Average Patient Satisfaction Research Articles

Office hysteroscopic myomectomy without myoma extraction: A multicenter prospective study

ObjectiveTo evaluate the feasibility and safety of leaving the submucous myoma (SM) in the uterine cavity after office hysteroscopic enucleation. Study DesignProspective multicenter study including patients who had a single SM diagnosed by transvaginal ultrasounds with surgical indication. Office hysteroscopic enucleation of the SM was performed using a 5 mm continuous flow office hysteroscope with a 2.9 mm rod lens optical system and a 5 Fr operative channel. After the SM was released preserving the pseudo capsule using cold instruments, it was left into the uterine cavity. The primary endpoint was the proportion of patients without evidence of the myoma at the transvaginal ultrasound performed after 90 days from surgery. ResultsBetween January 1st, 2018, and March 31st, 2020, a total of 204 patients were enrolled. Most patients were nulliparous and reported abnormal uterine bleeding as the leading symptom. 76.5 % of enucleated myomas had a diameter ranging between 1.5 and 2.5 cm, and 81.4 % of SMs were of G0 or G1. Hysteroscopic procedures had a mean duration of 23.2 ± 10.5 min. The operative time was associated with the SM grade and size. All hysteroscopic procedures were completed. A vasovagal reaction was observed in 3 women (1.5 %), and minimal post-operative bleeding was reported after 7 procedures (3.4 %). None reported pelvic pain or vaginal discharges/bleeding during follow-up. The average patient satisfaction from surgery was 4.59 (5-points Likert scale). The level of patient satisfaction was not associated with the grade and the size of the myoma. In 192 (94.12 %; 98 %CI: 89.03–96.93 %) out of 204 patients, the SM was absent at the transvaginal ultrasound performed at the follow-up end. A higher prevalence of G2 SMs and lower prevalence of G1 SMs were observed among patients with evidence of the myoma after 90 days from the surgery. ConclusionOffice hysteroscopic myomectomy with SM enucleation without mass extraction appears safe, well-tolerated, and effective in at least 89 % of patients. G2 SMs may be the factor associated with the procedure's failure.

Liposomal bupivacaine interscalene nerve block in shoulder arthroplasty is not superior to plain bupivacaine: a double-blinded prospective randomized control trial

Interscalene brachial plexus blocks are a common modality used to provide adjunctive pain relief with shoulder replacement surgery. In 2018, the Federal Drug Administration approved the use of liposomal bupivacaine (LB) for such nerve blocks. We sought to evaluate whether this formulation of bupivacaine would provide superior pain relief for shoulder replacement patients over standard bupivacaine alone. Our hypotheses were that in the LB cohort the average postoperative pain score over the first 72 hours would be significantly lower, time to block cessation would be longer, total opioid consumption would be lower, and the average patient satisfaction score regarding their pain management would be higher. A randomized, double-blinded study was designed comparing primary shoulder replacement surgery after an interscalene block with 25 mL of 0.5% plain bupivacaine vs. 133 mg of LB with 7.5 mL of 0.5% and 7.5 mL of 0.25% plain bupivacaine. A total of 104 patients were included in the study, with an equal number in each study arm. Patients' visual analog pain scores (VAPS) were followed for their inpatient stay, first 3 full outpatient days, and at a 3-week follow-up. Use of opioid medication was recorded for the same intervals and converted to morphine milligram equivalents. The time to first opioid rescue was documented, as well as the patients' satisfaction with their pain management at both the 3-day and 3-week intervals. No clinically relevant advantage to the use of LB over plain bupivacaine was found. During the second postoperative day, the mean VAPS was 2.4 with LB vs. 3.3 in the standard cohort (P = .0409). The only other statistically significant finding was a higher VAPS with LB during the third full day home compared with standard bupivacaine (4.0 vs. 2.8, respectively, P = .0197). Both of these differences were less than the minimal clinically important difference of 2 for the VAPS. Analysis of the VAPS for the first and third postoperative days, the first and second full days home, and at 3 weeks revealed no significant difference. Similarly, there was no significant difference in time to first opioid rescue, total morphine milligram equivalent use, and patient satisfaction with pain management. When used for an interscalene block to provide adjunctive pain relief in shoulder replacement surgery, the addition of LB to plain bupivacaine provides no additional clinically important benefit to the patient's pain experience over standard bupivacaine.

