Survey Of Health Care Providers Research Articles

Which Hospitals Promote a Sleep-Friendly Patient Experience?

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patient perceptions of hospital experience to determine the annual Center for Medicare and Medicaid Services (CMS) reimbursement. This study focuses on the "Quiet at Night" variable and identifies institutions with the highest scores to determine characteristics that facilitate patient sleep. The key findings were as follows: CMS Top Rated Hospitals have a mean score of 5 on the "Quiet at Night" variable.US News Honor Roll Hospitals have a mean score of 2.67, with a statistically significant difference of P < .001 between the groups.The key characteristics of the CMS Hospitals are that they are predominantly privately owned, specialized, surgical facilities with few total hospital beds.Knowing that HCAHPS scores directly impact and reflect patient experience, the objective of this study was to better understand the hospital practices that facilitate a high score on the "Quiet at Night" question to empower low scoring hospitals to improve their sleep practices at night and to score higher on the HCAHPS survey.

Abstract C116: Racial/ethnic disparities in perceived quality of breast cancer survivorship care among older women by general health status: A SEER-CAHPS study

Abstract Purpose: We aimed to outline the extent of racial/ethnic disparities in perceived quality of cancer survivorship care among older breast cancer survivors in the United States. Methods: We utilized the National Cancer Institute’s Surveillance, Epidemiology, and End Results program (SEER) and the Center for Medicare and Medicaid Services Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data linkage from 2000-2019. 19,017 female breast cancer survivors aged ≥65 years at survey with a prior diagnosis of primary invasive breast cancer were included. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression to determine the relationship between race/ethnicity (non-Hispanic white [NHW; referent], non-Hispanic Black [NHB], non-Hispanic Asian [NHA], Hispanic) and perceived quality of survivorship care (excellent in Getting Care Quickly, Getting Needed Care, Physician Communication, Getting Needed Prescription Drugs, and Overall Care, Health Plan, and Physician ratings), and usually/always having Enough Time with Physician, overall and by perceived general health status (excellent/very good, good, fair/poor). Results: Most survivors were NHW (78.1%) while the minority were NHB (8.1%), NHA (6.5%), or Hispanic (6.2%). Survivors reported an average of 76.3 years at survey (SD=7.14) and 4.65 years (SD=3.51) since diagnosis. Overall, NHB survivors were significantly less likely to report excellent for Overall Care (aOR, 0.80, 95% CI, 0.71-0.91) and usually/always having Enough Time with Physician (aOR, 0.74, 95% CI, 0.58-0.93) compared to NHW survivors. NHA survivors were significantly less likely to report excellent Getting Care Quickly (aOR, 0.75, 95% CI, 0.63-0.88), Getting Needed Care (aOR, 0.79, 95% CI, 0.63-0.99), Physician Communication (aOR, 0.84, 95% CI, 0.73-0.97), and Overall Care rating (aOR, 0.76, 95% CI, 0.67-0.87) compared to NHW survivors. The aORs for Hispanic survivors varied depending on outcome. When stratified by general health status, NHB compared to NHW survivors were significantly more likely (aOR, 1.30, 95% CI, 1.05-1.62) to report excellent in Getting Needed Care among those who reported good general health, but this disparity was not observed among those who reported excellent/very good general health (p-interaction=0.04). Compared to NHW survivors, NHB were significantly more likely (aOR, 1.54, 95% CI, 1.14-2.08) to report excellent Health Plan ratings among those who reported excellent/very good general health but not among those who reported good (p-interaction=0.03) or fair/poor general health (p-interaction=0.01). There were no significant interactions between general health status and NHA or Hispanic group for any outcome. Conclusion: These findings can be used to inform future interventions, care, and physician education throughout breast cancer survivorship. Citation Format: Kate E. Dibble, Zhengyi Deng, Avonne E. Connor. Racial/ethnic disparities in perceived quality of breast cancer survivorship care among older women by general health status: A SEER-CAHPS study [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C116.

