Predictors Of Overall Patient Satisfaction Research Articles

Patient-Reported Outcome Measures Using Modified Urethral Stricture Surgery

Purpose: To evaluate the patient-reported outcomes of primary direct visual internal urethrotomy (DVIU) and nontransecting bulbar urethroplasty techniques (NTBU) for the short segment (<2 cm) nontraumatic bulbar urethral stricture using the modified urethral stricture surgery patient-reported outcome measures (USS PROMs). Materials and Methods: The USS PROM questionnaire used to evaluate lower urinary tract symptom (LUTS) was modified by adding a six-item International Index of Erectile Function and a four-item version of MSHQ-EjD to evaluate erectile and ejaculatory domains. All cases of short nontraumatic bulbar urethral stricture who underwent primary DVIU and NTBU who consented were asked to fill the modified PROM at initial evaluation, at 6 months, and at 1 year. Results: The LUTS score for NTBU at 12 months is significantly better (1.93 ± 2.13 vs. 8.76 ± 5.92, P = 0.000). The Peeling score of the NTBU is significantly better at 12 months (1.41 ± 0.68 vs. 2.67 ± 0.73, P = 0.000). The erectile function score at 12 months for NTBU is better than DVIU (24.37 ± 3.2 vs. 21.143 ± 2.86, P = 0.001). The Ejaculatory function score at 6 months and 12 months is significantly better for the NTBU. Receiver operating characteristic (ROC) AND Odd's Ratio analysis for analyzing patient satisfaction showed erectile function (area under ROC [AUROC] - 0.889, P < 0.001), ejaculatory function (AUROC - 0.957, P < 0.001) at 1 year and maximum flow rate of urine on uroflometry (Qmax) (AUROC - 0.928, P < 0.001) at 6 months and (AUROC - 1.000, P < 0.001) at 1 year. The overall satisfaction rates in patients undergoing NTBU is 96.5%. Conclusion: NTBU shows superior outcomes in almost all domains of USS-PROM with better overall satisfaction rates. Improvement of sexual function domain, followed by the LUTS domain was the best predictor of overall patient satisfaction and improvement in the quality of life at 1 year.

MP22-02 MODIFIED USS PROM FOR DVIU AND NON TRANSECTING URETHROPLASTY FOR SHORT BULBAR URETHRAL STRICTURES

You have accessJournal of UrologyCME1 May 2022MP22-02 MODIFIED USS PROM FOR DVIU AND NON TRANSECTING URETHROPLASTY FOR SHORT BULBAR URETHRAL STRICTURES Arun Chawla, Suraj Jaidev Reddy, and Sitaram Mummalaneni Arun ChawlaArun Chawla More articles by this author , Suraj Jaidev ReddySuraj Jaidev Reddy More articles by this author , and Sitaram MummalaneniSitaram Mummalaneni More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002561.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the patient reported outcomes of Primary Direct visual internal urethrotomy (DVIU) and Non-transecting bulbar urethroplasty techniques (NTBU) for short segment (<2 cm) Non Traumatic bulbar urethral strictures using the Modified Urethral Stricture Surgery Patient Reported Outcome Measures (USS PROM). METHODS: The USS PROM questionnaire comprising of a six-item LUTS domain, a LUTS-specific QOL question, and a Peeling’s voiding picture score was further modified by adding a six-item IIEF and four-item version of MSHQ-EjD to evaluate Erectile and Ejaculatory domains. All cases of short non traumatic bulbar urethral stricture who underwent primary DVIU and NTBU who consented were asked to fill the modified PROM (USS -PROM+ IIEF +MSHQ-EjD) at initial evaluation, at 6 months and at 1 year. RESULTS: The LUTS score for NTBU at 12 months is significantly better (p=0.000). The Peeling score of the NTBU is significant better at 6 months (p=0.000) and 12 months (p=0.000). Erectile function score at 12 months for NTBU is significantly better than DVIU (p=0.001). The Ejaculatory function score at 6 months and 12 months is significantly better for the NTBU. Uroflowmetry (Qmax) is significant in NTBU group at 12 months (p =0.000). ROC AND Odd’s Ratio analysis for analyzing patient satisfaction showed Erectile function (AUROC-0.889, p <0.001), Ejaculatory function (AUROC-0.957, p <0.001) at 1 year and Qmax (AUROC-0.928, p <0.001) at 6 months and (AUROC-1.000, p <0.001) at 1year. Overall satisfaction rates in patients undergoing NTBU is 96.5%. CONCLUSIONS: NTBU shows superior outcomes in almost all domains of USS- PROM with better overall satisfaction rates. Improvement of Sexual function domain followed by the LUTS domain were the best predictors of overall patient satisfaction and improvement in the quality of life at one year. TABLE 2-Statistical Analysis Of Variables: Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e371 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Arun Chawla More articles by this author Suraj Jaidev Reddy More articles by this author Sitaram Mummalaneni More articles by this author Expand All Advertisement PDF DownloadLoading ...