68 Back Pain Patient Satisfaction Scores Did Not Change after Legislation Resulting in Opiate Prescription Decrease

In response to the opiate crisis, New Jersey (NJ) enacted legislation in February 2017 that required physicians, when prescribing opiates, to look up patients’ previous opiate prescription history, counsel safe opiate use and document all this in the emergency department (ED) chart. We previously found ED opiate prescriptions markedly decreased by 62% in the ten months after the legislation. We hypothesized that the decrease in ED opiate prescriptions would lead to a drop in ED back pain patient satisfaction scores. Retrospective multihospital cohort of ED visits. The setting was 16 NJ urban and suburban EDs with annual visits from 21,000 to 99,000. Consecutive patients seen by ED physicians from 1/1/2016 to 8/31/2018. Using ICD 10 codes, we identified back pain patients. For patient satisfaction, we used the results of a mailed survey (Press Ganey Associates). Although the return rate on this survey is low, the survey is widely used nationally to judge performance in the ED. We computed and plotted the average ED physician patient satisfaction scores for each month over the time period of the study. A priori we chose to calculate the average satisfaction score for the 12 months before and the 12 months after February 2017 (See Table). We also calculated the linear regression coefficient of the plot for the entire period (1/1/2016 to 8/31/2018). Of the 3,888,502 visits in the database, 112,296 were for back pain and of these 1523 surveys were returned. There was no change in the average ED physician patient satisfaction scores for the 12 months before and after February 2017 (average score = 84 for both periods). The linear regression coefficient of the plot for the entire period 1/1/2016 to 8/31/2018 was R squared = 0.0004 (p = 0.91). Contrary to our hypothesis, there was no change in ED back pain patient satisfaction scores after legislation, despite a marked decrease in ED opiate prescriptions.Tabled 112 months before and 12 months after February 2017Back painYear and month of serviceVisitsAvg Satisfaction ScoreAvg Doc Score# of Responses2016023,33085.385.66012016033,44482.984.83812016043,48982.380.05312016053,50381.982.74412016063,47585.182.74612016073,57688.388.36612016083,53382.782.04412016093,53286.987.74212016103,62184.383.86612016113,18087.685.44112016123,46584.183.25712017013,60481.481.4411averages84.484.049.8122017033,42086.386.75812017043,61079.878.44512017053,86279.478.05612017063,72184.685.54612017073,70985.284.24012017083,82091.192.14012017093,47687.386.65012017103,73088.588.35412017113,47185.586.64312017123,25682.880.74712018013,66385.083.63812018023,18481.478.1441averages84.884.146.812 Open table in a new tab

S1234 Maintaining Continuity of Gastroenterology Services at a Large Private Academic Medical Center During the COVID-19 Pandemic

INTRODUCTION: Social distancing mandates and temporary changes in telemedicine reimbursements have led to wide-scale adoption of telemedicine services in primary care and specialty clinics. In this study, we evaluated patient and provider satisfaction of the expanded use of telemedicine within our facility. METHODS: Patients originally scheduled or referred to Baylor Medicine Gastroenterology Clinic were offered telemedicine appointments during the COVID-19 pandemic. Video-based telemedicine visits from April 20 to May 5, 2020 were included. Patient demographics were obtained by chart review.Telephone questionnaires to assess patient satisfaction on care and quality were administered by personnel not involved in patient care. Questionnaires were also administered to providers to assess satisfaction and feasibility of telemedicine to evaluate disease states and symptoms. Satisfaction was assessed using a 5-point Likert scale (5 = very satisfied). Summary statistics were performed. RESULTS: In 15 days, 18 providers completed 268 visits. Of these,144 (54%) patients responded to the surveys. Median age was 49.5 years, 68% were female, 63% were White, and 97% had high school education or above. Median distance from the study site was 26 miles. Average patient satisfaction of provider care was 4.9 ± 0.3, and 89.5% would participate in a telemedicine encounter again even after the pandemic ceases. Average satisfaction with the interface quality was 4.6 ± 0.8, and average ease of set-up of 1.9 ± 1.4 (1 = very easy). Patients reported median savings of 90 minutes and $15 per visit. Of the 8 providers who responded to the survey, average provider satisfaction was 4 ± 0.5, and average likelihood of future telemedicine use independent of institutional policy was 4.8 ± 0.5 (5 = very likely). Technical difficulties were noted in 1.3% of visits and important physical exam findings were unable to be elicited in 1.3% of visits. Figure 1 shows the feasibility of providers to evaluate diseases or symptoms during video-enabled telemedicine encounters. CONCLUSION: Given very high patient and provider satisfaction with telemedicine use along with substantial time and money savings to patients, telemedicine is a viable way to provide care in the setting of the COVID-19 pandemic. Given its significant success, use of telemedicine for routine specialty visits should be evaluated and considered independent of social distancing mandates.Figure 1

Microbotox for the treatment of wide facial pores: A promising therapeutic approach.