Differences in Patient Experiences Among People From Ethnic Minority Backgrounds: A Comparative Analysis of HCAHPS Results

Patients from ethnic minority backgrounds often experience disparities in healthcare quality and outcomes. This study aimed to compare the patient-reported experiences of patients with limited English proficiency (LEP) to general patients in the Australian healthcare setting. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was used to evaluate patient experiences from patients in a metropolitan public healthcare network, spanning three hospitals. Level of English proficiency was based on primary language spoken at home. To identify disparities in experience ratings between patients with LEP and the general cohort, independent t-tests were employed. Data was analysed from 2,291 patients, collected over a five-year period (2017–2022), with 490 patients identified as LEP (i.e. speaking a language other than English at home). Statistically significant differences were identified between the cohorts, with LEP patients rating their experiences higher in three areas: doctors listening carefully, doctors explaining in a way they could understand, and quietness at night. Conversely, patients with LEP scored lower in areas regarding nursing respect and responsiveness to call bells. Although patients with LEP had a more positive overall experience, this difference was not statistically significant. The findings indicate potential misalignment between the often poorer health outcomes among people from ethnic minority backgrounds and their experiences in hospital. Additional research is crucial to delve into the unique experiences of ethnic minority patients, including those with LEP, to understand the differences influencing perceptions of care and contributing to disparities in health outcomes.

Survey of healthcare providers' testing practices for vulvovaginal candidiasis and treatment outcomes-United States, 2021.

Vulvovaginal candidiasis (VVC) is a common infection, and high-quality studies report that misdiagnosis is frequent, with diagnostic testing needed to distinguish it from other causes of vaginitis and avoid inappropriate empiric treatment. However, few recent studies have evaluated U.S. healthcare providers' testing practices for VVC in detail. We evaluated healthcare providers' self-reported testing practices for VVC and treatment outcomes as part of a nationwide online survey in order to identify potential opportunities for improving VVC testing and treatment in the United States. Among 1,503 providers surveyed, 21.3% reported "always" (7.4%) or "usually" (13.9%) ordering diagnostic testing for patients with suspected VVC; this proportion was higher among gynecologists (36.0%) compared with family practitioners (17.8%) and internists (15.8%). Most providers (91.2%) reported that patients' VVC "always" (6.4%) or "usually" (84.9%) responds to initial treatment. Whether the symptom resolution reported in this survey was truly related to VVC is unclear given high rates of misdiagnosis and known widespread empiric prescribing. With only about one-in-five providers reporting usually or always performing diagnostic testing for VVC despite guidelines recommending universal use, research is needed to address barriers to proper testing.

NORMALIZING COGNITIVE EVALUATIONS IN ADULTS: GETTING PEOPLE IN THE SCREENING PIPELINE EARLY

Abstract To understand how adults and healthcare providers perceive a dementia diagnosis and cognitive evaluations, AARP fielded a nationally representative survey of adults aged 40 and older (N=3,022) along with a companion survey of healthcare providers in a position to diagnose dementia (N=500). Like healthcare providers, Americans aged 40 and older understand the benefits of diagnosing dementia at an early stage, 81% agree that early detection would motivate them to engage in healthier behaviors to slow the progression of the disease. Adults look to healthcare providers as authorities to determine when a cognitive evaluation should be triggered with 63% saying they would get an evaluation if their doctor recommended it and 49% of healthcare providers saying evaluations should be done if the doctor feels it is necessary and 39% saying it should be done yearly beginning at age 65. The research also showed that most adults (76%) want to know if they have dementia. Additionally, majorities of adults would engage in healthy behaviors if they knew it’s good for their brain health. Given the desire to prevent and improve outcomes, routine screening for cognitive function should be as commonplace as getting a screening colonoscopy. Unlike a colonoscopy, routine screening for cognitive function is not a normalized process yet. Data from both populations suggest an opportunity for routine evaluation due to a shared understanding of the long and short-term benefits of screening.

1205. Does Perception of Cleanliness Matter? A Correlational Study Exploring Patient Perception of Cleanliness and HAC Score Performance

