Same-day Visits Research Articles

Implementation of a Pharmacist-Driven Contraception Service at a Safety-Net Health-System.

Background: Access to safe, effective, and appropriate contraception significantly reduces the rates of unintended pregnancies; however, this preventative care is not always easily accessible. There is a high patient demand for contraception visits that is often delayed or unmet due to lack of access to traditional providers. Pharmacists are highly accessible and can help manage this high demand, yet clinical pharmacists as providers of contraception services remains a gap in published literature. Objective: Develop and implement a pharmacist-led contraception service at a safety-net health-system. Methods: A comprehensive pharmacist-led clinical contraception service was created to improve patient access. To support this project, a collaborative practice agreement (CPA) was developed and enhancements were built into an electronic medical record. The CPA allowed the pharmacist to complete contraception-related interventions such as ordering urine pregnancy tests, prescribing hormonal and emergency contraceptives, and manage adverse effects. The piloting pharmacist was available at the Narcotics Treatment Program (NTP) clinic one half-day each week for scheduled and same-day visits. Results: Within the initial five half-day clinic sessions at NTP, the pharmacist had written seven prescriptions, including three for emergency contraceptives. Of all patients seen for this service at NTP, only one had been using a method of contraception consistently prior to their visit. Conclusion: The interventions that were able to be made by the pharmacist highlighted the need for improved access to contraceptives. Pharmacist-managed services in sexual and reproductive health can help fill this gap. Patients also self-reported ease of access as a benefit to this service.

Exploring drivers of overnight stays and same-day visits in the tourism sector

We employ mobile network data referred to the area of Lombardy in Italy to investigate alternative touristic behaviours, such as same-day visits and overnight stays in Italy. We show that larger availability of tourism accommodations, cultural and natural endowments are relevant factors explaining overnight stays. Conversely, temporary entertainment and transportation facilities increase municipalities attractiveness for same-day visits. The results also highlight a trade-off in the capability of municipalities of being attractive in connection to both the tourism behaviours. For instance, higher tourists arrivals are observed in areas receiving limited visitors, coming from municipalities with low same-day visits outflows. We highlight mobile data offer an adequate level of spatial and temporal granularity and can be thus employed to support policy makers in the design of effective tourist management strategies.

Worldwide Increasing Use of Nonfasting Rather Than Fasting Lipid Profiles.

Historically, lipids and lipoproteins were measured in the fasting state for cardiovascular risk prediction; however, since 2009 use of nonfasting lipid profiles has increased substantially worldwide. For patients, nonfasting lipid profiles are convenient and avoid any risk of hypoglycemia. For laboratories, blood sampling in the morning and extra visits for patients who have not fasted are avoided. For patients, clinicians, hospitals, and society, nonfasting sampling allows same-day visits with first blood sampling followed by a short wait for test results before clinical consultation. Therefore, nonfasting compared to fasting lipid profiles will save money and time and may improve patient compliance with cardiovascular prevention programs. We report on the progression of endorsement and implementation of nonfasting lipid profiles for cardiovascular risk prediction worldwide and summarize the recommendations from major medical societies and health authorities in different countries. We also describe practical advantages and disadvantages for using nonfasting lipid profiles. Further, we include a description of why fasting has been the standard historically, the barriers against implementation of nonfasting lipid profiles, and finally we suggest the optimal content of a nonfasting lipid profile. Lipid, lipoprotein, and apolipoprotein concentrations vary minimally in response to normal food intake and nonfasting lipid profiles are equal or superior to fasting profiles for cardiovascular risk prediction. Major guidelines and consensus statements in Europe, the United States, Canada, Brazil, Japan, India, and Australia now endorse use of nonfasting lipid profiles in some or all patients; however, there are still gaps in endorsement and implementation of nonfasting lipid profiles worldwide.

The Effect of Coordinating the Outpatient Treatment across Medical Specialities for Patients With Multimorbidity.

