Significant Increase In Patient Satisfaction Research Articles

The Three-points Chin: A Multilayered Filler Approach Using a Cannula.

The present study was conducted to evaluate the aesthetic results of the three-points chin filler injection using a SoftFil cannula, where the filler product is placed in a multilayered fashion. The study included 40 women who complained about their unaesthetic small chin. Revanesse Versa filler was injected into these patients using a SoftFil cannula in a multilayered fashion, targeting both the deep and superficial fat compartments. For the cannula, three points of entry were chosen depending on a specific anatomical landmark, providing chin beautification in three dimensions. All patients were followed up at the following intervals for recording their satisfaction score: 14 days, 2 months, 4 months, and 6 months. Satisfaction score recorded at 14-days follow-up showed a significant increase in patient satisfaction. This was maintained up to 6 months postoperative. The suggested three-points chin beautification technique using microcannula provides satisfactory results in three dimensions, compared with the original technique.

Promoting equitable and patient-centred care: an analysis of patient satisfaction in urban, rural and remote primary care sites in the Philippines

ObjectivesThis study measured changes in patient satisfaction levels before and after the introduction of primary care system strengthening interventions in urban, rural, and remote sites in the Philippines.MethodsA previously validated...

Perioperative managment for gynecological surgery in accelerated rehabilitation programme

The Enhanced Recovery After Surgery (ERAS), or Fast Track Surgery, aims to minimise the physiological stress of surgery and optimise patient rehabilitation. However, data on surgical interventions in obstetrics and gynaecology are limited. The aim of the study was to analyse the use of elements of the ERAS programme in gynaecologic surgery clinics and to assess the benefits of this approach. Analytical processing was carried out on systematic reviews and meta-analyses, articles and scientific reports published before June 2023, found and available through the PubMed, EMBASE, Cochrane Central Register of Controlled Trials databases. The data were obtained from relevant published studies, including changes in quality of life, postoperative pain, use of opioids or anaesthesia, postoperative nausea and vomiting, rate of readmission, cost of hospitalisation, and clinically significant increase in patient satisfaction. The ERAS programme is a multimodal and multidisciplinary programme aimed at optimising perioperative treatment and improving postoperative outcomes in operative gynaecology by minimising the patient’s stress response, promoting functional recovery and achieving rapid recovery, where the patient is in the field of view of a number of specialists. The presented publications demonstrate that this concept of FTS is a fundamentally new approach to the surgical treatment of gynaecological patients and covers all stages of perioperative therapy: preoperative, intraoperative and postoperative. Conclusions. The initial stage of the surgeon’s and anaesthetist’s acquaintance with the patient is very important, as communication and rational presentation of information using illustrative and video material helps the patient understand the disease, consciously choose the proposed method of treatment, reduces anxiety, increases the role of the surgical team in treatment and satisfaction with its outcome, reduces the risk of dissatisfaction from false expectations (duration of the perioperative period, pain, changes in nutrition and mobility, sutures, etc.). The introduction of evidence-based medicine into the practice of operative gynaecology restructures classical approaches and principles of patient treatment, raises awareness of doctors and heads of surgical departments, and also contributes to the improvement of the outcome of operations.

Is Lidocaine Patch Beneficial for Postoperative Pain: A Meta-analysis of raNdomized Clinical Trials.