Abstract Background One of the most common causes of healthcare associated infections (HAIs) is due to environmental contamination of surfaces in the patient care areas. Cleaning and disinfection of these surfaces has been shown to reduce the incidence of HAIs and contributes to the overall hospital cleanliness. Currently, hospital cleanliness is publicly reported through the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that is sent to all patients discharged from a healthcare facility. There is very limited research on if the perception of hospital cleanliness is related to the incidence of HAIs in a healthcare facility as defined by the facility's performance in the Healthcare Acquired Conditions (HAC) program. Methods A retrospective correlational study was performed to examine the relationship of patient perception of hospital cleanliness and the incidence of Clostridioides difficile (C. difficile) and Methicillin Resistant Staphylococcus aureus (MRSA) HAIs defined by the facility's HAC score. Multiple Center for Medicare and Medicaid Services (CMS) datasets were utilized for the study. There were approximately 2300 acute care facilities included that reported data on the patient perception of room cleanliness question, and either C. difficile or MRSA standardized infection ratio (SIR) for the time period of October 1, 2018 to September 30, 2019. Basic descriptive statistics and Spearman's correlational analyses were performed to analyze the relationships between the HAI HAC scores and the HCAHPS answer description to measure the potential association. Results The study found that as the percentage of patients who reported that their room was “always” clean increased, the hospital’s CDI or MRSA SIR decreased (r= -0.228,p= 0.00; r= -0.130,p= 0.00). The analysis also revealed that as the percentage of patients who reported their room was "never" clean increased, the facility's CDI or MRSA SIR increased (r= 0.180, p = 0.00; r=0.140, p= 0.00). Conclusion This study found that a hospital’s HCAHP performance on patient perception of cleanliness is related to their performance on certain HAIs as defined by performance on HAC scores. Further research is needed to determine if there are specific factors that influence patient perception of cleanliness. Disclosures Caitlin Stowe, MPH, CPH, CIC, CPHQ, VA-BC, ActivePure Medical: Employment|PDI Healthcare: Employment.

General dentists' readiness and barriers in intimate partner violence screening: a cross-sectional study in Jeddah City.

Intimate partner violence (IPV) has varying prevalence rates and risk factors based on cultural, social, and economic backgrounds. However, it is common for IPV victims to be seen in dental settings on a regular basis. Identifying IPV victims in dental settings might help address this overlooked global dilemma. This study was conducted to evaluate general dentists' readiness and potential barriers to performing IPV screening in a dental setting. A cross-sectional study was conducted using the Domestic Violence Healthcare Providers Survey (DVHPS). This validated and structured questionnaire was adopted, modified, and self-administered to evaluate general dentists' readiness and barriers to IPV screening. General dentists were recruited for the study population from 5 administrative territorial regions in Jeddah, Saudi Arabia. The questionnaire consists of 7 domains that assess general dentists' readiness and barriers to performing IPV screening for all dental patients. Out of the 273 dentists approached, a total of 200 participated in the study, with a total response rate of 73.3%. The percentages of female and male dentists were 54% and 46%, respectively. Almost 73% of the study population believed they could identify IPV in a dental setting. The multiple linear regression model indicated a substantial decrease in general dentists' readiness to perform IPV screening due to fear of offending patients, an increased number of patients treated per day, and professional role resistance. The current study suggests the high readiness of general dentists to perform IPV screening for all patients. However, prominent barriers to implementing IPV screening for all patients include fear of offending patients, an increased number of patients treated per day, and professional role resistance. Postgraduate continuous education is encouraged to re-enforce the importance of IPV screening in dental settings.

Survey Reveals Patient and Health Care Provider Experiences and Challenges With the Use of High Doses of Basal Insulin.

Type 2 diabetes is a chronic, progressive disease, and its management results in a high emotional burden on patients. Eventually many patients require and can benefit from the use of insulin. This article reports results of a survey of patients and health care providers regarding their experiences of and challenges with the use of basal insulin. Health care providers can play a key role in helping people with type 2 diabetes overcome the challenges associated with the use of basal insulin, including connecting with their emotional needs and understanding the stressors associated with managing diabetes.

Rural Needs and Gaps in Stroke Rehabilitation: Results of Statewide Healthcare Provider and Patient Survey