Microbotox is the injection of multiple microdroplets of diluted onabotulinum toxin A into the upper dermis. It has been previously used in one study only to decrease pore size and to improve skin texture. To evaluate the efficacy and safety of microbotox in the treatment of wide facial pores. Thirty-five patients with wide facial pores received a single session of microbotox. Objective measurements regarding improvement of pore size (0-4 scale) were recorded by two-blinded dermatologists. The improvements were confirmed by dermoscopic examination. Patient satisfaction was measured by Likert satisfaction scale (1-5 scale). Follow-up of the patients was done for 1year. After a single treatment session, the total average of improvement was 87.2%. The average improvement of pore size was 3.7 (0-4 scale). The average patient satisfaction after the end of therapy was 4.7. Dermoscopic evaluation confirmed the reduction in the size and number of pores. There were no serious or long-term side effects. A single treatment session of microbotox appears to be safe and effective for the reduction of facial pore size. Improvement of skin texture and oiliness was also observed.

Arthroscopic Treatment of Labral Tears in Patients 65 Years and Older.

The purpose of this multicenter study was to investigate the clinical outcomes after hip arthroscopy in a series of patients 65 years and older with labral tears with a minimum 2-year follow-up. Outcome data were prospectively collected and retrospectively reviewed for patients 65 years and older who underwent hip arthroscopy. Outcomes at minimum 2-year follow-up were analyzed using prospectively collected Hip Outcome Score (HOS) and modified Harris Hip Score (mHHS). A paired Student's t test was performed to determine significant differences between pre- and postoperative patient-reported outcome scores. Twenty-six patients were included, with a mean age of 67.7 years (range, 65-75 years) and mean follow-up of 50.5 months. The short-term survivorship rate was 65%, with 9 patients requiring total hip arthroplasty (THA) by latest follow-up. At minimum 2-year follow-up, mean mHHS, HOS-Activities of Daily Living, and HOS-Sports-Specific Subscale for surviving hips were 78.97 (range, 25-100), 78.56 (range, 21.7-100), and 65.93 (range, 2.78-100), respectively. The mean improvements for patients with pre- and postoperative mHHS and HOS-Sports-Specific Subscale were 28 and 36.6 (P=.0005 and P=.003, respectively). The average patient satisfaction was 7.7 on a scale of 10. There were no complications noted in this cohort. This study demonstrated that patients older than 65 years with labral pathology who have failed nonoperative measures obtain modest clinical improvement from hip arthroscopy. This clinical improvement yielded a high patient satisfaction, but due to the potential for subsequent THA in a subset of this population, surgeons should use a rigorous selection criteria and counsel patients appropriately. [Orthopedics. 2020;43(6):e579-e584.].

Penjadwalan Dinas terhadap Kepuasan Perawat di Rumah Sakit Y Jakarta

Nurse satisfaction in hospitals in Indonesia was still low. The low level of nurse discharge was influenced by a number of factors. The purpose of this study was to determine the relationship between nursing scheduling and patient satisfaction at Y Hospital Jakarta. The method used in this study was cross-sectional. The number of samples was 32 nurses (n = 32) through a stratified random sampling technique. The study was conducted at Y Hospital Jakarta. Inclusion criteria included implementing nurses who worked at least 1 year and were willing to become respondents. Data were analyzed by the Pearson correlation test. The results showed that the average patient satisfaction was 73, while the nurse's scheduling was 90.29. These results indicated that nurse satisfaction was still below the minimum service standard (SPM). This result also showed that there was a significant relationship between nursing scheduling and nurse satisfaction (p = 0.040; r = 0.349). The conclusion of this study was that there was a significant relationship between nursing scheduling and nurse satisfaction at Y Hospital. Recommendations were given to hospital managers to improve nurse satisfaction by managing to nurse scheduling properly

