of Caregivers

This qualitative study surveyed caregivers regarding their perspectives on the benefits of, challenges with, and suggestions for improving telehealth during the COVID-19 pandemic. Caregivers who had the responsibility for caring for at least one child aged under 18 years of age in Genesee County, MI, participated. The caregivers were biological parents, stepparents, foster parents, adoptive parents, and guardians. A total of 105 caregivers completed a survey with open-ended questions via Qualtrics. Two independent coders developed themes based on the responses using grounded theory. Participants were primarily biological parents and non-Hispanic White and African Americans. According to the participants, the benefits of telehealth included prevention of exposure to the COVID-19 virus, quality communication with physicians, savings in travel time, and cost-effective methods to receive care. The challenges included a lack of in-person interaction, fear of compromised confidentiality, and the potential for misdiagnosis. Suggestions for improvement by caregivers included increasing access to telehealth for poorer families, offering a media educational campaign to promote telehealth use, and creating a universal platform to share patient information. Future studies may test the effectiveness of interventions such as those suggested by caregivers in this study to improve telehealth.

Perceptions and attitudes toward the use of telemedicine for the postoperative outpatient urological care during the COVID-19 pandemic in an Academic Hospital in Southern Italy

INTRODUCTION

Telemedicine is a most used tools in various medical and surgical scenarios. The aim of the present study was to explore attitudes and perceptions by urologic patients toward the use of telemedicine in the context of patient-physicians communication during the post-operative follow-up in a large academic tertiary urology referral department in Italy.

MATERIALS AND METHODS

An anonymous questionnaire consisting of 15 multiple choice questions was designed including three sections: respondents' demographics, attitudes, and perceptions towards the use of telemedicine. Invitations to participate to this anonymous questionnaire was given to outpatients attended at Urology Department, University of Naples Federico II.

RESULTS

In total 697 responses were received (participation rate 73%). The frequency of telemedicine use was described as frequently, occasional, rarely, and never by 41.6%, 30.4%, 15.1%, and 12.6% of respondents, respectively. WhatsApp messenger used by 59.5% of respondents and telephone call (34.3%) were the most common type of tools. Satisfaction in using telemedicine was reported as very satisfied, satisfied, neutral, dissatisfied, and very dissatisfied by 39.6%,41.4%,10%,7% and 2% of respondents respectively. Overall, 43.7%% of participants individuated limited interaction and risk of misdiagnosis as the major limit of telemedicine.

CONCLUSIONS

Telemedicine represents the future of medical practice due to several benefits as well as convenience, increased access to care and decreased healthcare costs.