Evaluation Of Medical Care Research Articles

Multinational Medical Care Evaluation Concerning Aging Populations

Multinational Medical Care Evaluation Concerning Aging Populations

Analysis and assessment of accessibility of dental care to the adult population of Omsk city

The article presents the analysis and evaluation of the accessibility of dental care to the adult population of Omsk, which showed an insignificant influence of socio-demographic characteristics on the evaluation of medical care. The criteria favorably influencing the general assessment of the accessibility of dental care are revealed.

Racial/ethnic and socioeconomic differences in breast cancer surgery performed and delayed surgical treatment: Mediating impact on mortality.

585 Background: Breast cancer is the most common malignancy affecting women of all racial and ethnic backgrounds in the United States (US). Although Socioeconomic status (SES), race/ethnicity, and surgical type/delays are associated with breast cancer mortality outcomes, studies on these associations have been contrasting. This study examined the racial/ethnic and SES differences in surgical treatment types and delays. Also, we quantified the extent to which these differences explained the racial/ethnic disparities in breast cancer mortality. Methods: We studied 290,066 women 40+ years old diagnosed with breast cancer between 2010 and 2017 identified from the Surveillance, Epidemiology, and End Results database. We performed logistic regression models to examine the association of SES and race/ethnicity with surgical treatment type and delays. We performed mediation analysis models to quantify the extent to which mortality differences were mediated by treatment, sociodemographic, and clinicopathologic factors. The study subjects were de-identified, and there was no patient contact; thus, the study was exempted from an Institutional Review Board's (IRB) approval. A p-value less than 0.05 indicated significant associations for the descriptive statistics, logistic and Cox proportional hazard regressions, and mediation analysis. We used Stata 17 to perform the analyses. Results: Non-Hispanic (NH) Black [Odds ratio (OR) = 1.16, 95% CI: 1.13-1.19] and Hispanic women [OR = 1.27, 95% CI: 1.24-1.31] were significantly more likely to undergo mastectomy compared to NH White women. Similarly, NH Black and Hispanic women had higher odds of delayed surgical treatment than NH Whites. Patients in the highest SES quintile, compared to those in lowest the lowest, were less likely to experience breast cancer-specific mortality (BCSM). Variations in treatment, SES, and clinicopathological factors significantly explained 70% of the excess BCSM among NH Blacks compared to their NH White counterparts. Conclusions: In conclusion, health disparity continues to be a major societal concern in the US. It affects people of all ages, socioeconomic classes, and ethnic/racial backgrounds. The findings of this study showed that racial and ethnic minorities, the majority of whom have a lower socioeconomic position, are significantly disadvantaged regarding the evaluation, quality, cost, and duration of medical care. Future studies can assess the multifactorial effects of sociodemographic factors like SES, access to health care assessment, and educational background amidst other variables as a multidimensional predictor of treatment delay and overall survival of breast cancer and other health issues among minoritized populations.

MULTIMODAL FUSION ANALYSIS OF MEDICAL IMAGES BY DISCRETE WAVELET TRANSFORMATION

Medical image fusion is the development of registry and fusion of different pots of one or more imaging modalities in order to improve image value and reduce uncertainty and concern, to improve the applicability of the medical image for clinical opinion or the evaluation of medical care. difficulties. Multimodal medical image fusion algorithms and devices have achieved a remarkable result in improving the veracity of clinical decision support in medical images. The main objective is to improve the understanding of medical images using Discrete Wavelet Transform technology. DWT mainly uses blending rules involving the average pixel. Discrete wavelet transform has been implemented using fusion technology for medical image fusion. Fusion Power is calculated based on PSNR, MSE, and Total Progression Moment. The result demonstrates the success of the fusion scheme on wavelet transform imaging (MRI) and positron production tomography (PET). Other variants of MRI (magnetic resonance imaging) and PET (positron emission tomography) performed for medical diagnosis. Keywords: Multimodal fusion of medical images, fusion rules, magnetic signs,PET.

Depressive disorders among long-term care residents in the face of isolation due to COVID-19 pandemic.