Analisis Kepuasan Pasien Terhadap Pelayanan Rawat Jalan di RS Azra 2019

Kepuasan pasien merupakan tingkat kesesuaian antara ekspektasi pasien terhadap pelayanan yang ideal dan persepsi pasien terhadap pelayanan nyata yang mereka terima. Tjiptono (2007) menyatakan bahwa terdapat 5 dimensi kualitas pelayanan yaitu, tangible (berwujud), realibility (keandalan), responsiveness(daya tanggap), assurance (jaminan), dan emphaty (kesedian untuk peduli). Tujuan penelitian ini adalah menganalisis Kepuasan Pasien Terhadap Pelayanan Rawat Jalan di RS Azra 2019, metode penelitian ini deskriptif dengan metode IPA (Importance Performance Analisis). Hasil Penelitian Dari hasil penelitian diperoleh gambaran karakteristik responden yang berkunjung ke RS Azra Bogor yang tertera pada table 4.1. Berdasarkan umur responden paling banyak berusia < dari 40 tahun yaitu 100 responden (74,1 %), berdasarkan jenis kelamin paling banyak berjenis kelamin perempuan yaitu 104 responden (77 %), berdasarkan pendidikan yang terbanyak merupakan pendidikan tinggi yaitu 77 responden (57 %), berdasarkan pekerjaan responen terbanyak tidak bekerja yaitu 73 responden (54,1 %) dan berdasarkan pembiayaan yang terbanyak menggunakan pembiayaan non BPJS yaitu 107 responden (79,3 %). Dari 5 Dimensi yang diteliti tangible (berwujud), realibility (keandalan), responsiveness(daya tanggap), assurance (jaminan), dan emphaty menunjukkan pelayanan rumah sakit Azra sudah sangat baik dengan nilai rata-rata kepuasana pasien 94 % , hal ini sudah sesuai dengan standar mutu pelayanan pasien 90 %.

Is Patient Satisfaction Dictated by Quality of Care Among Patients Undergoing Complex Surgical Procedures for a Malignant Indication?

The current study aimed to define the relationship between patient satisfaction, hospital-level factors, and clinical outcomes among patients undergoingmajor surgery for cancer. The Medicare Inpatient Standard Analytic Files were used to identify patients undergoing lung, esophageal, colorectal, hepatic, or pancreatic surgery between 2016 and 2017, and Hospital Consumer Assessment of Healthcare Providers and Systems survey data were used to assess performance in terms of patient satisfaction. Among 60,446 patients, half were female (n = 31,244, 52%) with a median age of 73years (interquartile range [IQR] 69-78years). Patients who underwent surgery for esophageal resection (odds ratio [OR] 2.44; 95% confidence interval [CI] 1.10-5.40) and were Caucasian (OR 2.43; 95% CI 2.11-2.81) had optimal patient satisfaction. Hospital level factors such as urban location (OR 3.69; 95% CI 3.16-4.29), 200 + beds (OR 3.58; 95% CI 3.09-4.13), greater inpatient surgical volume (OR 3.03; 95% CI 2.82-3.25), higher nurse-to-bed ratio (OR 4.57; 95% CI 4.25-4.92), non-profit hospital status (OR 1.14; 95% CI 1.01-1.29), and non-teaching hospital status (OR 1.52; 95% CI 1.39-1.65) were related to optimal patient satisfaction. In adjusted analysis, patients undergoing surgery at hospitals reporting poor or average patient satisfaction had 22% higher odds of 90-day mortality than patients undergoing surgery at optimal-satisfaction hospitals (OR 1.22; 95% CI 1.09-1.36). In addition, hospitals with the highest patient satisfaction scores also had the highest proportion of surgical cases that achieved the composite textbook outcome (TO) quality metric (OR 1.12; 95% CI 1.05-1.20). Higher patient satisfaction was strongly associated with hospital structural measures such as bed number, urban location, nurse-to-bed ratio, and "optimal" TO after cancer surgery. These data highlight how high quality of care can directly lead to improved patient satisfaction among surgical patients with cancer.

Комбинированная терапия α1-адреноблокатором и ингибитором фосфодиэстеразы 5-го типа пациентов с доброкачественной гиперплазией предстательной железы и эректильной дисфункцией: результаты наблюдательного проспективного мультицентрового исследования