Patients with multimorbidity attend multiple outpatient clinics. We assessed the effects on hospital use of scheduling several outpatient appointments to same-day visits in a multidisciplinary outpatient pathway (MOP). This study used a quasi-experimental design. Eligible patients had multimorbidity, were aged ≥18 years and attended ≥2 outpatient clinics in five different specialties. Patients were identified through forthcoming appointments from August 2018 to March 2020 and divided into intervention group (alignment of appointments) and comparison group (no alignment). We used patient questionnaires and paired analyses to study care integration and treatment burden. Using negative binomial regression, we estimated healthcare utilisation as incidence rates ratios (IRRs) at one year before and one year after baseline for both groups and compared IRR ratios (IRRRs). Intervention patients had a 19% reduction in hospital visits (IRRR: 0.81, 95% CI: 0.70-0.96) and a 17% reduction in blood samples (IRRR: 0.83, 0.73-0.96) compared to comparison patients. No effects were found for care integration, treatment burden, outpatient contacts, terminated outpatient trajectories, hospital admissions, days of admission or GP contacts. The MOP seemed to reduce the number of hospital visits and blood samples. These results should be further investigated in studies exploring the coordination of outpatient care for multimorbidity. Can an intervention of coordinating outpatient appointments to same-day visits combined with a multidisciplinary conference influence the utilisation of healthcare services and the patient-assessed integration of healthcare services and treatment burden among patients with multimorbidity?

Select, route and schedule: optimizing community paramedicine service delivery with mandatory visits and patient prioritization.

Healthcare delivery in the United States has been characterized as overly reactive and dependent on emergency department care for safety net coverage, with opportunity for improvement around discharge planning and high readmissions and emergency department bounce-back rates. Community paramedicine is a recent healthcare innovation that enables proactive visitation of patients at home, often shortly after emergency department and hospital discharge. We establish the first optimization-based framework to study efficiencies in the management and operation of a community paramedicine program. The collective innovations of our modeling include i) a novel hierarchical objective function with the goals of fairly increasing patient welfare, lowering hospital costs, and reducing readmissions and emergency department visits, ii) a new constraint set that ensures priority same-day visits for emergent patients, and iii) a further extension of our model to determine the minimum supplemental resources necessary to ensure feasibility in a single optimization formulation. Our medical-need based objective function prioritizes patients based on their clinical features and seeks to select and schedule patient visits and route healthcare providers to maximize overall patient welfare while favoring shorter tours. We use our methods to develop managerial insights via computational experiments on a variety of test instances based on real data from a hospital system in Upstate New York. We are able to identify optimal and nearly optimal tours that efficiently select, route, and schedule patients in reasonable timeframes. Our results lead to insights that can support managerial decisions about establishing (and improving existing) community paramedicine programs.

Provider and administrator attitudes and experiences with implementing telebuprenorphine during the COVID-19 pandemic: a mixed-methods survey

ABSTRACT Introduction This mixed-methods study assessed buprenorphine provider and administrator perceptions and experiences in offering telebuprenorphine during the COVID-19 pandemic. Methods Semi-structured interviews were conducted between June 2021 and September 2021 among telebuprenorphine providers and administrators (N = 16) and assessed for program design and implementation strategies, clinical workflow, patient-level factors influencing program entry and retention, and challenges and solutions to improving clinical care. Results Clinician (n = 15) and administrator (n = 1) participants identified changes to clinical workflow, including increased administrative tasks to confirm patient receipt of prescribed medications, completion of referrals to community- or specialty treatment, and locating available pharmacies and laboratory services. Challenges consisted of staff redeployment to COVID-19 related responsibilities, prior authorization requirements for buprenorphine prescriptions, billing structures that under-reimbursed for telephone or video visits, and concerns with changes in government regulations. Strategies to improving telebuprenorphine included offering “hotlines” to facilitate same-day visits, expanding between-visit support, establishing workflows with community pharmacies to ensure seamless dispensing of buprenorphine, co-location of behavioral health providers, and distributing donated mobile phones to patients. Suggested technologies for enhancing care included text messaging (75%) and smartphone applications (56.3%). Conclusions Findings from this study highlight considerable heterogeneity in the delivery of telebuprenorphine services.

Weather myths: how attractive is good weather really for same-day visits to outdoor recreation destinations?

ABSTRACT From a short-term (e.g. daily) perspective, visitor numbers to an outdoor recreation destination are strongly influenced by good or bad weather conditions. However, to date, a large body of literature has focused on tourists’ responses to climate change or weather conditions over a longer temporal scale, such as a year. Using data for Mount Rigi, a Swiss outdoor recreation destination, we specify a regression model to explain the variation in daily visitor numbers. Our findings confirm the strong weather and seasonal sensitivity that are often found in previous studies. However, we also found that the effect of the weather on daily visitors is not homogeneous but decreases with the number of previous sunny days within a given tourist season. Our finding is that, contrary to popular belief, the impact of weather on tourist service providers and destinations is less pronounced when viewed seasonally. We provide some possible explanations for these observations based on the destination’s characteristics, its visitor segment(s) and the theory of planned behaviour in tourism.