The aim of this meta-analysis was to evaluate whether a lidocaine patch is beneficial for postoperative pain as an option for multimodal analgesia. Information was obtained from PubMed, Embase, and the Cochrane Central Register of Controlled Trials for clinical randomized controlled trials of lidocaine patches for postoperative pain (as of March 2022). Two researchers independently completed study screening, risk bias assessment, and data extraction. Review Manager (version 5.4, Cochrane collaboration) was used to conduct the meta-analysis. The evaluation metrics were postoperative pain scores, opioid consumption, and patient satisfaction. Sixteen randomized controlled trials were included, and data from 918 patients were available. Pain scores differed between the two groups at 12, 24, and 48 h postoperatively, and the pain scores of the lidocaine patch group were significantly lower (MD=-1.32 [95% CI: -1.96 to -0.68], P<0.0001; I2=92%) at 12 h after the operation; (MD=-1.23 [95% CI: -1.72 to -0.75], P<0.00001; I2=92%) at 24 h after the operation; and (MD=-0.25 [95% CI:-0.29 to -0.21], P<0.00001; I2=98%) at 48 h after the operation. In addition, the lidocaine patch group had decreased opioid requirements (MD=-3.57 [95% CI: -5.06 to -2.09], P<0.00001; I2=96%). The lidocaine patch group seemed to be more satisfied, but there was no significant difference [RR, 1.50 (95% CI: 0.74 to 3.05), P=0.26] between the groups. Lidocaine patches are beneficial for postoperative pain and can be used in multimodal analgesia to reduce opioid use, but there is no significant increase in patient satisfaction with pain control. More data are needed to support this conclusion due to the large heterogeneity in the present study.

Autologous Plasma Gel as an Effective Method of Facial Volume Restoration and Skin Rejuvenation

The primary aim of this retrospective study was to investigate the potential effectiveness of autologous platelet gel as a method for facial volume restoration and skin rejuvenation. High-frequency ultrasonography was utilized to assess the outcomes of the treatment. The study included a cohort of ten female patients aged between 40 and 50 who actively participated in the research. They reported moderate-to-severe static and dynamic wrinkles, volume loss, thinning, and roughness of the skin. Each patient received one session of autologous platelet gel injections. The gel was prepared accordingly with the manufacturer’s (INNMEDIS, ATR™) instructions. Medium viscosity gel was injected into the superficial subdermal fat pads in the temples, as well as in the middle and lower face areas, to improve facial volume. A high-frequency ultrasound (US) device was employed to quantify skin density, skin thickness, and the depth of nasolabial folds. The US images were captured at three time points: before gel administration, one month after the procedure, and three months after the procedure. The imaging focused on the nasolabial folds area to monitor changes and assess the effectiveness of the treatment over time. Based on the analyses, the use of autologous platelet gel is beneficial towards improving skin density and decreasing nasolabial fold depth. However, further research should be conducted into the gel’s effects on dermis thickness to achieve a stronger, more statistically significant conclusion. The level of satisfaction of the enrolled patients regarding their facial appearance was evaluated using the visual analogue scale (VAS). The VAS assessment revealed an average score of 4.1 before the commencement of the treatment, an average score of 7.9 one month after the treatment, and an average score of 7.5 three months following the treatment. The results indicate a significant increase in patient satisfaction following treatment completion. Autologous platelet gel appears to hold promise as a treatment option for volume replacement and skin rejuvenation, making it an attractive choice for individuals seeking natural skin treatments. Despite the encouraging findings from this observation, further validation is required through a larger controlled study to definitively confirm whether autologous platelet gel is indeed an effective method for volume replacement and skin rejuvenation.