<h3>Research Objectives</h3> To better inform a robust understanding of stroke rehabilitation needs in Nebraska (NE) among healthcare providers (HCPs) and stroke survivors. <h3>Design</h3> Cross-sectional survey. <h3>Setting</h3> Nebraska hospital settings: critical access/community, acute care, inpatient rehabilitation facility, skilled nursing facility and outpatient. <h3>Participants</h3> A total of 260 HCPs were recruited through the Nebraska Stroke Advisory Council to complete a 17-question online survey. HCPs included: physical, occupational and speech therapists, registered nurses, case managers and social workers. Separately, 28 stroke survivors recruited through social media and existing stroke support groups completed a 26-question online survey. Survivors included 12 females, 15 males (1 did not answer) ages 45-75+ years with the majority (35.7%) between 1 to 5 years since stroke. <h3>Interventions</h3> None. <h3>Main Outcome Measures</h3> Survey designed to assess perceptions of HCPs and stroke survivors evaluating outpatient therapy, social support, equipment, patient resources, and contextual factors such as transportation and insurance. <h3>Results</h3> HCPs identified the top barrier to providing stroke rehabilitation care as lack of insurance (62%), followed by lack of caregiver support (42%), and lack of specialized services (42%). When asked about survivors' greatest barrier to receiving care, the majority indicated a lack of insurance (74%), followed by financial burden (64%), and lack of caregiver/social support (50%). Survivors reported the top missing resource as communication about stroke support groups and sources of emotional support. HCPs indicated missing resources primarily include specialized rehab equipment, technology and services (52%), and professional opportunities for staff (37%). <h3>Conclusions</h3> Most stroke rehab HCPs identified specialized equipment and services as a missing resource, and indicated lack of insurance coverage as the top barrier to providing care, suggesting a need to understand where the specialized services are located in the state along with the insurance-related challenges patients face. Only 7% of stroke survivors indicated they learned about mental health resources during stroke recovery, while over a third (35%) reported feeling down or depressed suggesting there is a need for more information about mental health services available for survivors. <h3>Author(s) Disclosures</h3> None.

Barriers to and recommendations for integrating the age-friendly 4-Ms framework into electronic health records.

The Institute for Healthcare Improvement's 4-Ms framework of care for older adults recommends a multidisciplinary assessment of a patient's Medications, Mentation, Mobility, and What Matters Most. Electronic health record (EHR) systems were developed prior to this emphasis on the 4-Ms. We sought to understand how healthcare providers across the healthcare system perceive their EHRs and to identify any current best practices and ideas for improvement regarding integration of the 4-Ms. Anonymous survey of healthcare providers who care for older adults. The survey aimed to evaluate efficiency, error tolerance, and satisfaction (usefulness and likeability). The survey was distributed through organizational list serves that focus on the care of older adults and through social media. Sixty-six respondents from all geographic segments of the U.S. (n=62) and non-U.S. practices (n=4) responded. Most (82%) were physicians. Respondents used a range of EHRs and 82% had >5 years of experience with their current EHR. Over half of respondents agreed that their EHR had easy to find contact information (56%) and advance directives. Finding a patient's prior cognitive status (26% agreement), goals of care (24%), functional status (14%), and multidisciplinary geriatric assessments (27%) was more difficult. Only 3% were satisfied with how their EHR handles geriatric syndromes. In free text responses, respondents (79%) described three areas that the EHR assists in the care of older adults: screening tied to actions or orders; advance care planning, and medication alerts or review. Common suggestions on how to improve the EHR included incorporating geriatric assessments in notes, establishing a unified place to review the 4-Ms, and creating age-specific best practice alerts. The majority of healthcare providers were not satisfied with how their EHR handles multidisciplinary geriatric assessment and geriatric care. EHR modifications would aide in reporting, communicating, and tracking the 4-Ms in EHRs.

Survey of U.S. Healthcare Providers to Assess Attitudes and Practices Regarding Thromboprophylaxis of Hospitalized Adult Patients