The main aim of this study was to assess the effects of social and familial isolation due to COVID-19 on the mental well-being of patients staying in a residential medical care facility and evaluation of the effectiveness of therapeutic measures. The study was conducted among the patients of a residential medical care facility (58 patients). A short form of the Geriatric Depression Scale (GDS) was used to assess the severity of depressive disorders. The number of medical and psychological interventions during the individual months of isolation was also compared. In February 2020, when there was no isolation, 87.9% of the study group did not suffer from depression compared to 72.4% during the period of full isolation. After introducing controlled methods for contacting loved ones, the number of individuals with no depressive symptoms increased again. A mean of 1.76 medical and 0.23 psychological interventions per one patient were conducted during the period of full isolation. The number of medical and psychological interventions was higher during the period of full isolation compared to months without compulsory isolation due to COVID-19. After the introduction of full isolation, the scores in the GDS were significantly higher, which means that the residents were at a higher risk of depressive disorders than in the months without isolation.

Medical expert evaluation of medical care for patients with musculoskeletal injuries

The objective of the study is to analyze 220 forensic medical examinations on criminal and civil cases and pre-investigation checks concerning the quality of emergency trauma care, involving an orthopedic traumatologist as a member of the expert panel. The main aspects of the forensic evaluation of medical care for patients with musculoskeletal injuries are described, including a thorough review of medical documentation data, completeness of past and present medical history in the medical records, injury mechanism, and completeness of the trauma course description in the medical records. The reasons for the forensic examinations, the causes of the main types of defects in medical care, and their relation to adverse outcomes were determined.

Evaluation of the effectiveness of internal quality control of medical care during control and supervision activities in medical organizations

Introduction. Currently, medical organizations of Moscow Healthcare Department have a three-level system of internal control for assessing the quality and safety of medical activities. At the same time, insurance companies have adopted a logically consistent, alternating multi-level system of inspections (medical and economic control) and evaluations (medical and economic evaluation, quality of medical care evaluation). Methods, techniques, criteria and guidelines for external and internal control of the quality and safety of medical activities are different. In this regard, assessment of the effectiveness of internal quality control of medical care in medical organizations during control and supervision activities is an important task that requires an evidence-based decision. Objectives. To provide evidence for the effectiveness of assessment criteria when conducting internal quality control of medical care and to determine their impact on effective performance of medical organizations. Materials and methods. The authors studied the results of 10 inspections and 36 evaluations of regulatory and supervisory authorities (insurance companies, Federal Service for Surveillance in Healthcare (Roszdravnadzor), etc.) and systematized the reasons for applying deductions and penalties. We performed a comparative analysis with evaluation criteria used by the heads of structural divisions (departments, laboratories) of City Clinical Hospital named after brothers Bakhrushin of Moscow Healthcare Department, as well as other private medical organizations. Authors studied technical capabilities of various automated information systems (Megaclinic, Asklepius, Doctor’s Automated Workstation, EMIAS for polyclinics and hospitals, etc.). Results. Authors performed comparative analysis of criteria used in inspections and evaluations of external and internal control of the quality and safety of medical activities. Analysis showed that the currently used assessment criteria do not fully ensure fulfillment of requirements and guidelines, violation of which entails financial sanctions (deductions, fines). Conclusion. It is necessary to develop and implement methods for organizing and conducting internal control of quality and safety of medical activities to create «effective criteria» that will minimize financial sanctions (deductions, fines) applied during various inspections (evaluations) of control and supervisory authorities.

Does surgical observed structured clinical exam (OSCE) predict clerkship grade, shelf exam scores, and preceptor clinical evaluation?

BackgroundClinical evaluation of medical student performance has been criticized as variable and subjective. The aim of this study was to assess the correlation of a summative surgical OSCE exam to clinical faculty evaluations as well as surgery shelf exam score and final grades. MethodsThe performance of 392 students who completed the surgical clerkship between 2017 and 2019 was assessed via Pearson Coefficients comparing OSCE grades, clinical evaluations of Medical Knowledge and Patient Care, Communication and Professionalism, the National Board of Medical Examiners (NBME) shelf surgical subject exam, and final clerkship grade. ResultsResults demonstrate a statistically significant positive relationship between the OSCE, Shelf score and grade, final clerkship grade, and all clinical evaluations except Communication skills. The greatest correlation occurred between OSCE and shelf scores and grades. Although significant, the degree of correlation with clinical observation was significantly less. ConclusionThis study demonstrates that a surgical OSCE has a small positive correlation with clinical knowledge as measured by the NBME shelf exam. There is also an equal correlation with medical knowledge standards, with the OSCE better predicting NBME shelf outcome. This lower correlation to clinical assessment suggests that either the clinical grades contain elements not detected on an OSCE exam but could also support the hypothesis that variability in clinical grades do contain a significant degree of subjectivity.