To evaluate the efficacy and safety of combination therapy with 1-blocker and phosphodiesterase type 5 inhibitor (PDE5) in patients with benign prostatic hyperplasia (BPH) and erectile dysfunction (ED). The observational multicenter program involving 18 medical institutions in Moscow included 315 men aged 40-65 years with BPH and ED. The inclusion criteria were a total IPSS score more than 8 points, QoL score of more than 3 points and clinical manifestations of ED ( less or equal 20 points on the IIEF-5 score). All patients received combined pharmacotherapy with Alfuprost MP 10 mg/day and Viatail 50 mg/day (if necessary, the dose was increased to 100 mg/day) for 3 months. The combination therapy showed a high clinical efficiency and a favorable safety profile. Lower urinary tract symptoms improved by more than 60%, QoL increased by 64% and erectile function improved in more than 80% of patients. At the end of treatment, the average patient satisfaction score on the Likert scale was 4.2 (high and very high satisfaction), while doctors satisfaction with the clinical response of patients to the treatment was 4.35 points, which also corresponds to high and very high efficacy of therapy. Combination of Alfuprost MP 10 mg/day and Viatail 50 mg/day (100 mg, if necessary) can be considered as one of the best options for non-surgical treatment of patients with BPH and ED.

Assessing the Impact of a Rapidly Scaled Virtual Urgent Care in New York City During the COVID-19 Pandemic.

BackgroundThe coronavirus disease (COVID)-19 pandemic quickly challenged New York City health care systems. Telemedicine has been suggested to manage acute complaints and divert patients from in-person care.ObjectivesThe objective of this study was to describe and assess the impact of a rapidly scaled virtual urgent care platform during the COVID-19 pandemic.MethodsThis was a retrospective cohort study of all patients who presented to a virtual urgent care platform over 1 month during the COVID-19 pandemic surge. We described scaling our telemedicine urgent care capacity, described patient clinical characteristics, assessed for emergency department (ED) referrals, and analyzed postvisit surveys.ResultsDuring the study period, a total of 17,730 patients were seen via virtual urgent care; 454 (2.56%) were referred to an ED. The most frequent diagnoses were COVID-19 related or upper respiratory symptoms. Geospatial analysis indicated a wide catchment area. There were 251 providers onboarded to the platform; at peak, 62 providers supplied 364 h of coverage in 1 day. The average patient satisfaction score was 4.4/5. There were 2668 patients (15.05%) who responded to the postvisit survey; 1236 (49.35%) would have sought care in an ED (11.86%) or in-person urgent care (37.49%).ConclusionsA virtual urgent care platform was scaled to manage a volume of more than 800 patients a day across a large catchment area during the pandemic surge. About half of the patients would otherwise have presented to an ED or urgent care in person. Virtual urgent care is an option for appropriate patients while minimizing in-person visits during the COVID-19 pandemic.

Tu1091 POST-COLONOSCOPY COMPLICATIONS WITHIN ONE MONTH; PATIENT SATISFACTION, AND PATIENT EXPERIENCE

The ASGE recently summarized complications of colonoscopy. How we present these risks when describing these, and when obtaining informed consent, should depend on having a true risk assessment. Patients may choose where and from whom they may receive treatment for adverse events (AEs) from colonoscopies. Thus, unless specific AEs and outcomes are proactively searched for, they might never be discovered. Establish accurate rates of colonoscopy-related AEs and identify modifiable factors to improve patient satisfaction, patient experience, and possibly other medical outcomes. Patients who underwent outpatient colonoscopies at one large academic hospital were contacted one month later by a medical secretary who used a standard questionnaire. Over a 34-month period, 2483 randomized patients were contacted. 149 refused to participate. 178 patients reported having suffering from abdominal pain, bleeding, or fever. 28/178 sought medical care. Among them, 21/178 (11.8%) contacted their primary care physician and 19/21 were referred to emergency departments, where 12/19 were admitted. Two additional patients were directly hospitalized without the emergency department. 11/14 were hospitalized at our hospital and three were admitted to other hospitals. 11/14 hospitalized patients had had procedures during their colonoscopies (n=5 polypectomies, n=4 biopsies, n=2 polypectomies + biopsies). 6/2334 patients were hospitalized for reasons unrelated to the colonoscopy and 2 patients were hospitalized for elective surgeries. 6/2134 patients were hospitalized for colonoscopy-related complications. The reasons for colonoscopy-related hospitalizations included intestinal perforation, post-polypectomy bleeding and abdominal pain due to the procedure. On a scale from one to five, the average overall patient satisfaction was 4.89 (n=2334). 2118 (98.6%) of patients would recommend to friends to undergo a colonoscopy at our center. 14/2334 patients suffered from serious AEs that were determined to be related to the colonoscopy. 3/14 serious AEs would have gone unnoticed even if every patient with an SAE treated at this hospital had been reported to the GI institute due to hospitalization at other hospitals. There were no mortalities. In this study, we found high levels of patient satisfaction. This may increase adherence to screening guidelines, increasing prevention and early treatments thus reducing morbidity and mortality. This study demonstrated low rates of serious AEs. Individual endoscopists found to have less desirable outcomes should be directed towards improving care. Knowing our AE rates helps us to properly prepare patients. Focus should be given to ensuring a high level of patient satisfaction and experience as well as minimizing true complication rates on a local level, not only based on literature statistics.