Attitudes and preferences of visitors of Krka National Park, Croatia

The primary function of national parks (NPs) is nature conservation, but for the majority of them, tourism also plays an important role. Tourism generates significant incomes, but the benefits are often unequally distributed in space, as are the disadvantages. The karst regions are generally less developed terrains in terms of traditional livelihoods, but due to their special morphology, tourism offers great opportunities. Nonetheless, mass tourism can also pose increased environmental risks. In this article, we examine the above questions on the example of Krka NP, especially from the perspective of tourists, as we conducted a questionnaire survey with visitors. The results confirmed that there is a high degree of spatial inequality both in the awareness of attractions and the distribution of tourist accommodation. This fact has already been recognised by the management of the NP, and serious steps have already been taken to reduce inequality, but their impact is not yet significant enough. Based on the survey, tourism in Krka NP is determined by same-day visits. Tourists who come here primarily consider waterfalls, lakes and rivers to be the most important values of the landscape, while cultural values are considered less significant and even less known. Local products are virtually unknown in the NP palette, so this could be a direction for development. Another point that could be developed is the awareness of visitors in the field of karstification. As the survey was conducted during COVID period, its impact on tourism was also briefly examined. This impact was manifested in the fact that the proportion of retirees and tourist buses was very small, whereas the majority of visitors (90%) arrived in the NP as independent travellers. For one third of foreigners, COVID played a role in choosing Croatia as a destination. As for domestic tourists, two thirds chose to find a destination in Croatia because of COVID.

Unconventional Tourist Mobility: A Geography-Oriented Theoretical Framework

Prior to the COVID-19 pandemic, tourism had permeated all spaces of experience, reaching nearly every country, region, community, and corner of the globe. In recent decades, the meanings, implications, and roles of tourism have also expanded significantly. This article focuses on unconventional tourism mobilities, including same-day visits, which are an important but often neglected part of the tourism system, constantly challenging both scholars and tourism industry stakeholders. Unconventional tourism is an umbrella term that covers most kinds of unregistered or unaccounted tourist mobilities, some of which might not appear to be ‘tourism’ but should be in certain localities and under certain conditions. Given the growth of unregistered tourist flows and unaccounted leisure (or utilitarian) mobilities, there is a need in tourism studies to apply innovative research methods and to reconceptualize the meanings of tourism in different geographical and social contexts. It is expected that people’s desire to travel in the post-pandemic era will educe new spatial and temporal travel experiences and behaviours in which unconventional tourisms will play an important role. To better understand this phenomenon and to evaluate the development of new approaches to travel and behavioural spatialities, new ways of thinking, new theoretical constructs, and new methodologies are needed. This article seeks to explore certain hidden or invisible tourism mobilities, focusing on the geographical patterns, processes, and hidden aspects of unconventional tourism.

Patient Autonomy in Direct Primary Care

Patient Autonomy in Direct Primary Care

Outcomes of a NYC Public Hospital System Low-Threshold Tele-Buprenorphine Bridge Clinic at 1 Year

Background: This study evaluated clinical outcomes of a low barrier tele-buprenorphine bridge program for NYC residents with opioid use disorder (OUD) at 1 year during the coronavirus disease 2019 (COVID-19) pandemic. Methods and materials: This retrospective analysis of the NYC Health + Hospitals (NYC H + H) Virtual Buprenorphine Clinic registry assessed baseline demographic and clinical characteristics, rates of referrals to community treatment, and induction-related adverse events among city residents with OUD, from March 2020 to the end of March 2021. Results: The program enrolled 199 patients, of whom 62.3% were provided same-day visits (n = 124). Patients were enrolled in the program for a median of 14 days (range 0-130 days). Referrals sources included hospital and clinic staff (n = 83, 47.7%), word of mouth (n = 30, 17.2%), and correctional health or reentry services (n = 30, 17.2%). Induction-related adverse events were mostly limited to precipitated withdrawal symptoms (n = 21, 5%). Roughly half of patients were referred to community treatment (n = 109, 54.8%) and of those 51.4% (n = 56/109) completed at least one visit in community treatment. Discussion: Our experience indicates that a low threshold tele-buprenorphine bridge program in place of a safe and feasible approach to facilitating entry in community treatment for underserved people who use opioids in a large metropolitan area.

Weather myths: how attractive is good weather really for same-day visits to outdoor recreation destinations?