Background: Venous thromboembolism (VTE) is a leading cause of mortality among hospitalized patients, but appropriate thromboprophylaxis remains underutilized. A significant proportion of VTE associated with hospitalization occurs after discharge. We conducted a national survey of healthcare providers to explore attitudes, practices, and barriers related to thromboprophylaxis in hospitalized patients, including practices for post discharge VTE prevention. Methods: We developed a survey exploring current attitudes and practices around VTE prophylaxis in adult hospitalized patients. Healthcare providers targeted for the survey were physicians, nurses, physician assistants, and pharmacists. The survey was administered to a targeted convenience sample. Participants were recruited through social media, professional healthcare organizations, and internal medicine program directors across the US. The overarching survey areas included (1) use of appropriate prophylaxis, including perceived rates of appropriate prophylaxis at respective institutions, (2) perceived barriers to appropriate prophylaxis, (3) practices to educate about and prevent post discharge VTE events, and (4) views on use of risk assessment models (RAMs) and other strategies to improve rates of VTE prophylaxis. Since it is generally understood by the healthcare provider respondents of this survey that administration of VTE prophylaxis depends on a patient's risk, survey questions did not specify a definition for appropriate prophylaxis. We summarized data as proportions with 95% confidence intervals (CI). Results: Of 607 U.S.-based respondents, 69.9% were 40 years or younger, 55.7% were female, 68.2% were white, and 63.1% reported working in an academic hospital. Physicians comprised 70.7% of respondents, of whom 46.6% identified as trainees; among non-trainees, 49.0% had been in practice for more than 10 years. Hospital medicine was the most frequent specialty (52.1%) followed by hematology (20.8%). Nearly all respondents agreed that VTE prophylaxis is important for patient care (98.8%, 95% CI: 97.6-99.5) and that current measures are safe (92.6%, 95% CI: 90.2-94.5) and effective (93.8%, 95% CI: 91.6-95.6). Yet only 52.0% (95% CI: 47.9-56.0) of respondents perceived that hospitalized patients at their institution were on appropriate VTE prophylaxis almost all of the time. The most commonly cited reasons for patients not being on appropriate VTE prophylaxis included patient refusal (21.8%), risk of bleeding outweighs benefit (21.6%), and unclear indications (16.0%) and contraindications (17.6%) for prophylaxis. Less than half of respondents reported using institutional protocols (48.3%) or a standardized RAM (35.4%) to select patients for VTE prophylaxis and most respondents (72.3%) relied on clinical judgement to assess bleeding risk when deciding on prophylaxis (Figure 1). Respondent views on strategies that could improve VTE prophylaxis rates in hospitalized patients included integration of RAMs into electronic health records (66.6%), automatic electronic reminders (55.0%), and order sets in electronic systems (46.1%) (Figure 2). Less than 20% of respondents reported routinely educating patients about risks (15.1%, 95% CI: 12.3-18.2) and symptoms (17.9%, 95% CI: 14.9-21.2) of post-discharge VTE events, and 8.6% (95% CI: 0.06-11.1) routinely prescribe VTE prophylaxis on discharge. Respondent views on strategies that could help reduce post-discharge VTE events included using standardized risk assessments at discharge (60.0%), providing educational materials at discharge (51.2%), and including post-discharge VTE prophylaxis in discharge checklists (45.5%) (Figure 2). Conclusion: To our knowledge, this is the largest U.S. national survey to date that focuses on VTE prevention practices in hospitalized patients. VTE prophylaxis was almost universally accepted as important, safe, and effective for patients at risk for VTE. Less than half of the respondents reported using standardized protocols or RAMs to guide appropriate thromboprophylaxis administration. Discharge education regarding risks of VTE is infrequent. This national multidisciplinary survey study highlights gaps in current practices and strategies for VTE prevention in hospitalized patients. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

A 360 Evaluation of Neonatal Care Quality at a Level II Neonatal Intensive Care Unit when Delivered Using a Hybrid Telemedicine Service.

In 2013, the Section of Neonatal and Perinatal Medicine at the University of Oklahoma's Children's Hospital began providing advanced care to a regional level II neonatal intensive care unit (NICU), using a hybrid telemedicine program. This project compares health care providers' and parents' assessments of health care quality using this program. This is a prospective, anonymous, nonrandomized survey of health care providers and parents of neonates using our hybrid telemedicine services. Physicians, neonatal nurse practitioners (NNPs), nurses, and parents completed pencil-and-paper surveys based on their participatory roles. Institutional Review Board approval was obtained at OU Medical Center and Comanche County Memorial Hospital. Surveys consisted of 5-point Likert's scale questions. Descriptive statistics compared the level of agreement with each question across participant groups. A service quality (SQ) composite score was created by summing responses from six SQ questions. Between-group analysis was done on the SQ score using the Mann-Whitney U-test. Nine physicians, 10 NNPs, 12 nurses, and 40 parents completed the survey. Providers agreed (90%) that telemedicine can effectively deliver advanced neonatal care; the care patients receive is comparable to direct patient care (87%); telemedicine enhanced overall patient care quality (90%); providers can effectively interact with each other and families using telemedicine (90.3%), and overall telemedicine experience was good (90%). In total, 61% of providers reported telemedicine improves physician-patient interaction. Parents of newborns agreed that they were well informed about telemedicine use for their child's care (88%), were able to communicate routinely with neonatologists (85%), and were comfortable with their child's physical examinations (93%). Provider's versus family's (SQ) score was not significantly different. All survey participants, including neonatologists, NNPs, nurses, and patient families, reported high levels of satisfaction with the hybrid telemedicine model developed and implemented at this institution which may be comparable to in-person direct patient care. · Implementation of a hybrid telemedicine system provides an alternative to the transfer of newborns needing advanced care to tertiary care facilities.. · In this study, both health care providers and patient family members were satisfied with the quality of care using hybrid telemedicine.. · In this study, families of newborns could fully participate in their child's care using the hybrid telemedicine system..