P6. A BIG DATA APPROACH TO UNDERSTANDING PATIENT SATISFACTION WITH MASTOPEXY SURGERY

PURPOSE: A physician’s online footprint is becoming increasingly important in the age of social media. Therefore, understanding what drives patient satisfaction and behavior on social media is paramount to increasing patient satisfaction and maintaining a pristine online image. This study utilizes data obtained from Realself.com, a social media platform that allows patients to leave reviews of their plastic surgery experiences, to further elucidate the drivers behind patient satisfaction. METHODS: Patient reviews from the ‘Mastopexy’ category of Realself.com were collected using Scrapy, a python web crawling software that collects textual data from websites. Patient review data includes star ratings 1-5 in overall rating and various subcategories, as well as a free text entry, and cost data. Each entry was manually reviewed and categorized. Additionally, multiple regression was performed to assess independent predictors of overall satisfaction on the overall experience. RESULTS: A total of 968 mastopexy reviews were collected, 85.6% positive and 14.4% negative. The most common reasons for positive experience were aesthetic appearance (66.5%) and good physician bedside manner (21.7%). Similarly, negative reviews also most frequently cited appearance(58.3%) and bedside manner (26.6%). Several independent predictors of overall satisfaction were identified. Physician bedside manner (p<0.001), after-care follow up(p<0.001), staff professionalism and courtesy(p=0.016) and wait times (p=0.011) were independently associated with a positive overall review. CONCLUSION: We found that physician bedside manner, after-care follow up, staff professionalism and courtesy and wait times are independent predictors of overall patient satisfaction. Understanding the importance of these factors will increase rates of patient satisfaction and improve their overall online footprint.

Patient-Reported Outcomes After Genital Gender-Affirming Surgery With Versus Without Urethral Lengthening in Transgender Men

In our institution, genital Gender-Affirming Surgery (gGAS;phalloplasty or metoidioplasty) in transgender men is offered with or without Urethral Lengthening (UL). The aim of this cross-sectional and retrospective study was to assess the effect of gGAS with or without UL on several Patient-Reported Outcomes (PROs), and to identify predictors of overall patient satisfaction at follow-up. A self-constructed Patient-Reported Outcome Measure (PROM) was sent to transgender men who were ≥1 year after gGAS. The survey comprises 25 questions divided into 5 domains: type of surgery, satisfaction with the appearance and functionality, quality of life, feelings of masculinity, and sexuality. Answers to the survey were compared between groups, and a linear regression analysis was conducted to identify predictors of overall patient satisfaction. Of 154 eligible transgender men, the PROM was sent to 118 (77%) willing to participate, and 102 (66%) completed the survey. The majority previously underwent phalloplasty (n=74;73%) compared to metoidioplasty (n=28;27%). Urethral Lengthening was performed in 56/102 (55%) participants, 51/74 (69%) in phalloplasty, 5/28 (18%) in metoidioplasty. The mean number of complications and reoperations was significantly higher in the UL group (2.7vs1 and 1.6vs0.4 respectively, both P < .001). Most participants were satisfied to very satisfied with life (75%), the appearance (66%), voiding (59%), the effect of surgery on masculinity (82%), and confirmed that the end surgical result matched their expectations (61%), independently of UL. Lowest scores in satisfaction were observed for the sexual functioning of the neophallus, with 34% satisfied to very satisfied participants. Both satisfaction with the appearance of the neophallus (P < .001) and with voiding (P=.02) were positive predictors of overall patient satisfaction at follow-up, in contrast to the complication and reoperation rate postoperatively (P=.48 and P=.95 respectively). Transgender men choosing for gGAS with or without UL can be adequately informed on PROs regarding type of surgery, satisfaction with the appearance and functionality, quality of life, feelings of masculinity, and sexuality. Study strengths comprise the relatively large cohort, long duration of follow-up, completeness of the data, and innovativeness of the studied outcomes. Limitations are the cross-sectional and retrospective design, possible participation bias and non-validated survey. No significant differences in several PROs were observed between participants who chose gGAS with or without UL in this retrospective study. Additionally, according to this study, satisfaction with the appearance of the neophallus and with voiding were positive predictors of overall patient satisfaction at follow-up. de Rooij FPW, van de Grift TC, Veerman H, etal. Patient-Reported Outcomes After Genital Gender-Affirming Surgery With Versus Without Urethral Lengthening in Transgender Men. J Sex Med 2020;18:974-981.