Weather myths: how attractive is good weather really for same-day visits to outdoor recreation destinations?

Practice Characteristics of Pediatric Otolaryngology Same-Day Appointments.

This study aims to assess characteristics of same-day clinic appointments in a pediatric population at an academic otolaryngology practice. Retrospective chart review of patients aged 18 or younger who had same-day clinic appointments between January 1, 2016, and December 31, 2018, at a single academic institution. Demographic data, diagnosis(es), procedures, and operations completed were included in the analysis. There were 363 same-day visits by 322 patients in the 3-year study period. Two hundred sixty-nine (269) of these visits were from new patients. Otitis media and rhinosinusitis were the most frequently coded diagnoses. One hundred forty-four (144) procedures were completed the day of the visit and 169 operations were performed as a result of the same-day visit. If the patient had a procedure or operation performed, they were more likely to have been referred by another provider. Providing same-day appointments can help provide timely and appropriate otolaryngology specialty care to pediatric patients. Further evaluation is needed to determine the effects on patient satisfaction as well as no-show rates.

Improving the efficiency of same-day ill calls.

56 Background: Burnout is a syndrome whose manifestations include pervasive emotional and physical exhaustion, depersonalization, a lack of motivation and an inability to complete tasks efficiently. We sought to use quality improvement (QI) methodology to approach problems contributing to burnout and workplace stress in our oncology care team. Methods: Through a broad survey of cancer center team members, we identified the coordination of same-day outpatient visits for acutely ill oncology patients as a source of excessive stress for team members across various disciplines including case managers, infusion clinic nurses, advanced practice providers, and physicians. We used the Plan-Do-Study-Act (PDSA) framework to identify a feasible, appropriate intervention to reduce the time required to coordinate visits with the specific aim of reducing the time to schedule an ill patients by 25%. We generated a cause and effect diagram to map the elements involved in the ill call scheduling process, and used a priority/payoff matrix to evaluate possible countermeasures that could streamline the process by re-designing/improving the efficiency of the workflow for scheduling ill calls. Our initial workflow involved paging individual practitioners at three locations. The process led us to the creation of a HIPPA-compliant group text to simultaneously coordinate scheduling of an ill call among/between three campuses in a more collaborative/efficient manner. We tracked time from patient call to time of scheduled appointment pre- and post-test of change (Voalte group text). We also tracked quantity of phone calls required to arrange a visit and perceived frustration with the process. Results: After one PDSA cycle, we found case manager time required to arrange a visit had decreased by 21%, number of calls required by 59% and frustration with the process by 41%. Conclusions: While we did not meet our specific aim of decreasing scheduling time by 25%, we feel use of a QI approach led to an easily implemented, yet effective modification to streamline a previously inefficient and disruptive workflow. The use of QI methodology ensured we understood the baseline process and involved all stakeholders before implementing a change and also ensured we followed data to understand the impact of our intervention on team members. Viewing sources of burnout and workplace frustration through the lens of QI may lead to more consistently high-yield interventions than traditional wellness-based, administrative approaches.

Exploring the contribution of activity sports tourism to same-day visit expenditure and duration

ABSTRACT Drawing upon a unique large-scale data source (n=5,004) and motivated by the time allocation model of consumer demand in economics, this paper critically analyses the relationship between the expenditure from, and duration of, same-day visits that comprise a large component of the domestic tourism market in England. It focusses on the contribution of activity sports tourism as a component of same-day visits. Three-stage least squares (3SLS) instrumental variable estimation is employed to account for the simultaneous determination of duration and expenditure as implied by economic theory. Controlling for socio-economic characteristics and general trip behaviours, the research identifies that although total expenditures and trip durations are positively related, there are trade-offs between these when focussing on the direct effects of the activities undertaken. However, accounting for the interrelationship between the duration of visits and the expenditures on them, it is found that walking reduces the expenditures on trips and their duration. Field sports increase them both. No effects are identified for running and cycling, as land-based activity sports tourism, or swimming and water sports, as water-based activity sports tourism. The key drivers of expenditure, which also increase the duration of trips, are visiting attractions and hospitality. The research provides a theoretically informed and empirically robust foundation for a more nuanced and targeted activity sports tourism strategy, which might have implications for how activity sports tourism may contribute to health and well-being and local economic development to better inform tourism planning and policy.