Acceptability of pre-referral rectal artesunate for severe malaria in children under 5 years by health workers and caregivers in the Democratic Republic of the Congo, Nigeria and Uganda

BackgroundFor children below 6 years with suspected severe malaria attending a health care provider unable to provide parenteral malaria treatment, pre-referral rectal artesunate (RAS) is recommended by the World Health Organization to prevent death and disability. A number of African countries are in the process of rolling out quality-assured RAS for pre-referral treatment of severe malaria at community-level. The success of RAS depends, among other factors, on the acceptability of RAS in the communities where it is being rolled-out. Yet to date, there is limited literature on RAS acceptability. This study aimed to determine the acceptability of RAS by health care providers and child caregivers in communities where quality assured RAS was rolled out. This study was nested within the comprehensive multi-country observational research project Community Access to Rectal Artesunate for Malaria (CARAMAL), implemented in the Democratic Republic of the Congo (DRC), Nigeria, and Uganda between 2018 and 2020. Data from three different sources were analysed to understand RAS acceptability: interviews with health workers during three health care provider surveys (N = 341 community health workers and 467 primary health facility workers), with caregivers of children < 5 years of age during three household surveys (N = 9332 caregivers), and with caregivers of children < 5 years of age who were treated with RAS and enrolled in the CARAMAL Patient Surveillance System (N = 3645 caregivers).ResultsRAS acceptability was high among all interviewed stakeholders in the three countries. After the roll-out of RAS, 97–100% heath care providers in DRC, 98–100% in Nigeria and 93–100% in Uganda considered RAS as very good or good. Majority of caregivers whose children had received RAS for pre-referral management of severe malaria indicated that they would want to get the medication again, if their child had the same illness (99.8% of caregivers in DRC, 100% in Nigeria and 99.9% in Uganda). In three household surveys, 67–80% of caregivers whose children had not previously received RAS considered the medication as useful.ConclusionRAS was well accepted by health workers and child caregivers in DRC, Nigeria and Uganda. Acceptability is unlikely to be an obstacle to the large-scale roll-out of RAS in the studied settings.

8532 Patient Satisfaction with Postoperative Follow up after Benign Minimally Invasive Hysterectomy: A Randomized, Controlled Trial

<h3>Study Objective</h3> To assess whether patient satisfaction varies with a single six week versus a two- and six-week postoperative visit after minimally invasive hysterectomy (MIH). Secondary aim was to determine the rate of postoperative complications between randomized groups. <h3>Design</h3> Prospective, randomized controlled trial of English-speaking women aged 18 to 70 undergoing MIH at an academic institution from August 2018 to December 2019. Patient satisfaction was determined by The Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) global satisfaction response and compared between groups using a non-inferiority test with 12% non-inferiority limit. Comparison of postoperative outcomes were performed utilizing the Clavien-Dindo Classification System. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> 174 patients were randomized for postoperative follow up; 140 included in overall analysis. <h3>Interventions</h3> Randomization to either a two and six week or a single six-week postoperative appointment. <h3>Measurements and Main Results</h3> For the primary outcome of an S-CAHPS satisfaction score of 8 or higher, the six weeks only group was non-inferior to the two- and six-week group (93% satisfaction in both groups; non-inferiority p=0.003). There was no difference in satisfaction with number of postoperative appointments between groups: 94% for two and six week and 90% for six weeks only (p=0.694). When asked if more or fewer appointments were desired, there was no difference between groups (p=0.465). Patients with abnormal uterine bleeding were more likely to be satisfied (p=0.030). Between the two and six weeks versus six weeks only groups, there was no significant increase in emergency room visits (18% versus 20%, respectively, p=0.863) or hospital readmissions (3% versus 6%, respectively, p=0.682). <h3>Conclusion</h3> Patient satisfaction with postoperative visits are similar among women randomized to a two and six week and a single six week visit. Postoperative complications were rare and comparable between groups. A single six-week appointment showed non-inferior patient satisfaction relative to a two- and six-week schedule.

Patient Experience for Hispanic Older Adults Varies by Language Preference.