Patient satisfaction with the ocular surface individualized medical program.

To improve the medical management system and the quality of medical treatment, this study aimed to assess patient satisfaction related to an ocular surface individualized medical program for dry eye, and identified patient needs that should be addressed in future. We enrolled 166 patients from the dry eye clinic at the Peking University Third Hospital from December 2017 to May 2019. An investigator followed up with all patients by telephone 2 months after the first assessment of overall patient satisfaction, expectations, and experiences. We determined patient satisfaction using a questionnaire and analyzed the results. Multivariate linear regression analysis was used to assess the predictors of overall patient satisfaction. The overall patient satisfaction with the ocular surface individualized medical program skewed toward a positive assessment. Ten variables were significantly associated with overall patient satisfaction: two involving fulfilment of expectations, seven involving patient-reported experiences, and one involving socio-demographics. The most important predictor of overall patient satisfaction was patient-reported experiences with the treatment outcome (β = 0.281, p < 0.001), followed by experiences with medical staff services (β = 0.240, p = 0.002), examination services (β = 0.198, p = 0.002), and interpretation and professionalism (β = 0.168, p = 0.04), expectations fulfilment (β = 0.147, p = 0.025), as well as age (β = -0.13, p = 0.014). Free response-style negative patient feedback suggested that examination wait time and environment needed improvement. Overall, the ocular surface individualized medical program is effective and is able to achieve satisfaction for most patients. The examination procedures and environment require improvements, and treatment must be made more patient-centric to improve satisfaction.

Satisfaction With Healthcare Services Among Patients With Diabetes, Hypertension, and/or Dyslipidemia in Mexico: A Cross-Sectional Study

ObjectivesTo examine the factors associated with satisfaction with healthcare services provided to patients with diabetes, hypertension, and/or dyslipidemia in the Mexican population. MethodsIn a cross-sectional, retrospective study, we used data from the 2016 Half-Way National Health and Nutrition Survey in Mexico (ENSANUT MC 2016). This contained self-reported information about patient satisfaction and use of healthcare services by 2529 adults. An ordinal regression model was performed to identify predictors of overall patient satisfaction. ResultsGood or very good satisfaction was reported by 85.2% of the respondents. Patient satisfaction was positively associated with the quality of medical care (very good, odds ratio [OR] = 29.71, 95% confidence interval [CI] 9.04-97.62; good, OR = 13.24, 95% CI 5.07-34.57; and regular, OR = 6.56, 95% CI 2.49-17.30) and having been attended by a medical specialist (OR = 2.42, 95% CI 1.01-5.83). Patient satisfaction was negatively associated with a worse perception of health status (OR = 0.07, 95% CI 0.02-0.25), no change in health status (OR = 0.377, 95% CI 0.15-0.98), time in the waiting room (OR = 0.99, 95% CI 0.99-1.01), and poor conditions of the health center (OR = 0.09, 95% CI 0.04-0.18). ConclusionThere are several elements of organization, structure, and delivery of healthcare that are associated with patient satisfaction, although our findings need to be confirmed using longitudinal designs. Governments could use these findings to strengthen actions for improving patient satisfaction.

Predictors of Patient Satisfaction in Pediatric Oncology.