Platelet-Rich Fibrin as an Effective Method of Skin Revitalization

The objective of this retrospective study was to verify with the use of high-frequency ultrasonography whether Platelet-Rich Fibrin (PRF) can increase skin density and become an effective method of skin revitalization as well as to determine an optimal procedure protocol for the use of Platelet-Rich Fibrin to revitalize skin of the periorbital region. Ten patients (women, age 32–45) were assigned for the observation. They reported thinning and wrinkles of the skin in the periorbital area. For each individual two vials (18 mL) of peripheral blood were collected and placed in preprogrammed centrifuge ( 60 g , 3 minutes). After centrifugation injectable-PRF (i-PRF, 2 mL) was collected and injected intradermally in the periorbital area, using the mesotherapy technique with 4 mm 30 G needles. The patients underwent four procedures in one month intervals. A high-frequency ultrasound device was used to measure skin density. Skin density analyses were performed before PRF administration, a month after the second and a month after the third procedure in the crow’s feet area. The results demonstrated an increase in skin density in all patients after just one procedure: on average it was 1.66 times higher compared to the baseline after the second and 5.08 times higher after the third treatment which was visualized using the DUB SkinScanner imaging. The enrolled patients’ satisfaction with their facial skin appearance was measured with the visual analogue scale (VAS). Digital photographs were taken before the first treatment and a month after the last treatment. The VAS assessment results were as follows: the average score before the treatment was 4 and the average score after the treatment was 8.5, indicating a significant increase in patient satisfaction. i‐PRF seems to be a promising treatment modality for skin rejuvenation in the periorbital area and might be a solution for those seeking natural methods. Although the results of this observation are very promising, there is need for larger controlled research to definitely confirm Platelet-Rich Fibrin efficacy in the skin revitalization processes.

Real world impact of added FFR-CT to coronary CT angiography on clinical decision-making and patient prognosis – IMPACT FFR study

ObjectivesThe addition of CT-derived fractional flow reserve (FFR-CT) increases the diagnostic accuracy of coronary CT angiography (CCTA). We assessed the impact of FFR-CT in routine clinical practice on clinical decision-making and patient prognosis in patients suspected of stable coronary artery disease (CAD).MethodsThis retrospective, single-center study compared a cohort that received CCTA with FFR-CT to a historical cohort that received CCTA before FFR-CT was available. We assessed the clinical management decisions after FFR-CT and CCTA and the rate of major adverse cardiac events (MACEs) during the 1-year follow-up using chi-square tests for independence. Kaplan–Meier curves were used to visualize the occurrence of safety outcomes over time.ResultsA total of 360 patients at low to intermediate risk of CAD were included, 224 in the CCTA only group, and 136 in the FFR-CT group. During follow-up, 13 MACE occurred in 12 patients, 9 (4.0%) in the CCTA group, and three (2.2%) in the FFR-CT group. Clinical management decisions differed significantly between both groups. After CCTA, 60 patients (26.5%) received optimal medical therapy (OMT) only, 115 (51.3%) invasive coronary angiography (ICA), and 49 (21.9%) single positron emission CT (SPECT). After FFR-CT, 106 patients (77.9%) received OMT only, 27 (19.9%) ICA, and three (2.2%) SPECT (p < 0.001 for all three options). The revascularization rate after ICA was similar between groups (p = 0.15). However, patients in the CCTA group more often underwent revascularization (p = 0.007).ConclusionAddition of FFR-CT to CCTA led to a reduction in (invasive) diagnostic testing and less revascularizations without observed difference in outcomes after 1 year.Key Points• Previous studies have shown that computed tomography–derived fractional flow reserve improves the accuracy of coronary computed tomography angiography without changes in acquisition protocols.• This study shows that use of computed tomography-derived fractional flow reserve as gatekeeper to invasive coronary angiography in patients suspected of stable coronary artery disease leads to less invasive testing and revascularization without observed difference in outcomes after 1 year.• This could lead to a significant reduction in costs, complications and (retrospectively unnecessary) usage of diagnostic testing capacity, and a significant increase in patient satisfaction.

The balanced scorecard as a strategic management tool in hospital pharmacies: an experimental study