Applying the Collaborative Care Model to treat depression and anxiety in breast cancer (BC) patients.

e14004 Background: Depression and anxiety are frequent causes of excess morbidity for cancer patients, but access to mental health care, including outpatient psychiatry, is limited across academic and community settings. The Collaborative Care Model (CoCM) is a team-based model of care that is proven to leverage limited mental health resources across a wider population in primary care (Raney L, Am J Psychiatry, 2015). Evidence suggests that CoCM can be effectively applied to cancer populations too (Walker J, Gen Hosp Psychiatry, 2009). Methods: The investigators adapted CoCM to treat depression and anxiety in an academic BC clinic. A quality protocol was approved by the institutional board. All English-speaking BC patients were screened for depression using the PHQ-2 and PHQ-9. Patients with PHQ-9 ≥15 or clinical suspicion of severe anxiety or depression were referred to CoCM. The CoCM intervention included social work care management and regular case reviews by a psychiatrist. Medical oncologists prescribed all psychiatric medications. Patients were referred to mental health services in the community as needed. Results: From November 2018 through January 2020, a total of 74 patients were enrolled in CoCM. Median age was 50 years (range: 28-74 years) with BC stages I-III (n = 49, 66.2%) and stage IV (n = 25, 33.8%). Treatments within the cohort include: endocrine therapy (n = 39, 52.7%), chemotherapy (n = 18, 24.3%), observation (n = 9, 12.1%), single agent HER2 inhibitor targeted therapy (n = 4, 5.4%), immunotherapy (n = 2, 2.7%), single agent CDK4/6 inhibitor (n = 1, 1.4%), and radiation (n = 1, 1.4%). Of the 74 patients, 28 had PHQ-9 scores ≥15 at enrollment. On average, ending PHQ-9 scores decreased 39% from the initial score (average beginning score of 19.3 and ending score of 11.3 [n = 19]). 50 patients had GAD-7 ≥10 at enrollment. On average, ending GAD-7 scores decreased 36% from the initial score (average beginning score of 15.4 and ending score of 9.9 [n = 32]). On a 5-point scale, the average patient satisfaction score was 4.3 [range: 4.1-4.5] and the average medical oncology satisfaction score was 4.6 [range: 4.5-4.7]. Financial viability is promising based on projections that 93.4% of psychiatry costs (10% salary + benefits) are covered by reimbursements for care and 2 existing social workers serving as care managers. Conclusions: The collaborative care model is an effective and financially sustainable approach to promptly address depression and anxiety symptoms in BC. Further studies are needed to assess its applicability to patients with other forms of cancers.

Hot Off the Press: SGEM #285-Adult Coloring for Anxiety in the Emergency Department.

Hot Off the Press: SGEM #285-Adult Coloring for Anxiety in the Emergency Department.

Topping-off technique for stabilization of lumbar degenerative instabilities in 322 patients.

Semi-rigid instrumentation (SRI) was introduced to take advantage of the concept of load sharing in surgery for spinal stabilization. The authors investigated a topping-off technique in which interbody fusion is not performed in the uppermost motion segment, thus creating a smooth transition from stabilized to free motion segments. SRI using the topping-off technique also reduces the motion of the adjacent segments, which may reduce the risk of adjacent segment disease (ASD), a frequently observed sequela of instrumentation and fusion, but this technique may also increase the possibility of screw loosening (SL). In the present study the authors aimed to systematically evaluate reoperation rates, clinical outcomes, and potential risk factors and incidences of ASD and SL for this novel approach. The authors collected data for the first 322 patients enrolled at their institution from 2009 to 2015 who underwent surgery performed using the topping-off technique. Reoperation rates, patient satisfaction, and other outcome measures were evaluated. All patients underwent pedicle screw-based semi-rigid stabilization of the lumbar spine with a polyetheretherketone (PEEK) rod system. Implantation of PEEK rods during revision surgery was performed in 59.9% of patients. A median of 3 motion segments (range 1-5 segments) were included and a median of 2 motion segments (range 0-4 segments) were fused. A total of 89.4% of patients underwent fusion, 73.3% by transforaminal lumbar interbody fusion (TLIF), 18.4% by anterior lumbar interbody fusion (ALIF), 3.1% by extreme lateral interbody fusion (XLIF), 0.3% by oblique lumbar interbody fusion (OLIF), and 4.9% by combined approaches in the same surgery. Combined radicular and lumbar pain according to a visual analog scale was reduced from 7.9 ± 1.0 to 4.0 ± 3.1, with 56.2% of patients indicating benefit from surgery. After maximum follow-up (4.3 ± 1.8 years), the reoperation rate was 16.4%. The PEEK rod concept including the topping-off principle seems safe, with at least average patient satisfaction in this patient group. Considering the low rate of first-tier surgeries, the presented results seem at least comparable to those of most other series. Follow-up studies are needed to determine long-term outcomes, particularly with respect to ASD, which might be reduced by the presented approach.