To understand key drivers of patient satisfaction in pediatric hematology/oncology. The "top-box" scores of patient satisfaction surveys from 4 pediatric hematology/oncology practices were collected from 2012 to 2014 at an integrated Children's Health Network. One item, "Likelihood of recommending practice," was used as the surrogate for overall patient satisfaction, and all other items were correlated to this item. A total of 1244 satisfaction surveys were included in this analysis. The most important predictors of overall patient satisfaction were cheerfulness of practice ( r = .69), wait time ( r = .60), and staff working together ( r = .60). The lowest scoring items were getting clinic on phone, information about delays, and wait time at clinic. Families bringing their children for outpatient care in a hematology/oncology practice want to experience a cheerful and collaborative medical team. Wait time at clinic may be a key driver in the overall experience for families with children with cancer. Future work should be directed at using this evidence to drive patient experience improvement processes in pediatric hematology/oncology.

Key drivers of patient experience in ambulatory paediatric cardiology.

Patient experience is becoming a central focus of healthcare. A broad range of studies on how to increase patient satisfaction ratings exists; however, they lack the specificity to adequately guide physicians and hospitals on how to improve patient experience. The objective of this study was to define the aspects of patient experience within paediatric cardiologist practices that can serve as predictors of excellent patient satisfaction. From 1 January, 2013 to 28 February, 2015 (26 months), outpatients who visited paediatric cardiologists were asked to complete a 39-question patient satisfaction survey regarding their experience. Surveys were collected over a 26-month period by Press Ganey, an independent provider of patient satisfaction surveys. Participants were asked to rate their experience on a 1-5 Likert-scale: a score of 1 demonstrated a "poor" experience, whereas a score of 5 demonstrated a "very good" experience. This retrospective study of 2468 responses determined that cheerfulness of the practice (r=0.85, p<0.001), a cohesive staff (r=0.83, p<0.001), and a care provider explaining problems and conditions (r=0.81, p<0.001) were key aspects of a paediatric cardiologist's practice that can be used as predictors of overall patient satisfaction. Awareness of how doctors can personalise a patient's experience is vital to achieve greater patient satisfaction and, ultimately, better patient outcomes.

Patient satisfaction: does surgical volume matter?

BackgroundPatient satisfaction is an increasing area of interest due to implications of pay for performance and public reporting of results. Although scores are adjusted for patient factors, little is known about the relationship between hospital structure, postoperative outcomes, and patient satisfaction with the hospital experience. MethodsHospitals participating in the University HealthSystem Consortium database from 2011–2012 were included. Patients were restricted to those discharged by general surgeons to isolate surgical patients. Hospital data were paired with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results from the Hospital Compare website. Postoperative outcomes were dichotomized based on the median for all hospitals and stratified based on surgical volume. The primary outcome of interest was high on overall patient satisfaction, whereas other HCAHPS domains were assessed as secondary outcomes. Chi square and binary logistic regression analyses were performed to evaluate whether postoperative outcomes or surgical volume more significantly influenced high patient satisfaction. ResultsThe study population consisted of 171 hospitals from the University HealthSystem Consortium database. High surgical volume was a more important predictor of overall patient satisfaction regardless of hospital complication (P < 0.001), readmission (P < 0.001), or mortality rates (P = 0.009). Volume was found to play less of a role in predicting high satisfaction on the other HCAHPS domains. Postoperative outcomes were more predictive of high satisfaction with providers, the hospital experience, and environment. ConclusionsHigh surgical volume more strongly predicted overall patient satisfaction on the HCAHPS survey than postoperative outcomes, whereas volume was less predictive in other HCAHPS domains. Patients may require more specific questioning to identify high quality, safe hospitals.

Psychometric properties of the new patients’ expectations questionnaire

The authors explore the development of the Patients’ Expectations Questionnaire (PEQ) and examination of psychometric characteristics it encompasses by reviewing surveys of primary care and hospital outpatients before and after their clinic visit. Three scales were developed for Pre-visit Ideal and Realistic expectations, and Post-visit Experiences (met expectations), based on literature review, semi-structured interviews, and subsequently piloted and refined. Patients completed the questionnaire about their ideal and realistic expectations before they saw the doctor, and were asked if their expectations had been met afterwards. The results show the scales met acceptability criteria for reliability (Cronbach’s alphas exceeded ? 0.70), administration mode (interview and self-completion), and sample type (general practice and hospital). Split-half reliability was also acceptable. Adjusted odds ratios showed that post-visit experiences (met expectations), followed by feelings of control in life, and age, were the most powerful independent predictors of overall patient satisfaction ratings with the clinic visit, and independent self-ratings of whether their expectations had been met overall. This leads the authors to conclude that the PEQ as a self-report instrument, has good reliability and validity and covers the main types of patient expectations of ambulatory health care. It has policy potential for monitoring expectation management, and is thus of potential benefit to providers and purchasers of health services, and ultimately to patients.