PurposeA balanced scorecard (BSC) is an applied tool for implementing strategic management in various organizations. Implementing strategic management using the BSC approach has not received much attention in pharmacy departments. This study aims to provide a model for the strategic management of pharmacy departments using the BSC framework.Design/methodology/approachThis experimental study was conducted from 2015 to 2018 in a 300-bed hospital and regional healthcare centers affiliated with the Petroleum Industry Health Organization in Tehran province, Iran. After carefully reviewing the organization's mission and vision, the strategic objectives were determined via the internal matrix and the external matrix (IE matrix), and the strengths–weaknesses–opportunities–threats matrix (SWOT matrix) were examined. Then, six BSC measures and interventions were identified, and each was examined from the perspectives of finance, patient satisfaction, internal processes and learning/growth. Finally, the proposed strategy was evaluated.FindingsResults showed significant increases in patient satisfaction and gross profit. The observed increase range, from 0.09 to 0.29, indicates more effective operational management for optimal resource utilization. In addition, the pharmacy department was able to save US $539,137 by implementing prepared protocols for expensive medications. Similarly, the pharmacy department saved $442,899 during the two years of our strategic management plan by implementing the standard mechanism for returning unused medications to the pharmacy department after patients were discharged from various treatment units.Originality/valueThis study is among the first studies to demonstrate the simultaneous development, implementation and evaluation of the proposed strategy using the BSC in a pharmacy department in a public healthcare center. The BSC application improved the optimal use of resources and reduced costs while increasing patient satisfaction. It appears that the application of such an intervention may be as valuable to public pharmacies as it is to other private centers.

906 Implementing and Re-Designing A Virtual Fracture Clinic (VFC) During The COVID-19 Pandemic

IntroductionWe have implemented a VFC model during the COVID-19 pandemic to minimise the number of face-to-face consultations and the risk of transmission.MethodThe VFC was implemented and assessed using 3 PDSA cycles. Initially, a paper referral system was introduced along with treatment pathways. Subsequently an electronic referral system was established. The 3rd PDSA cycle involved training A&E staff on referrals and treatment pathways. At each stage the number of VFC referrals and clinic follow-ups were measured. Patient satisfaction was assessed using a telephone survey with a random sample of 30 patients.ResultsThere was a statistically significant reduction in face-to-face follow-ups between pre-VFC (Total:4083, Average:86.87) and post-VFC (Total:713, Average:35.65) p-value<0.0001. There was a statistically significant increase in patient satisfaction after the implementation of the electronic referral system and staff re-training(9.25) compared to paper referrals(8.23), p-value=0.02064.ConclusionsOur study demonstrated that the VFC successfully reduced the number of face-to-face follow-ups while maintaining patient satisfaction. Thus, it is an effective alternative to conventional fracture clinics. A similar model can be introduced at other hospitals to minimise in-person consultations and risk of transmission, while standardising patient care. It has also highlighted the importance of appropriate technological infrastructure, staff training and service evaluation.

Diverse Approaches to Assessing What Matters to Older Adults

Asking older adults What Matters to them and assuring that care plans are aligned with these preferences is the cornerstone of an Age-Friendly Health System (AFHS). Health systems have struggled to identify clear ways to ask this question and meaningfully utilize the responses. Both simple and complex options for addressing this challenge have been developed at Rush University Medical Center. At Rush, nurses began asking every inpatient What Matters and placing the response on the white board in the patient’s room. Results of this practice include increased awareness of staff and significant increases in patient satisfaction. Qualitative analysis of responses yields increased awareness of patterns that the hospital can more systematically address. The Rush Center for Excellence in Aging hosts Schaalman Senior Voices, in which older adults from diverse backgrounds are given the unique opportunity to offer their perspectives on life, health and aging related to “What Matters” to them. The films have been used effectively to stimulate conversations among older adults and families in the community and in health professions courses, and with health systems executives. The Rush College of Medicine has integrated AFHS training into communication skills for medical students. Faculty introduce the 4Ms and demonstrate methods for having What Matters (WM) conversations. Students then practice WM conversations with simulated patients; some have had the opportunity to practice with real patients in preceptorships. Implications for the health system and community will be discussed as Rush builds an Age-Friendly Health Community.