A pilot study of rehabilitation at home after stroke: a health-economic appraisal

This study aimed at describing the health-economic implications and organisational issues of rehabilitation at home in south-west Stockholm of 15 acute stroke patients, mean age 68.2, male:female ratio 9:6, independent in feeding and continent one week after their stroke. Average patient satisfaction with different dimensions of care was 92%. Perceived dysfunction, by means of the Sickness Impact Profile, 3 months after stroke was highest for Recreation-and-Pastime, Home Management and Ambulation. Between 3-12 months after stroke, functional improvement was particularly seen in Home Management, Recreation-and-Pastime and Emotional Behaviour. Three fourths of the patients received help with different ADL tasks from a family caregiver and 1/5 from home service assistants. According to the scores for subjective health of the spouses and time used to help the patient, the burden that the programme put on the patient's family was modest, temporary and in accordance with preferences reported by the elderly in Sweden. The mean duration of hospital stay for patients under rehabilitation at home was 14 days and for a selected comparison group with similar ADL-grade, 27 days. The mean number of therapy sessions at home was 11. Each home visit took 3.2 hours, 60% of which were direct patient time. In the selected comparison group, 1/3 was referred to other departments for rehabilitation and care, and 40% had contacts with day-care and paramedical professionals after discharge from the hospital. During the first year after stroke, the average, direct, per capita cost for rehabilitation at home amounted to SEK 127,730 divided between hospital care (50%), followed by contribution by family caregivers (18%), rehabilitation at home (10%), out-patient visits to physicians and nurses (8.8%), home-help service (7%), auxiliary equipment (2%), medication (1.5%), home adaptation (1%) and transportation service (0.3%). This organisational model of home-based rehabilitation of stroke patients constitutes a feasible, possibly less expensive alternative and complement to current rehabilitation in hospital and primary care, which could be further developed and evaluated.

Bedside Report: Nursing Handoffs Impact Outcomes for Caregivers, Healthcare Providers, and Organizations.

Bedside Report: Nursing Handoffs Impact Outcomes for Caregivers, Healthcare Providers, and Organizations.

Pilot Randomized Trial of a Recovery Navigator Program for Survivors of Critical Illness With Problematic Alcohol Use.

Objective:Many survivors of critical illness have problematic alcohol use, associated with risk of death and hospital readmission. We tested the feasibility, acceptability, treatment fidelity, and potential efficacy of a customized alcohol intervention for patients in ICUs. The intervention was delivered by a Recovery Navigator using principles of motivational interviewing and shared decision-making.Design:Pilot randomized trial.Setting:Two urban ICUs in Denver, CO.Patients:Patients with problematic alcohol use were enrolled prior to hospital discharge.Interventions:Patients were randomly assigned to usual care, single-session motivational interviewing and shared decision-making, or multisession motivational interviewing and shared decision-making.Measurements and Main Results:We assessed feasibility via enrollment and attrition, acceptability via patient satisfaction (Client Satisfaction Questionnaire-8), fidelity via observation and questionnaires, and potential efficacy via group means and CIs on measures of alcohol use, psychiatric symptoms, cognition, and other alcohol-related problems. Over 18 months, we offered the study to 111 patients, enrolled 47, and randomized 36; refusals were mainly due to stigma or patients' desire to handle problems on their own. Groups were similar at baseline, and 67% of patients met criteria for alcohol use disorder. Average patient satisfaction was high (mean = 28/32) regardless of group assignment. Sessions were delivered with 98% adherence to motivational interviewing principles and excellent motivational interviewing spirit; patients perceived the intervention to be more autonomy supportive than usual care. Group means after 6 months suggested that patients receiving the intervention might improve on measures such as alcohol use, psychiatric symptoms, legal problems, and days of paid work; however, they did not receive more substance use treatment. All results were nonsignificant due to small sample size.Conclusions:A Recovery Navigator intervention was feasible and acceptable for delivering high-fidelity brief interventions to ICU patients. Changes in alcohol-related problems with motivational interviewing and shared decision-making were nonsignificant but clinically meaningful in size. A full-scale randomized trial of motivational interviewing and shared decision-making is warranted.