Early Follow-up of Reverse Total Shoulder Arthroplasty in Patients Sixty Years of Age or Younger

Reverse shoulder arthroplasty (RSA) is an accepted treatment that provides reproducible results in the treatment of shoulder arthritis and rotator cuff deficiency. Concerns over the longevity of the prosthesis have resulted in this procedure being reserved for the elderly. There are limited data in the literature with regard to outcomes in younger patients. We report on the early outcomes of RSA in a group of patients who were sixty years or younger and who were followed for a minimum of two years. A retrospective multicenter review of sixty-six patients (sixty-seven RSAs) with a mean age of 52.2 years was performed. The indications included rotator cuff insufficiency (twenty-nine), massive rotator cuff disorder with osteoarthritis (eleven), failed primary shoulder arthroplasty (nine), rheumatoid arthritis (six), posttraumatic arthritis (four), and other diagnoses (eight). Forty-five shoulders (67%) had at least one prior surgical intervention, and thirty-one shoulders (46%) had multiple prior surgical procedures. At a mean follow-up time of 36.5 months, mean active forward elevation of the arm as measured at the shoulder improved from 54.6° to 134.0° and average active external rotation improved from 10.0° to 19.6°. A total of 81% of patients were either very satisfied or satisfied. The mean American Shoulder and Elbow Surgeons (ASES) score and visual analog scale (VAS) score for pain improved from 40.0 to 72.4 and 7.5 to 3.0, respectively. The ability to achieve postoperative forward arm elevation of at least 100° was the only significant predictor of overall patient satisfaction (p < 0.05) that was identified in this group. There was a 15% complication rate postoperatively, and twenty-nine shoulders (43%) had evidence of scapular notching at the time of the latest follow-up. RSA as a reconstructive procedure improved function at the time of short-term follow-up in our young patients with glenohumeral arthritis and rotator cuff deficiency. Objective outcomes in our patient cohort were similar to those in previously reported studies. However, overall satisfaction was much lower in this patient population (81%) compared with that in the older patient population as reported in the literature (90% to 96%).

Patient satisfaction on tuberculosis treatment service and adherence to treatment in public health facilities of Sidama zone, South Ethiopia

BackgroundPatient compliance is a key factor in treatment success. Satisfied patients are more likely to utilize health services, comply with medical treatment, and continue with the health care providers. Yet, the national tuberculosis control program failed to address some of these aspects in order to achieve the national targets. Hence, this study attempted to investigate patient satisfaction and adherence to tuberculosis treatment in Sidama zone of south Ethiopia.MethodsA facility based cross sectional study was conducted using quantitative method of data collection from March to April 2011. A sample of 531 respondents on anti TB treatment from 11 health centers and 1 hospital were included in the study. The sample size to each facility was allocated using probability proportional to size allocation, and study participants for the interview were selected by systematic random sampling. A Pre tested, interviewer administered questionnaire was used to collect the data. Collected data was edited, coded and entered to Epi data version 3.1 and exported to SPSS version 16. Confirmatory factor analysis was done to identify factors that explain most of the variance observed in most of the manifested variables. Bivariate and Multivariate analysis were computed to analyze the data.ResultThe study revealed 90% of the study participants were satisfied with TB treatment service. However, 26% of respondents had poor adherence to their TB treatment. Patient perceived on professional care, time spent with health care provider, accessibility, technical competency, convenience (cleanliness) and consultation and relational empathy were independent predictors of overall patient satisfaction (P < 0.05). In addition to this, perceived waiting time was significantly associated with patient satisfaction (Beta = 0.262). In multivariate analysis occupational status, area of residence, perceived time spent with health care provider, perceived accessibility, perceived waiting time, perceived professional care and over all patient satisfaction were significantly associated with adherence to TB treatment (P < 0.05). Moreover, patient waiting time at reception room (Adjusted OR = 1.022, 95% CI 1.009, 1.0035) and Patient treatment phase (Adjusted OR = 0.295, 95% CI 0.172, 0.507) were independent predictor of adherence to TB treatment.ConclusionThe finding of this study showed that patients’ perceptions on health care provider interaction had a significant influence on patient satisfaction and adherence to TB treatment. Moreover, absence of drugs and long waiting time had a negative outcome on patient adherence. Therefore, the problem needs an urgent attention from programme managers and health care providers to intervene the challenges.