Spirituality and satisfaction with physicians among hospitalized patients

We examined the relationship between a patient’s spirituality and satisfaction with physicians during hospitalization. Data were collected using the Daily Spiritual Experience Scale (DSES), the Tool to Assess Inpatient Satisfaction with Care from Hospitalists (TAISCH) and a five-question, internally-developed, patient satisfaction questionnaire (5QS). Scores were rescaled from 0 to 100 for easy comparison. Results showed a statistically significant increase in patient satisfaction with increasing spirituality. In the unadjusted model, each 1% increase in DSES score (or 1% decrease in spirituality) was associated with 0.21% (p < 0.001) and 0.14% (p = 0.002) decrease in patient satisfaction with physicians as measured by 5QS and TAISCH respectively. The results were consistent after adjustment for the patient’s age, gender, and race. With the increasing influence, patient satisfaction scores have on the health care system, the results from this study help us better understand how these scores are influenced.

Reducing Postoperative Call Volume Through Verbal Preoperative Education.

To improve patient satisfaction and understanding of what to expect after chronic ear surgery and reduce call volume to an otology clinic at an academic tertiary referral center. Quality improvement initiative. A single-academic tertiary referral center. One hundred and ten patients who underwent chronic ear surgery in March to May 2018. Preoperative counseling over the phone 1 week before surgery. Patient call volume to the clinic within a 2-week postoperative window, patient understanding, and satisfaction of perioperative course. There was a significant increase in patient satisfaction (10.1% increase, 9.8 intervention vs. 8.9 no intervention, p = 0.0032) and in patient understanding of what to expect after surgery (6.7% increase, 9.5 intervention vs. 8.9 no intervention, p = 0.0275). There was a significant decrease in mean number of calls per patient to the clinic (57.6% decrease, 0.31 intervention vs. 0.72 no intervention, p = 0.0105) and in percentage of patients who made any number of calls to the clinic (20% intervention vs. 46%, no intervention, p = 0.00438). Verbal preoperative counseling over the phone was effective in significantly reducing unnecessary call volume to the clinic and in improving patient satisfaction and overall understanding of what to expect after surgery.

Supracor LASIK treatment of hyperopic and myopic presbyopes: a comparative study

Background Supracor is a relatively new technique that has been approved for hyperopic presbyopia correction; however, till now, no published studies have evaluated the performance of supracor in myopic patients with presbyopia. Objective The aim of this study was to compare the results of supracor treatment of presbyopia between hyperopic and myopic patients. Patients and methods The study included two groups: hyperopic group and myopic group. Complete preoperative examination consisted of cycloplegic and manifest refraction, spherical equivalent (SE), binocular uncorrected and corrected distant visual acuity (UCDVA and CDVA), binocular uncorrected and corrected near visual acuity (UCNVA and CNVA), measurement of higher order aberrations, and the determination of the dominant eye using hole-in-the card test. Patients were examined at the first day, third day, 1 month, 3 months, and 6 months postoperatively. UCDVA, CDVA, UCNVA, CNVA, higher order aberrations, and SE were measured, and all complications were recorded. Furthermore, patient’s satisfaction was documented by a detailed questionnaire. All data were collected, analyzed, and compared between the two groups. Results The study included 20 hyperopic and 19 myopic patients. There were no statistically significant differences (P>0.05) between the two groups regarding postoperative UCDVA, CDVA, UCNVA, CNVA, SE, spherical aberrations, and complications. However, there was a statistically significant difference (P<0.05) between the studied groups regarding patient satisfaction at 1 month, 3 months, and 6 months postoperatively (which was higher in patients with hyperopia), with a significant increase in patient satisfaction in those with hyperopia over time. Conclusion Supracor was found to be effective, predictable, and stable technique in the management of presbyopia in both patients with myopia and those with hyperopia, with similar results in the two groups except for patient satisfaction, which was higher in those with hyperopia.

Patient expectations and satisfaction 6 and 12months following total hip and knee replacement.