Minimum 5-Year Outcomes of Arthroscopic Hip Labral Reconstruction with Nested Matched-Pair Benchmarking Against a Labral Repair Control Group

Objectives:Labral reconstruction has demonstrated short-term benefit for the treatment of irreparable labral tears. Nonetheless, there is a scarcity of evidence for mid-term outcomes of this treatment. The purpose of our study was to report 5-year outcomes in patients who underwent segmental labral reconstruction. In addition, we compared 5-year outcomes of patients who underwent primary segmental labral reconstruction (PLRECON) with a matched-pair control group that underwent primary labral repair (PLREPAIR). We hypothesized that arthroscopic segmental reconstruction in the setting of irreparable labral tears would show improvement in patient-reported outcomes (PROs) and high patient satisfaction at minimum 5-year follow-up. Secondly, PLRECON would experience similar improvement in PROs at minimum 5-year follow-up when compared to a matched-pair PLREPAIR control group.Methods:Data from February 2008 to April 2013 was retrospectively reviewed. Patients were included if they underwent hip arthroscopy for segmental labral reconstruction in the setting of irreparable labral tear and femoro-acetabular impingement (FAI), with minimum 5-year follow-up for modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score-Sports Specific Subscale (HOS-SSS), and Visual Analogue Scale (VAS) for pain. Exclusion criteria were Tönnis osteoarthritis grade >1, prior hip conditions, or Workers’ Compensation claims. PLRECON were matched in a 1:3 ratio to a PLREPAIR group based on age ±5 years, gender, and body mass index (BMI) ±5 kg/m2.Results:Twenty-eight patients were eligible for the study, of which 23 (82.14%) had minimum 5-year follow-up. We found significant improvement from preoperative to latest follow-up in all outcome measures recorded: 17.8-point increase in mHHS (P=0.002), 22-point increase in NAHS (P<0.001), 25.4-point increase in HOS-SSS (P=0.003), and a 2.9-point decrease in VAS pain ratings (P<0.001). Average patient satisfaction was 7.1 out of 10. In the nested matched-pair analysis, 17 PLRECON were matched to a control group of 51 PLREPAIR patients. PLRECON demonstrated comparable survivorship and comparable improvements in all PROs with the exception of patient satisfaction.Conclusion:Hip arthroscopy with segmental labral reconstruction resulted in significant improvement in PROs at minimum 5-year follow-up. PLRECON reached comparable functional outcomes when compared to a benchmark PLREPAIR control group, but demonstrated lower patient satisfaction at latest follow-up.Figure:PROs comparison between preoperative, minimum 2-year, and minimum 5-year followup for patients undergoing segmental labral reconstruction.

Leveraging Big Data Analytics to Improve Quality of Care in Healthcare Organizations: A Configurational Perspective

AbstractBig data analytics (BDA) is beneficial for organizations, yet implementing BDA to leverage profitability is fundamental challenge confronting practitioners. Although prior research has explored the impact that BDA has on business growth, there is a lack of research that explains the full complexity of BDA implementations. Examination of how and under what conditions BDA achieves organizational performance from a holistic perspective is absent from the existing literature. Extending the theoretical perspective from the traditional views (e.g. resource‐based theory) to configuration theory, the authors have developed a conceptual model of BDA success that aims to investigate how BDA capabilities interact with complementary organizational resources and organizational capabilities in multiple configuration solutions leading to higher quality of care in healthcare organizations. To test this model, the authors use fuzzy‐set qualitative comparative analysis to analyse multi‐source data acquired from a survey and databases maintained by the Centres for Medicare &amp; Medicaid Services. The findings suggest that BDA, when given alone, is not sufficient in achieving the outcome, but is a synergy effect in which BDA capabilities and analytical personnel's skills together with organizational resources and capabilities as supportive role can improve average excess readmission rates and patient satisfaction in healthcare organizations.