Study of the Situation of Venezuelan Emigrants in Ecuador based on NeutroAlgebra

Venezuelan migration to neighboring countries in the area is a phenomenon that has been growing in recent years. Ecuador is one of the main countries where migrants who leave Venezuela have gone to reside.They initially arrived in the country as a transit to reach other countries, however, over time many of them decided to settle in Ecuador permanently. Venezuelan migration in our country presents certain characteristics, such as the youth of those who arrive, the high educational level, and the motivation for economic improvement that prompted them to emigrate at first and in a second wave for family reunification. This research aims to apply a survey to know more precisely the economic, social, labor, and humanitarian situation of this sector of migration in the country. We selected a model that uses NeutroAlgebra and is generated by the PROSPECTOR function. PROSPECTOR function is the well-known function used in the classic medical expert system MYCIN, while NeutroAlgebra is an algebra that has at least one NeutroOperation or one NeutroAxiom, where some cases are indeterminate. This model has previously been used in the evaluation of medical care of migrants in Chile. However, unlike the model we are inspired on, here input data are linguistic terms associated with Single-Valued Neutrosophic Numbers, which allows respondents to express more reliably what they want to say.

Comparative evaluation of various strategies medical care for chronic hepatitis С in the Republic of Sakha (Yakutia)

Hepatitis C is a major public health problem and measures against it require the development of a national strategy and concept of a prognostic model. This is relevant for Yakutia, as a tremendous region with extremely specific and severe climatic and social conditions that cause a high incidence of hepatitis C.Objective: to evaluate the effectiveness of various scenarios for the development of the epidemiological situation of hepatitis C in RS (Y) depending on the strategy for providing medical care to people with chronic hepatitis C.Material and Methods. The work uses the materials of official statistics of the Federal State Institution of Rospotrebnadzor for RS (Y) and information from the register «Chronic viral hepatitis in RS (Y). To assess the burden of disease, the main scenarios were analyzed using the dynamic Excel model.Results and discussion. RS (Y) is a disadvantaged territory of the Russian Federation for parenteral viral hepatitis, including hepatitis C. According to the register «Chronic viral hepatitis in RS (Y)», 14643 people are registered, of which with chronic hepatitis C — 7395, which amounted to 50,5%. The proportion of HCV infection in the group of people with cirrhosis is 44.1%, with hepatocellular carcinoma 59,3%, and 76% in the total structure of the dead. Implementation of the WHO scenario for hepatitis C will reduce mortality by 65%, the number of people with hepatocellular carcinoma by 66%, decompensated cirrhosis by 66% and reduce the overall incidence by 34% by 2030.Conclusion. Achieving the WHO goals by 2030 seems realistic when creating a regional strategy to eliminate HCV in RS (Y), which includes increasing access to therapy with modern drugs with direct antiviral effects, an interdisciplinary approach to the diagnosis and management of patients with chronic hepatitis C, specialties about the problem of chronic hepatitis C and the possibility of curing it.

Utilization of Telehealth Services in Libya in Response to the COVID-19 Pandemic: Cross-sectional Analysis.

BackgroundHealth care systems in transitional countries have witnessed unprecedented challenges related to adequate and continuous health care provision during the COVID-19 pandemic. In many countries, including Libya, institutions and organizations have begun to implement telehealth technology for the first time. This serves to establish an alternative modality for direct physician-patient interviews to reduce the risk of COVID-19 transmission.ObjectiveThis study aimed to assess the usability of telehealth services in Libya and to provide an overview of the current COVID-19 scenario.MethodsIn this cross-sectional study, an anonymous web-based survey was administered to Libyan residents between April and May 2020. Participants were contacted through text messaging, emails, and social media. The survey items yielded information on the sociodemographic characteristics, availability and accessibility of health care services, effects of the COVID-19 pandemic on health care services, mental health status, and the feasibility and application of the telehealth system.ResultsWe obtained 2512 valid responses, of which 1721 (68.5%) were from females. The participants were aged 28.2 (SD 7.6) years, of whom 2333 (92.9%) were aged <40 years, and 1463 (58.2%) were single. Regarding the health care services and their accessibility, 786 (31.1%) participants reported having a poor health status in general, and 492 (19.6%) reported having a confirmed diagnosis of at least one chronic disease. Furthermore, 498 (19.9%) participants reported varying degrees of difficulty in accessing health care centers, and 1558 (62.0%) could not access their medical records. Additionally, 1546 (61.6%) participants experienced problems in covering medical costs, and 1429 (56.9%) avoided seeking medical care owing to financial concerns. Regarding the feasibility of the telehealth system, approximately half of the participants reported that telehealth services were useful during the COVID-19 pandemic, and 1545 (61.5%) reported that the system was an effective means of communication and of obtaining health care services. Furthermore, 1435 (57.1%) participants felt comfortable using the telehealth system, and 1129 (44.9%) felt that they were able to express themselves effectively. Moreover, 1389 (55.3%) participants found the system easy to understand, and 1354 (53.9%) reported having excellent communication with physicians through the telehealth system. However, only 1018 (40.5%) participants reported that communication was better with the telehealth system than with traditional methods.ConclusionsOur study revealed high levels of usability and willingness to use the telemedicine system as an alternative modality to in-person consultations among the Libyan residents in this study. This system is advantageous because it helps overcome health care costs, increases access to prompt medical care and follow-up evaluation, and reduces the risk of COVID-19 transmission. However, internet connectivity and electricity issues could be a substantial barrier for many resource-limited communities, and further studies should address such obstacles.