PS2-21: Explanation to Understanding: Practices of the Highest Performing Physicians by Patient Survey

Abstract Background The MD-Patient Communication Study aims were the best practice communication behaviors of physicians during outpatient clinic visits; and to collect physician perspectives of communication behaviors. Researchers have consistently found the top predictors of overall patient satisfaction are quality of the physician-patient relationship and contributing communications. There is limited understanding however, of the range of specific behaviors in the interaction associated with positive and negative patient perceptions and reactions. Methods In phase 1, we conducted a naturalistic, observational study of fifty-five, Permanente Primary Care physician-patient visits using videotape recordings, and incorporating patient and physician reactions to the tape. The physicians, who practiced in Los Angeles and Honolulu, spanned the three strata of high, medium, and low historical patient satisfaction scores. In phase 2, a standardized six-question set was posed, in semi-structured, 60-minute interviews, to 77 of the highest-performing physicians on this patient survey, including: 20 of the highest performers (top 5%) from the LA and Honolulu groups; and 42 and 15, respectively, of the highest performing physicians in Portland and Oakland. These interviews were audio taped with permission, transcribed and coded for patterns. Results Explanation to achieve understanding was the most commonly cited activity in answer to a ‘physicians’ role in their patients’ healing,’ and in what constitutes a “therapeutic moment in the visit.’ Pattern dimensions include: context – trust, relationship; communication – connection, dialogue; content – visual explanation; role – patient ownership; and support – reassurance, encouragement. Representative verbatims: “It’s how the information is interpreted and packaged, and what’s emphasized, and how it’s customized to the individual;” “I spend a fair amount of time explaining physiology in their terms so they understand why we’re doing what we’re doing, or what’s happening and what to expect;” “If you don’t have a relationship with your patient, then you don’t have a really effective treatment protocol.” Conclusions With national health care reform’s new Prevention Codes calling for “Discussion,” and patients’ dependence on explanation to understand and follow through with treatment recommendations, describing how high performing physicians create high patient satisfaction, is of great importance.

Overall patient satisfaction with hospitals: effects of patient-reported experiences and fulfilment of expectations

BackgroundPatient satisfaction and experiences are important parts of healthcare quality, but patient expectations are seldom included in quality assessments. The objective of this study was to estimate the effects of...

Patient satisfaction with outpatient neurology services: A momentum for improvement

BackgroundOutcome measures of patient satisfaction are increasingly accepted as an integral component of the overall healthcare quality assessment. Aims of studyA survey of the outpatient neurology services in Addis Ababa, Ethiopia was performed to determine the overall patient satisfaction, provide an assessment of current services and form the foundation for improved expansion of neurological care. Methods233 patients were recruited from the Addis Ababa University Teaching Hospital outpatient general neurology clinic by a cross-sectional sample survey design. Data from structured interview and abstraction of medical records were analyzed by SPSS for Windows version 15.0 computer software. Visual analysis of mean satisfaction scores and Spearman's rho correlation coefficients generated priority indices serving to guide expansion of neurology services. Results212 patients with mean age of 40.1 and a 1:1M: F ratio completed the survey. The variation of overall patient satisfaction (mean, 70.4; SD, 12.4) was independently predicted by patient clinical outcome expectations and satisfaction on waiting area, overall service of doctor and card room [R2=0.305; F (8,195)=10.685, p=0.000]. Mean satisfaction scores for specific dimensions of the outpatient general neurology clinic ranged from 57.2 for waiting time at the clinic to 74.0 for overall service of the guards. Waiting time at the clinic stood first among the top five priority indices. ConclusionThis survey demonstrates predictors of overall patient satisfaction with the outpatient neurology services, and delineates priority areas warranting further improvement. It is the first African study on patient satisfaction with neurology services, and provides a guide for neurological or other specialty clinics seeking to improve and expand medical services.