Impact of Alternative Payment Methodology on Primary Care Visits and Scheduling

In 2013, Oregon initiated an Alternative Payment Methodology (APM) Experiment for select health centers, initiating capitated payments for patients with Medicaid. To use electronic health record data to evaluate the impact of APM on visit and scheduling metrics in the first wave of experiment clinics. Retrospective clinic cohort. Difference-in-differences analysis using generalized linear mixed modeling across 2 time thresholds: the initiation of APM and the start of the Affordable Care Act Medicaid expansion. Eight primary clinics enrolled in APM on March 1, 2013 and 10 comparison clinics not enrolled in APM during the study period (July 1, 2012 to February 28, 2015). Independent variable: intervention status of the clinics (APM or comparison). Dependent variables: total patient encounters, total alternative encounters, new patient visits, provider appointment availability, number of appointment overbooks and no-shows/late cancellations. Comparison clinics had smaller patient panels and more advanced practice providers than APM clinics, but both had similar proportions of Hispanic, Medicaid, and uninsured patients. APM clinics had a 20% greater increase in same-day openings than non-APM clinics across the APM implementation (Relative Ratio, 1.20; 95% CI, 1.02 to 1.42). Otherwise, there were minimal differences in APM clinics and control clinics in wait times, visit rates, patient no-shows, and overbooks. APM clinics experienced a greater increase in same-day visits over the course of this experiment, but did not significantly differ from comparators in other visit metrics. Further research into other impacts of this experiment are necessary and ongoing.

Urgent care centres reduce emergency department and primary care same-day visits: a natural experiment.

The aim of this study is to evaluate the impact of urgent care centres' (UCCs) implementation on emergency department (ED) and same-day visits in primary care in a Chilean public healthcare network. Quasi-experimental design study assessing changes in patient visits after UCC implementation in a local health district. Ten family health centres (FHC), nine UCCs and three EDs in the Talcahuano Health District, Chile. A total of 1603055 same-day visits to FHC, 1528319 visits to UCCs and 1727429 visits to EDs, monthly grouped, from 2008 to 2014. Data were obtained from the Monthly Statistical Register Database. We used quasi-experimental methods to evaluate the impact of UCC implementation on ED visits and same-day visits to FHC. We used a difference-in-difference analysis with seasonal adjustments to control potential confounders. We used a triple difference model to test for potential short-term effects. We used as an intervention a group of FHCs and EDs that implemented UCCs from 2008 to 2014 and, as a comparison group, the FHCs and EDs that implemented UCCs before that period. We observed a 5.70% (95% CI: -11.05 to -0.35) decrease in the same-day visits rate to FHCs and a 2.69% (95% CI: -3.96 to -1.43) reduction in ED visits after UCC implementation. The negative trend in same-day visits was more pronounced in children and adolescents (-14.18%; 95% CI: -20.10 to -8.25). The negative trend in ED visits was more pronounced in adult (-4.15%; 95% CI: -5.46 to -2.83) and elderly population (-2.24%; 95% CI: -4.00 to -0.48). We also confirmed that our results are not driven by transient short-term effects after the intervention. UCC implementation reduced ED visits. However, they also reduced same-day visits to primary care centres. This could have a negative impact on the quality of primary care provided.

Striving toward team-based continuity: provision of same-day access and continuity in academic primary care clinics

BackgroundAn important goal of the patient-centered medical home is increasing timely access for urgent needs, while maintaining continuity. In academic primary care clinics, meeting this goal, along with training medical residents and associated professionals, is challenging.MethodsThe aim of this study was to understand how academic primary care clinics provide continuity to patients requesting same-day access and identify factors that may affect site-level success. We conducted qualitative interviews from December 2013–October 2014 with primary care leadership involved with residency programs at 19 Veterans Health Administration academically-affiliated medical centers. Interview recordings were transcribed verbatim. To analyze the data, we created comprehensive, structured transcript summaries for each site. Site summaries were then entered into NVivo 10 software and coded by main categories to facilitate within-case and cross-case analyses. Themes and patterns across sites were identified using matrix analysis.ResultsInterviewees found it challenging to provide continuity for same-day in-person visits. Most sites took a team-based approach to ensure continuity and provide coverage for same-day access, notably using NPs, PAs, and RNs in their coverage algorithms. Further, they reported several adaptations that increased multiple types of continuity for walk-in patients, urgent care between in-person visits, and follow-up care. While this study focused on longitudinal continuity, both by individual PCPs or by a team of professionals, informational continuity and continuity of supervision, as well as, to a lesser extent, relational and management continuity, were also addressed in our interviews. Finally, most interviewees reported clinic intention to provide patient-centered, team-based care and a robust educational experience for trainees, and endeavored to structure their clinics in ways that align these two missions.ConclusionsIn contending with the tension between providing continuity and educating new clinicians, clinics have re-conceptualized continuity as team-based, creating alternative strategies to same-day visits with a usual provider, coupled with communication strategies. Understanding the effect of these strategies on different types of continuity as well as patient experience and outcomes are key next steps in the further development and dissemination of effective models for improving continuity and the transition to team-based care in the academic clinic setting.