To assess (1) patient expectations before total hip (THR) and knee (TKR) replacement; (2) which expectations are met and unmet 6 and 12months post-surgery; (3) the role of unmet expectations in satisfaction. Questionnaires were mailed to consecutive patients following surgeon referral for primary THR or TKR. Patients listed their own expectations and also completed the Hospital for Special Surgery (HSS) Expectation Survey. We used content analysis to group expectations into themes. At 6 and 12months post-surgery, patients were given a copy of their own list of individual expectations and reassessed each one as met or unmet. We also assessed fulfilled HSS expectations and satisfaction with surgery. The sample of 556 patients (49% THR, 57% female) had a mean age of 64years (SD10). The five most frequent expectation themes were pain relief, mobility, walking, physical activities, and daily activities. Of these, physical activities had the lowest percentage met 12months post-surgery. 95% (THR) and 87% (TKR) were satisfied/very satisfied with their surgery 12months post-surgery. Very satisfied patients had a significantly greater percentage of met expectations (96% THR; 92% TKR) than dissatisfied patients (42% THR; 12% TKR). Although most expectations listed by patients were included in the HSS surveys, some were not, particularly for TKR. From 6 to 12months, there was a significant increase in patient satisfaction for self-care, daily activities, and met expectations for THR and pain relief, self-care, daily activities, and recreational activities for TKR. Expectations should be explicitly addressed before surgery, including a discussion of realistic expectations, particularly for physical activities.

Effectiveness and Patient Satisfaction with Budesonide/Formoterol Easyhaler® Among Patients with Asthma or COPD Switching from Previous Treatment: a Real-World Study of Patient-Reported Outcomes.

IntroductionPersistent symptoms, poor disease control, and reduced quality of life (QoL) are common in patients with asthma and chronic obstructive pulmonary disease (COPD). Current therapies are only partially effective and inhaler misuse contributes to insufficient disease control and poor outcomes. This real-world study aimed to evaluate the effectiveness of budesonide/formoterol fumarate (B/F) Easyhaler® in everyday clinical practice in Hungary.MethodsPost hoc, subgroup analyses of this 12-week, real-world, multicenter, open-label study were conducted in adults diagnosed with asthma or COPD. Endpoints included the change in patient-reported outcome measures; i.e., symptoms and disease control measured by Asthma Control Test or COPD Assessment Test and health-related (HR)QoL measured by mini-Asthma Quality of Life Questionnaire or modified Medical Research Council dyspnea scale. Changes in lung function and patient satisfaction with B/F Easyhaler versus their previous inhaler were also evaluated. Results were stratified by the inhaler device used at visit 1 (baseline, when patients switched device); comparisons were made with B/F Easyhaler use after 12 weeks, assessed at visit 3.ResultsIn total, 398 and 563 patients with asthma and COPD, respectively, were analyzed. Significant improvements (p < 0.0001) in symptoms and disease control, HRQoL, and lung function were reported 12 weeks after switching treatment to B/F Easyhaler from the most commonly used devices (≥ 10% of patients). Significant increases in patient satisfaction were also reported versus comparators.ConclusionsPatients with asthma or COPD who switched to B/F Easyhaler from their previous inhaler due to lack of disease control achieved significant improvements in symptoms and disease control, HRQoL, and lung function within 12 weeks of real-world use with significant increase in patient satisfaction also observed. Such comparative information may reassure clinicians and patients that may be viewed as an appropriate and potentially beneficial treatment option.Trial Registration NumberOGYÉI/13942-5/2016 (National Pharmaceutical Institute of Pharmacy and Nutrition of Hungary).FundingOrion Corporation, Orion Pharma.Plain Language SummaryPlain language summary available for this article.Electronic supplementary materialThe online version of this article (10.1007/s41030-019-0097-7) contains supplementary material, which is available to authorized users.

Governance Practices in an Era of Healthcare Transformation: Achieving a Successful Turnaround.

