Patient Age, Race and Emergency Department Treatment Area Associated with "Topbox" Press Ganey Scores.

Moon Lee,Ewen Wang,Jonathan Altamirano,Yvonne Maldonado,Ryan Ribeira,Magali Fassiotto,Laleh Gharahbaghian,Michael Gisondi,Suzanne Lippert,Luis Garcia

doi:10.5811/westjem.2020.8.47277

Moon Lee, Ewen Wang + Show 8 more

Open Access

https://doi.org/10.5811/westjem.2020.8.47277

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Abstract

IntroductionHospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. PG scores range from 1 to 5, with 5 being the highest, which is known as the “topbox” score. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED).MethodsWe looked at PG surveys from January 2015–December 2017 at an academic, urban hospital with 78,000 ED visits each year. Outcomes were topbox scores for the questions: “Likelihood of your recommending our ED to others”; and “Courtesy of the doctor.” We analyzed topbox scores using generalized estimating equation models clustered by physician and adjusted for patient and physician factors. Patient factors included age, gender, race, ethnicity, and ED area where patient was seen. The ED has four areas based on patient acuity: emergent; urgent; vertical (urgent but able to sit in a recliner rather than a gurney); and fast track (non-urgent). Physician factors included age, gender, race, ethnicity, and number of years at current institution.ResultsWe analyzed a total of 3,038 surveys. For “Likelihood of your recommending our ED to others,” topbox scores were more likely with increasing patient age (odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03–1.12); less likely among female compared to male patients (OR 0.81; 95% CI, 0.70–0.93); less likely among Asian compared to White patients (OR 0.71; 95% CI, 0.60–0.83); and less likely in the urgent (OR 0.71; 95% CI, 0.54–0.93) and vertical areas (OR 0.71; 95% CI 0.53–0.95) compared to fast track. For “Courtesy of the doctor,” topbox scores were more likely with increasing patient age (OR 1.1; CI, 1.06–1.14); less likely among Asian (OR 0.70; 95% CI, 0.58–0.84), Black (OR 0.66; 95% CI, 0.45–0.96), and Hispanic patients (OR 0.68; 95% CI, 0.55–0.83) compared to White patients; and less likely in urgent area (OR 0.69; 95% CI, 0.50–0.95) compared to fast track.ConclusionIncreasing patient age was associated with increased likelihood of topbox scores, while Asian patients, and urgent and vertical areas had decreased likelihood of topbox scores. We encourage hospitals that use PG topbox scores as financial incentives to understand the contribution of non-service factors to these scores.

Highlights

Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance
For “Likelihood of your recommending our emergency department (ED) to others,” topbox scores were more likely with increasing patient age; less likely among female compared to male patients; less likely among Asian compared to White patients; and less likely in the urgent and vertical areas compared to fast track
For “Courtesy of the doctor,” topbox scores were more likely with increasing patient age; less likely among Asian, Black, and Hispanic patients compared to White patients; and less likely in urgent area compared to fast track

Summary

Introduction

Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED). Patient satisfaction is positively associated with improved physician-patient communication, medication compliance, provider job satisfaction, reductions in malpractice claims, and hospital profitability.[3,4,5,6,7,8] Hospitals have used financial incentives to link physicians’ professional and financial success to their patient satisfaction scores. (South Bend, IN) first developed patient satisfaction surveys in 1985, and have become the industry standard for measuring patient experience in the outpatient setting.[10,11,12,13,14,15] Hospitals typically distribute Press Ganey (PG) standardized surveys to a random sample of patients to solicit feedback regarding providers, staff, and clinical environments. A score of 5, the most favorable, is known as the “topbox” score.[13,16] Topbox scoring is the standard for customer satisfaction and consumer research.[17]

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