The relationship between service quality measures and overall patient satisfaction in oncology.

e16550 Background: Cancer patients usually undergo extensive and debilitating treatments, which makes patient satisfaction with care in oncology an important health care assessment measure. We evaluated the relationship between commonly used service quality measures and subsequent single top box “overall patient satisfaction” among oncology patients. Methods: 2,018 returning cancer patients treated at Cancer Treatment Centers of America responded to an internally developed service quality questionnaire, covering the following dimensions: operations and services, physicians and staff, and patient endorsements. Items were measured on a 7-point Likert scale ranging from “completely dissatisfied” to “completely satisfied.” Overall patient satisfaction “Considering everything, how satisfied are you with your overall experience with CTCA?” was also measured on a similar scale and was dichotomized into 2 categories: top box response (7) versus all others (1-6). The relationship between service quality and “overall patient satisfaction” was assessed via forward stepwise multiple logistic regression. Results: 959 patients were newly diagnosed while 1059 were previously treated. 902 were males and 1,116 females. Mean age was 54.7 years and the most frequent diagnoses were breast (412), lung (294), prostate (260), colorectal (179) and pancreas (169). 1,335 (66.2%) patients were “completely satisfied” with their overall experience with CTCA. Upon multivariate logistic regression, items that were significantly predictive of overall patient satisfaction in the final model, independent of age, gender and treatment history were timeliness of care delivered (OR = 2.1; 95% CI: 1.7 to 2.6), ease of care delivered (OR = 2.6; 95% CI: 1.9 to 3.5), staff caring for patient as an individual (OR = 1.7; 95% CI: 1.1 to 2.5), hospital providing with a sense of well-being (OR = 1.8; 95% CI: 1.3 to 2.7), whole person approach to patient care (OR = 1.5; 95% CI: 1.1 to 2.1) and team explaining treatment options (OR = 2.2; 95% CI: 1.8 to 2.8); p < 0.01 for all. Conclusions: We found several service quality drivers related to hospital operations & services as well as physicians and staff as independent predictors of overall patient satisfaction. No significant financial relationships to disclose.

PS1-32: Doctor's Role in Their Patient's Healing: Practices of the Highest Performing Physicians by Patient Survey

Background: The MD Patient Communication Study aims were to improve the best practice communication behaviors of physicians during outpatient clinic visits and to collect physician perspectives of communication behaviors. Researchers have consistently found the top predictors of overall patient satisfaction are quality of the physician-patient relationship and contributing communications. There is limited understanding however, of the range of specific behaviors in the interaction associated with positive and negative patient perceptions and reactions. Methods: In phase 1, we conducted a naturalistic, observational study of 55 Kaiser Permanente Primary Care physician-patient visits using videotape recordings, and incorporating patient and physician reactions to the tape. The physicians, who practiced in Los Angeles and Honolulu, spanned the three strata of high, medium, and low historical patient satisfaction scores. In phase 2, a standardized six-question set was posed in semi-structured, 60-minute interviews to 77 of the highest-performing physicians on this patient survey, including 20 of the highest performers (top 5%) from the LA and Honolulu groups and 42 and 15, respectively, of the highest performing physicians in Portland and Oakland. These interviews were audio taped with permission, transcribed and coded for patterns. Results: This abstract addresses the 4th question: What role do you feel you play in your patients’ healing? Do you think you, as a doctor, contribute to your patients’ healing through non-technical, non-physical, or non-scientific ways? All physicians agreed but varied in their role. Representative quotes: Giving people the confidence to go through something. People feel better coming in and seeing/talking to you. People realizing they have the power to heal themselves their involvement is essential. Our relationship: Interpersonal connection is so powerful. The art of medicine is the art of healing. These narratives provide deep, coherent learning about physicians’ role in healing: relationship, education, empowerment, emotion, personal connection, hope. Conclusions: With primary care in crisis nationally, and specialists increasingly procedure-focused, understanding physicians’ role in patients’ healing, especially as it creates high patient satisfaction, is of great importance to sustaining the highest quality medical care and service.

Distribution and determinants of patient satisfaction in oncology with a focus on health related quality of life.