Utilisation patterns of privately funded mental health services in Australia.

The purpose of this paper is twofold: first, to present patient-level utilisation patterns of hospital-based mental health services funded by private health insurers; and second, to examine the implications of the findings for planning and delivering private mental health services in Australia. Analysing private health insurance claims data, this study compares differences in demographic and hospital utilisation characteristics of 3,209 patients from 13 private health insurance funds with claims for mental health-related hospitalisations and 233,701 patients with claims for other types of hospitalisations for the period May 2014 to April 2016. Average number of overnight admissions, length of stay and per patient insurer costs are presented for each group, along with overnight admissions vs same-day visits and repeat services within a 28-day period following hospitalisation. Challenges in analysing and interpreting insurance claims data to better understand private mental health service utilisation are discussed. Patients with claims for mental health-related hospitalisations are more likely to be female (62.0 per cent compared to 55.8 per cent), and are significantly younger than patients with claims for other types of hospitalisations (32.6 per cent of patients aged 55 years and over compared to 57.1 per cent). Patients with claims for mental health-related hospitalisations have significantly higher levels of service utilisation than the group with claims for other types of hospitalisations with a mean length of stay per overnight admission of 15.0 days (SD=14.1), a mean of 1.3 overnight admissions annually (SD=1.2) and mean hospital costs paid by the insurer of $13,192 per patient (SD=13,457) compared to 4.6 days (SD=7.3), 0.8 admissions (SD=0.6) and $2,065 per patient (SD=4,346), respectively, for patients with claims for other types of hospitalisations. More than half of patients with claims for mental health-related hospitalisations only claim for overnight admissions. However, the findings are difficult to interpret due to the limited information collected in insurance claims data. This study shows the challenges of understanding utilisation patterns with one data source. Analysing insurance claims reveals information on mental health-related hospitalisations but information on community-based care is lacking due to the regulated role of the private health insurance sector in Australia. For mental health conditions, and other chronic health conditions, multiple data sources need to be integrated to build a comprehensive picture of health service use as care tends to be provided in multiple settings by different medical and allied health professionals. This study contributes in two areas: patient-level trends in hospital-based mental health service utilisation claimed on private health insurance in Australia have not been previously reported. Additionally, as the amount of data routinely collected in health care settings increases, the study findings demonstrate that it is important to assess the quality of these data sources for understanding service utilisation.

Validation of the Modified Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE) Questionnaire: A Prospective Analysis of Facial Plastic and Reconstructive Surgery Procedures.

Although periorbital edema and ecchymosis are commonly encountered after facial plastic and reconstructive surgery procedures, there is currently no validated grading scale to qualify these findings. In this study, the modified "Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE)" questionnaire is used as a grading scale for patients undergoing facial plastic surgery procedures. This article aims to validate a uniform grading scale for periorbital edema and ecchymosis using the modified SPREE questionnaire in the postoperative period. This is a prospective study including 82 patients at two different routine postoperative visits (second and seventh postoperative days), wherein the staff and resident physicians, physician assistants (PAs), patients, and any accompanying adults were asked to use the modified SPREE questionnaire to score edema and ecchymosis of each eye of the patient who had undergone a plastic surgery procedure. Interrater and intrarater agreements were then examined. Cohen's kappa coefficient was calculated to measure intrarater and interrater agreement between health care professionals (staff physicians and resident physicians); staff physicians and PAs; and staff physicians, patients, and accompanying adults. Good to excellent agreement was identified between staff physicians and resident physicians as well as between staff physicians and PAs. There was, however, poor agreement between staff physicians, patients, and accompanying adults. In addition, excellent agreement was found for intraobserver reliability during same-day visits. The modified SPREE questionnaire is a validated grading system for use by health care professionals to reliably rate periorbital edema and ecchymosis in the postoperative period. Validation of the modified SPREE questionnaire may improve ubiquity in medical literature reporting and related outcomes reporting in future.