Hispanic people with Medicare report worse patient experiences than non-Hispanic White counterparts. However, little research examines how these disparities may vary by language preference (English/Spanish). Using Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data, assess whether 2014-2018 disparities in patient experiences for Hispanic people with Medicare vary by language preference. We fit a series of linear, case-mix adjusted models predicting Medicare CAHPS measures by race/ethnicity/language preference (Hispanic Spanish-respondents; Hispanic Spanish-preferring English-respondents; Hispanic English-preferring respondents; and non-Hispanic White English-respondents). A total of 1,006,543 Hispanic and non-Hispanic White respondents to the Medicare 2014-2018 CAHPS surveys. There were disparities for all Hispanic groups relative to non-Hispanic White English-respondents. Hispanic Spanish-preferring English-respondents reported worse experience than Hispanic Spanish-respondents for getting care quickly (-8 points), getting needed care (-5 points), doctor communication (-2 points), and customer service (-1 point), but better experiences for flu immunization (+2 points). Similarly, Hispanic Spanish-preferring English-respondents reported worse experience than Hispanic English-preferring respondents for getting care quickly (-4 points) and getting needed care (-2 points). Hispanic English-preferring respondents reported worse experience than Hispanic Spanish-respondents for getting care quickly (-4 points), getting needed care (-3 points), doctor communication and customer service (-2 points each), but better experience for flu immunization (+2 points). Regardless of language preference, Hispanic people with Medicare experience disparities in patient care relative to non-Hispanic White English-preferring counterparts. Hispanic Spanish-preferring English-respondents report the worse experiences, followed by Hispanic English-preferring respondents. Hispanic Spanish-respondents experienced the least disparities of the three Hispanic language subgroups.

Patient Satisfaction with Women vs Men Surgical Interns and Senior Residents

INTRODUCTION: Patient satisfaction with surgical resident care is not well characterized. This study aimed to understand whether patient evaluation of surgical trainees varies by gender. METHODS: General surgery inpatients were invited to evaluate surgical resident care using a modified Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS) after positively identifying photos of surgical trainees. S-CAHPS items were scored by the “top-box” method. Patient evaluations of women vs men were stratified by training level and compared. RESULTS: Ninety-one percent of approached patients participated (n = 324/357, mean age = 62.2 years, 50.3% male). Patient demographics, pain level, and attitudes towards resident care were similar between those evaluating women vs men trainees. Women surgical interns were recognized by patients at a lower rate than men (75% vs 87.2%, p=.01). S-CAHPS scores for women vs men interns were equivalent except for spending sufficient time with the patient (75.6% vs 88.0%, p = 0.02). For senior residents (PGY3-PGY5), there was no difference in patient recognition of women vs men (83.9% vs 85.2%, p = 0.91) or in any S-CAHPS domain (all p > 0.05). CONCLUSION: Gender differences in patient evaluation of surgical trainees are resolved by the senior years, with patients reporting the quality of care of women and men senior surgical residents to be equivalent across all S-CAHPS domains. Future work should aim to understand how to best incorporate patient evaluation into trainee assessment to support development, including a focus on ensuring patients recognize and understand the role of resident care providers regardless of gender. Table 1. - Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey Scores of Women vs Men Surgical Trainees S-CAHPS item Patient evaluations indicating top-box score, women vs men interns (%) p Value, Fisher’s exact test Patient evaluations indicating top-box score, women vs men senior residents (%) p Value, Fisher’s exact test Using any number from 0 to 10, where 0 is the worst intern doctor/senior resident possible and 10 is the best intern doctor/senior resident possible, what number would you use to rate all your care from this trainee? 51.2 vs 56.8 .42 60.3 vs 54.1 .32 Would you recommend this intern doctor/senior resident to your friends and family? 78.5 vs 84.7 .28 86.3 vs 87.8 .85 During your stay in the hospital, did this intern doctor/senior resident listen carefully to you? 90.5 vs 94.6 .29 95.8 vs 96 1.0 During your stay in the hospital, did this intern doctor/senior resident spend enough time with you? 75.6 vs 88.0 .02 88.1 vs 89.2 .85 During your stay in the hospital, did this intern doctor/senior resident encourage you to ask questions? 78.1 vs 81.4 .61 92.4 vs 84.9 .08 During your stay in the hospital, did this intern doctor/senior resident show respect for what you had to say? 95.2 vs 97.0 .48 99.2 vs 96.0 .14 During your stay in the hospital, did this intern doctor/senior resident discuss the outcome of your surgery with you? 60.0 vs 70.6 .13 85.6 vs 89.0 .45 During your stay in the hospital, did this intern doctor/senior resident make sure you were physically comfortable or had enough pain relief? 77.8 vs 81.2 .61 93.3 vs 85.6 .05 Evaluations that received top-box scores across all 8 S-CAHPS items, % 32.1 vs 38.0 .41 48.3 vs 38.0 .11

Reasons Primary Care Practices Chose Patient Experience Surveys During Patient-Centered Medical Home Transformation.