BackgroundCancer patients usually undergo extensive and debilitating treatments, which make quality of life (QoL) and patient satisfaction important health care assessment measures. However, very few studies have evaluated the relationship between QoL and patient satisfaction in oncology. We investigated the clinical, demographic and QoL factors associated with patient satisfaction in a large heterogeneous sample of cancer patients.MethodsA cohort of 538 cancer patients treated at Cancer Treatment Centers of America® (CTCA) was assessed. A patient satisfaction questionnaire developed in-house by CTCA was used. It covered the following dimensions of patient satisfaction: hospital operations and services, physicians and staff, and patient endorsements for themselves and others. QoL was assessed using the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30). The clinical, demographic and QoL factors were evaluated for predictive significance using univariate and multivariate logistic regression.ResultsThe mean age of our patient population was 54.1 years (SD = 10.5, range 17-86), with a slight preponderance of females (57.2%). Breast cancer (n = 124) and lung cancer (n = 101) were the most frequent cancer types. 481 (89.4%) patients were "very satisfied" with their overall experience. Age and several QoL function and symptom scales were predictive of overall patient satisfaction upon univariate analysis. In the multivariate modeling, only those with a score above the median on the fatigue measure (i.e. worse fatigue) had reduced odds of 0.28 of being very satisfied (p = 0.03).ConclusionPatient fatigue, as reported by the QoL fatigue scale, was an independent significant predictor of overall patient satisfaction. This finding argues for special attention and programs for cancer patients who report higher levels of fatigue given that fatigue is the most frequently reported symptom in cancer patients.

Developing an Efficient Model to Select Emergency Department Patient Satisfaction Improvement Strategies

Patient satisfaction is an important performance measure for emergency departments (EDs), but the most efficient ways of improving satisfaction are unclear. This study uses optimization techniques to identify the best possible combination of predictors of overall patient satisfaction to help guide improvement efforts. The results of a satisfaction survey from 20,500 patients who visited 123 EDs were used to develop ordinal logistic regression models for overall quality of care, overall medical treatment, willingness to recommend the ED to others, and willingness to return to the same ED. Originally, 68,981 surveys were mailed, and 20,916 were returned, representing an overall response rate of 30.3%. We then incorporated these regressions into an optimization model to select the most efficient combination of predictors necessary to increase the 4 overall satisfaction measures by 5%. A sensitivity analysis was also conducted to explore differences across hospital peer groups and regions. Results differ slightly for each of the 4 overall satisfaction measures. However, 4 predictors were common to all of these measures: "perceived waiting time to receive treatment," "courtesy of the nursing staff," "courtesy of the physicians," and "thoroughness of the physicians." The selected predictors were not necessarily the strongest predictors identified through regression models. The optimization model suggests that most of these predictors must be improved by 15% to increase the overall satisfaction measures by 5%. This study introduces the use of optimization techniques to study ED patient satisfaction and highlights an opportunity to apply this technique to widely collected data to help inform hospitals' improvement strategies. The results suggest that hospitals should focus most of their improvement efforts on the 4 predictors mentioned above.

A helicopter cost analysis

Patient satisfaction is an increasing area of interest due to implications of pay for performance and public reporting of results. Although scores are adjusted for patient factors, little is known about the relationship between hospital structure, postoperative outcomes, and patient satisfaction with the hospital experience.Hospitals participating in the University HealthSystem Consortium database from 2011–2012 were included. Patients were restricted to those discharged by general surgeons to isolate surgical patients. Hospital data were paired with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) results from the Hospital Compare website. Postoperative outcomes were dichotomized based on the median for all hospitals and stratified based on surgical volume. The primary outcome of interest was high on overall patient satisfaction, whereas other HCAHPS domains were assessed as secondary outcomes. Chi square and binary logistic regression analyses were performed to evaluate whether postoperative outcomes or surgical volume more significantly influenced high patient satisfaction.The study population consisted of 171 hospitals from the University HealthSystem Consortium database. High surgical volume was a more important predictor of overall patient satisfaction regardless of hospital complication (P < 0.001), readmission (P < 0.001), or mortality rates (P = 0.009). Volume was found to play less of a role in predicting high satisfaction on the other HCAHPS domains. Postoperative outcomes were more predictive of high satisfaction with providers, the hospital experience, and environment.High surgical volume more strongly predicted overall patient satisfaction on the HCAHPS survey than postoperative outcomes, whereas volume was less predictive in other HCAHPS domains. Patients may require more specific questioning to identify high quality, safe hospitals.