This article illustrates the successful application of principles established by the American Hospital Association (AHA) to foster hospital transformations (). We examined a small community hospital's successful transition from one emergency care center (ECC) physician group to another and the methods by which significant improvements in outcomes were achieved. The foundation of this transformation included a generative governance style at the board level, a shared governance model at the employee level, a renewed sense of employee and physician engagement, and a sense of individual accountability. Outcomes included improved communication, a more unified vision throughout the ECC (which led to improved efficiency and accountability among staff), improved metrics, and a positive impact on the community's perception of care. Press Ganey scores and ECC operational metrics demonstrated significant increases in patient satisfaction and decreases in wait times for seven operational metrics. These data serve as a proxy for the transformation's success. Structured interviews revealed an increase in employee satisfaction associated with the transition. The positive outcomes demonstrate the importance of the AHA-articulated governance principles. The AHA recommendations for a superior value-based care model closely align with the methods illustrated through Bristol Hospital's successful transformation. Other institutions can apply the lessons from this case study to drive positive change and improve patient care.

Abstract P2-09-15: A multi-institutional, prospective study of incorporating the genomic platform breast cancer index as a tool for decision-making regarding extension of adjuvant endocrine therapy

Abstract Background: Extending adjuvant endocrine therapy (AET) for hormone responsive breast cancer (HRBC) from 5 to 10 years is beneficial for many in preventing late relapse. Current decision-making regarding extension relies on a decision-making process that weighs non-personalized recurrence risks against risks and benefits of extended AET. The Breast Cancer Index (BCI, BioTheranostics Inc) has been validated to quantify the risk of late recurrence and to predict likelihood of benefit from AET extension based on an individual's tumor genomic profile. The purpose of this study was to conduct a multi-institutional study to prospectively assess the impact of BCI i) on provider's recommendation using the BCI results; 2) the confidence with decision-making; and 3) patient's satisfaction regarding extension of AET. Methods: Patients with stage I-III HRBC treated at Yale Cancer Center and University of Pittsburgh Medical Center (UPMC), who had completed at least 3.5 years of AET were eligible. BCI was performed on FFPE samples from the original tumor sample (bioTheranostics Inc.). Patients and physicians completed pre- and post-test questionnaires examining preferences for extending AET, patients also completed anxiety and decision-conflict surveys. Results: 140 patients [mean age 61, 80% postmenopausal, 73% stage I] were included. No extended AET was recommended for 35.3% patients' pre-testing. Reasons physicians did not recommend extended AET were perceived low risk of recurrence (87%), risk of osteoporosis (25%) and side effects (13%). Extended therapy was recommended for 65.7% patients pre-testing. Integration of BCI resulted in a change in physician treatment recommendation in 29% of patients. The recommendation for no extended AET rose to 48% and recommendation for extended AET dropped to 52% (OR=1.76 95% CI 1.08-2.85; p=.003). Of the recommendations that changed (N=41), the majority (73%) was for not extending endocrine therapy. However, 27% of recommendations were to extend endocrine therapy because of high risk or high likelihood of benefit results. More physicians felt strongly confident in their recommendation after the test result (26.4%) than before (9.3%) (OR= 3.5 95% CI 1.77-6.95; p&amp;lt;.0001). Satisfaction of decision increased in 23% of patients (OR=2.72 95% CI 1.66-4.46; p&amp;lt;.0001). Patient reported concerns including the cost, safety and benefit of extended AET decreased from pre- to post-testing (p=.025; p&amp;lt;.0001; p=.0012 respectively) Conclusions: Overall, incorporation of BCI into clinical practice resulted in significant changes in physician recommendations regarding AET duration, with the majority of recommendations for no extended AET. Physicians reported increased confidence for their recommendation when incorporating the test result. There was also a significant increase in patient satisfaction and decrease in patient reported concerns regarding cost, safety and benefit of extended AET. The BCI is a tool that could be incorporated into decision-making algorithms to enhance physician confidence and patient satisfaction with recommendations for extending AET. Citation Format: Sanft T, Berkowitz A, Schroeder B, Hatzis C, Schnabel C, Aktas B, Brufsky A, Pusztai L, vanLonden GJ. A multi-institutional, prospective study of incorporating the genomic platform breast cancer index as a tool for decision-making regarding extension of adjuvant endocrine therapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-09-15.