The comparison of patients' satisfaction with primary health care received in the context of the process of reforming health care sector in Ukraine: a cross-sectional research (based on the example of the primary health care center in the city of Kyiv)

The purpose of the research is to compare the satisfaction of patients of the PHC center in the city of Kyiv who made declarations with doctors and received primary health care in 2019 with the satisfaction of patients of former therapeutic sites who received PHC in 2017. A cross-sectional research was conducted in the primary health care center in the city of Kyiv in two stages. The first phase was held during the 6 months of 2017. In total, 397 people at the age of 18 and older were selected, who contacted with primary health care physicians at the time of the research not less than one year. The EUROPEP questionnaire that was used consists of 23 questions with possible rating them according to five-point Likert scale and covering the following aspects: relationship between a doctor and a patient, evaluation of direct medical care, information and support of the patient by doctor, organizational aspects of health care delivery, availability of primary health care. The second phase of the research, using the same EUROPEP questionnaire was held during the 6 months of 2019. In total, there were 402 respondents who took part in research. We offered to determine the average value of the proportion of patients with the evaluation criteria «good» and «excellent» from received by them PHC for each of the 23 questions of a questionnaire as an integral indicator of satisfaction with the received PHC. The research found that the integral indicator of satisfaction with the received PHC in the city of Kyiv during the last two years in the context of the process of reforming the health care sector in Ukraine has increased from 75,5 ± 0,5 in 2017 to 85,9 ± 0,4 in 2019. The comparison of the average values obtained as a result of the research before and after the reforming of the primary care link in the city of Kyiv has revealed a statistically significant (p˂0,01) increase in patients’ satisfaction with the PHC in all the investigated aspects, except the answers to Q1 (making you feel you had enough time for consultation?) and Q23 questions (urgent care delivery).

P067: Ondansetron and rehydration in pediatric gastroenteritis

Introduction: Gastroenteritis (GE) is one of the most common causes of emergency room visits, especially in pediatrics. The Canadian Paediatric Society and Choosing Wisely have issued high-grade recommendations to physicians working in the Emergency Department. It suggests, trying oral ondansetron followed by oral rehydration before installing venous rehydration in children with GE with adequate hydration or mild to moderate dehydration. This quality of medical care evaluation aims to determine if these recommendations were being applied for children aged 6 months to 12 years, with adequate hydration status or mild to moderate dehydration, who presented to the Chicoutimi emergency room between November 2016 and November 2018. Methods: Practice conformity was assessed according to two explicit criteria: prescription of oral ondansetron and appropriate mean of rehydration. A data collection tool was created and files were reviewed by investigators after standardization. Several secondary outcomes were assessed, including, among others, duration of symptoms, the number of vomiting and diarrhea. The hydration status was measured according to the capillary refill, feeling of skin to the touch, condition of buccal mucosa, tears, heart rate and mental status. These variables were analyzed to understand their impact on practice conformity. We excluded cases in which there was infections needing antibiotics, hypoglycemia, hemodynamic instability, no vomiting in the last 24 hours, convulsions and history of diabetes. Results: A total of 270 patient files were analyzed, 181 of which were included. Oral ondansetron was tried in 49 % of children. Rehydration was adequate in 55% of cases. The hydration level was written in 18% of files and the hydration status noted by the emergency room physician overestimated the dehydration score in 16% of cases. When hydration status was well assessed, adequate rehydration was observed in 63% of cases, while ondansetron was attempted in only 44% of cases. Conclusion: Use of oral ondansetron and adequate mean of rehydration to treat children aged 6 months to 12 years with GE in Chicoutimi emergency department is suboptimal. The difficulty of adequate dehydration assessment may be one of the causes. Concerted dehydration assessment grid and a group prescription for the administration of ondansetron during the nurse triage may constitute potential solutions.

Improving the Care for Pediatric Transplant Patients through Integration of Patient-Reported Outcome Measures into Clinical Practice

Subjective evaluation of medical care and treatment from the patient's perspective is increasingly important. Patient-reported outcome measures (PROMs) are "any report of the patient's health condition that comes directly from the patient, without interpretation of the patient's response by a clinician or anyone else" and can comprise information about symptoms, functional status, and quality of life. PROMs have the ability to engage patients meaningfully, give them a voice in their healthcare, and capture their experiences and attitudes. This study explores the perspectives of pediatric solid organ transplant patients, caregivers and healthcare providers on implementing PROMs into clinical practice. Semi-structured interviews were conducted at five Canadian pediatric transplant centres. Maximum variation sampling was used to provide concurring and confirming data, and ensure saturation. An iterative coding process was applied with constant comparative data analysis to identify themes. A total of 20 patients, 22 caregivers and 20 healthcare providers participated. Nearly all participants (n = 59, 95%) were supportive of implementing PROMs with the primary goals to 1) enhance patient-provider communication - "Opens conversations"; "[Patients] state what they're feeling", and 2) increase patient engagement - "Like you're part of the team". Participants discussed the potential impact of PROMs as the provision of preventative - "You'll be proactive", and holistic care - "You cannot separate medical from other aspects. [Patients] are struggling from a mental health perspective". Participants identified selected PROMs, the PedsQLTM Generic Core Scales - "Covers aspects I wouldn't usually include in my assessment" and the PedsQLTM Transplant Module - "More related to transplant patients". Recommendations included 1) PROM data collection for patients eight years of age and older, 2) remote administration and completion of electronic PROMs, prior to clinical appointments, and 3) visual data representation. Findings highlight support for the implementation of PROMs into pediatric solid organ transplantation. Future research is needed to develop implementation strategies to effectively integrate PROMs into clinical workflow and assess the impact on patient health outcomes.

Cost analysis of blood purification: a tool for decision-making and supply chain optimization

This study complies with the reorganization of health care provider processes based on the cost of life cycle of the product. The aim is to determine the costs of treatment administration of extracorporeal dialysis and other treatments in extracorporeal systems.The strategy here was to apply for the first time the “bill of material” (BoM) method to the production and management of the services above.By using standard replacement flows, we build the “bill of materials” to calculate the cost of a CRRT (continuous renal replacement therapy) with anticoagulant. The standard cost of the process is thus obtained.The method here developed can be used for accounting purposes and for economic planning, as a tool for accurate statistical evaluation of medical care.

Patient-reported outcome measures within pediatric solid organ transplantation: A systematic review.

Subjective evaluation of medical care and disease outcomes from patients' perspectives has become increasingly important. Patient-reported outcome measures (PROMs) play a prominent role in engaging patients, capturing their experiences and improving patient care. This systematic review sought to identify PROMs that are used in the field of pediatric solid organ transplantation, with the aim to inform the implementation of PROMs into clinical practice for this population. A systematic review of English language, peer-reviewed articles was performed on key health science databases to identify publications using PROMs in pediatric solid organ transplantation. The search yielded 3670 articles, with a final data set of 62 articles that included 47 different PROMs. The three most frequently used PROMs included the following: (a) PedsQL™ Generic Core Scales (n=25); (b) Children's Depression Inventory (n=6); and (c) Child Health Questionnaire (n=6). Of the 47 PROMs, 42 were generic and five were disease-specific; only six PROMS had a documented psychometric evaluation within a pediatric solid organ transplant population. This review outlines the attributes of the instruments (eg, domains captured), as well as the psychometric properties of those evaluated. PROMs are increasingly used in the field of pediatric transplantation; however, there are limited details in the current literature about their conceptual underpinnings and psychometric properties. This review highlights the need for additional psychometric evaluation of identified measures to establish the necessary foundation to inform the implementation of PROMs into clinical care for pediatric solid organ transplant patients.