Outcomes in Open Structure Septorhinoplasty

Objectives: The aim of our study was to look at patient related outcome measures and complications post–open structure septorhinoplasty performed by the same experienced rhinologist and to look at any factors associated with increased risk for requirement of revision surgery. Methods: Retrospective review of case notes of all patients who underwent septorhinoplasty at the same institute, performed by the same rhinologist, between January 2009 and February 2013. Assessment of patient satisfaction was made using the Rhinoplasty Outcomes Evaluation (ROE) tool. Results: One hundred seventy patients were included in the study, with mean follow-up of 28.2 months. The most common complication was residual deformity (10/170, 5.9%). Eleven patients required further revision nasal surgery (11/170, 6.5%). There was a statistically significant increase in the ROE scores pre- and postoperatively in all patients undergoing surgery (19.5 ± 9.41 vs 68.4 ± 23.7, P &lt; .001). There was a statistically significantly higher rate of revision surgery in patients who had complex surgery (4/16 vs 7/154, P = .01), a higher rate of nasal tip deformity in the revision surgery group compared with the primary surgery group (10/24 vs 29/146, P = .03), and a higher rate of augmentation surgery in the revision surgery group compared with the primary surgery group (13/24 vs 40/146, P =.02). Conclusions: Open structure septorhinoplasty results in a significant increase in patient satisfaction. Our rate of revision surgery is lower than the average reported in the literature. The rate of revision surgery is higher in cases judged to be more complex preoperatively.

Improving Wait Times and Patient Satisfaction in Primary Care

A strong and inverse relationship between patient satisfaction and wait times in ambulatory care settings has been demonstrated. Despite its relevance to key medical practice outcomes, timeliness of care in primary care settings has not been widely studied. The goal of the quality improvement project described here was to increase patient satisfaction by minimizing wait times using the Dartmouth Microsystem Improvement Curriculum (DMIC) framework and the Plan-Do-Study-Act (PDSA) improvement process. Following completion of an initial PDSA cycle, significant reductions in mean waiting room and exam room wait times (p = .001 and p = .047, respectively) were observed along with a significant increase in patient satisfaction with waiting room wait time (p = .029). The results support the hypothesis that the DMIC framework and the PDSA method can be applied to improve wait times and patient satisfaction among primary care patients. Furthermore, the pretest-posttest preexperimental study design employed provides a model for sequential repetitive tests of change that can lead to meaningful improvements in the delivery of care and practice performance in a variety of ambulatory care settings over time.

Integration of HIV Care with Primary Health Care Services: Effect on Patient Satisfaction and Stigma in Rural Kenya

HIV departments within Kenyan health facilities are usually better staffed and equipped than departments offering non-HIV services. Integration of HIV services into primary care may address this issue of skewed resource allocation. Between 2008 and 2010, we piloted a system of integrating HIV services into primary care in rural Kenya. Before integration, we conducted a survey among returning adults ≥18-year old attending the HIV clinic. We then integrated HIV and primary care services. Three and twelve months after integration, we administered the same questionnaires to a sample of returning adults attending the integrated clinic. Changes in patient responses were assessed using truncated linear regression and logistic regression. At 12 months after integration, respondents were more likely to be satisfied with reception services (adjusted odds ratio, aOR 2.71, 95% CI 1.32–5.56), HIV education (aOR 3.28, 95% CI 1.92–6.83), and wait time (aOR 1.97 95% CI 1.03–3.76). Men's comfort with receiving care at an integrated clinic did not change (aOR = 0.46 95% CI 0.06–3.86). Women were more likely to express discomfort after integration (aOR 3.37 95% CI 1.33–8.52). Integration of HIV services into primary care services was associated with significant increases in patient satisfaction in certain domains, with no negative effect on satisfaction.