Evaluation of Medical Care and Patient's Knowledge About the Behavior to Take on Secondary Prevention of Anaphylaxis

Evaluation of Medical Care and Patient's Knowledge About the Behavior to Take on Secondary Prevention of Anaphylaxis

Iatrogenesis in the Intensive Care

The problem of iatrogenesis in the medical practice is still urgent: according to published data, in healthcare institutions of the Ministry of Public Health of the Russian Federation, about 50.0% of errors in medical care are made by surgeons; among these errors, diagnostic errors prevail (80.0 %) due to improper examination of patients and lack of follow up. Together with surgeons, anesthesiologists and intensivists are in the top five of physicians who demonstrated the greatest number of defects in medical care (about 30.0%).The purpose of our study is prevention of iatrogenesis in the intensive care unit (ICU).Materials and methods. We analyzed findings of the forensic examination and evaluation of medical care of a patient with knife wounds.Results. We determined the immediate cause of death, and describe the causal link between the outcome and identified defects in the medical care.Conclusion. Preventing the iatrogenesis in ICU is right strategy to improvemethe medical care quality.

Forensic-medical evaluation of improper medical care, provided by the nursing personnel

A retrospective review of all alleged medical malpractice cases between 2007 and 2016 handled at Ternopil, Zhytomir and Chernivtsi Regional Bureaus of Forensic medical Examination, was performed. Peculiarities of improper medical care provided by nursing staff were studied on the base of the reports of Commission Forensic medical Examination. Lacks of health care provision committed by nurses were detected in 11,7% of the cases. The study showed that unjustifiable medical care occurred as usual in policlinics and ambulatories. 8 types of nursing mistakes were determined. Unintentional medical care was confirmed by forensic medical expert commission as a rule in diagnostics, medical procedures or medical treatment. Insufficient or incomplete medical care provided by nursing personnel seemed more frequently. Nursing errors were caused by subjective reasons in almost 44,8% of the alleged medical malpractice cases. All these reasons were stipulated by poor quality of medical staff. Dereliction of duty by the nursing personnel that was strongly connected with causal relationship between the damage claimed by the patient and unskilful medical care was revealed in 13,8% of the cases.

"A Phenomenal Person and Doctor": Thank You Letters to Medical Care Providers.

BackgroundThank you letters to physicians and medical facilities are an untapped resource, providing an invaluable glimpse into what patients notice and appreciate in their care.ObjectiveThe aim of this study was to analyze such thank you letters as posted on the Web by medical institutions to find what patients and families consider to be good care. In an age of patient-centered care, it is pivotal to see what metrics patients and families apply when assessing their care and whether they grasp specific versus general qualities in their care.MethodsOur exploratory inquiry covered 100 thank you letters posted on the Web by 26 medical facilities in the United States and the United Kingdom. We systematically coded and descriptively presented the aspects of care that patients and their families thanked doctors and medical facilities for. We relied on previous work outlining patient priorities and satisfaction (Anderson et al, 2007), to which we added a distinction between global and specific evaluations for each of the already existing categories with two additional categories: general praise and other, and several subcategories, such as treatment outcome, to the category of medical care.ResultsIn 73% of the letters (73/100), physicians were primarily thanked for their medical treatment. In 71% (71/100) of the letters, they were thanked for their personality and demeanor. In 52% cases (52/100), these two aspects were mentioned together, suggesting that from the perspective of patient as well as the family member, both are deemed necessary in positive evaluation of medical care. Only 8% (8/100) of the letters lacked reference to medical care, personality or demeanor, or communication. No statistically significant differences were observed in the number of letters that expressed gratitude for the personality or demeanor of medical care providers versus the quality of medical care (χ21, N=200=0.1, not statistically significant). Letters tended to express more specific praise for personality or demeanor, such as being supportive, understanding, humane and caring (48/71, 68%) but more general praise for medical care (χ21, N=424=63.9, P<.01). The most often mentioned specific quality of medical care were treatment outcomes (30/73, 41%), followed by technical competence (15/73, 21%) and treatment approach (14/73, 19%). A limitation of this inquiry is that we analyzed the letters that medical centers chose to post on the Web. These are not necessarily a representative sample of all thank you letters as are sent to health care institutions but are still indicative of what centers choose to showcase on the Web.ConclusionsPhysician demeanor and quality of interaction with patients are pivotal in how laymen perceive good care, no less so than medical care per se. This inquiry can inform care providers and medical curricula, leading to an improvement in the perceived quality of care.