Patient-centered medical home takes years to attain. Fifteen-to-eighteen percent of US primary care practices in 2008-2017 sought or maintained patient-centered medical home recognition. We conducted interviews with a stratified-random sample of 105 of these practices to determine why patient experience surveys were chosen. Fifty-one were using a Consumer Assessment of Healthcare Providers and Systems survey and 53 administering another patient survey. The 3 most common reasons were (1) to compare performance against other practices, which requires systematically collected data across large numbers of practices (ie, the Consumer Assessment of Healthcare Providers and Systems survey), (2) participation in an external patient-centered medical home program, and (3) survey administration cost. Leaders invested in a second patient survey for quality improvement needs.

Needs assessment survey of healthcare providers' perceptions and practices regarding delirium prevention at a university medical center.

Background: Despite the high prevalence and serious implications of delirium, identification, tracking, and documentation of the condition remain a challenge for the health care team, impeding management of patients. This survey is the first phase of a qualitative study to build a conversational agent-based tool for screening and managing delirium-prone patients. Objectives: To assess healthcare providers’ perceptions of delirium management, focusing on patient assessment, therapeutic interventions, and subsequent communication and documentation. Design: An electronic web-based survey was distributed to healthcare providers identified as caring for inpatient acutely ill older adults admitted for medical and orthopedic surgery needs. Respondent contact information was removed to preserve anonymity. Setting: A 1,000 bed university-affiliated teaching hospital in an urban setting. Participants: 23 residents in family practice, 36 residents in internal medicine, and a total of 492 advanced care nurses, nurses, and clinical staff. Approach: The analysis of survey responses provided insight into providers’ current experiences with delirium assessment tools including computerized documentation, as well as their perceptions and attitudes toward delirium prevention. Key results: Most respondents (89%) thought delirium could be prevented, and 85% thought targeting delirium risk factors was helpful. Fifty one percent reported patients’ loneliness and need for companionship, and 65% believed delirium was linked to higher mortality. Only 14% of respondents thought existing Electronic Health Record (EHR) alerts to identify high-risk delirium patients were useful, and 38% thought current delirium assessment protocols were helpful. In addition, 33% of nurses never received formal delirium prevention training, and 48% indicated that they needed improved systems to assess and manage patients at risk for delirium. Conclusion: A majority of providers affirmed that current delirium protocols are helpful; however, existing screening instruments and methods for documentation are cumbersome, resulting in incomplete or limited documentation of episodes. These barriers lead to an understatement of evidence available for continuous improvement of the patient management process.

Outcomes at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults in the USA: a follow-up surveillance study

BackgroundData on medium-term outcomes in indivduals with myocarditis after mRNA COVID-19 vaccination are scarce. We aimed to assess clinical outcomes and quality of life at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination in adolescents and young adults.MethodsIn this follow-up surveillance study, we conducted surveys in US individuals aged 12–29 years with myocarditis after mRNA COVID-19 vaccination, for whom a report had been filed to the Vaccine Adverse Event Reporting System between Jan 12 and Nov 5, 2021. A two-component survey was administered, one component to patients (or parents or guardians) and one component to health-care providers, to assess patient outcomes at least 90 days since myocarditis onset. Data collected were recovery status, cardiac testing, and functional status, and EuroQol health-related quality-of-life measures (dichotomised as no problems or any problems), and a weighted quality-of-life measure, ranging from 0 to 1 (full health). The EuroQol results were compared with published results in US populations (aged 18–24 years) from before and early on in the COVID-19 pandemic.FindingsBetween Aug 24, 2021, and Jan 12, 2022, we collected data for 519 (62%) of 836 eligible patients who were at least 90 days post-myocarditis onset: 126 patients via patient survey only, 162 patients via health-care provider survey only, and 231 patients via both surveys. Median patient age was 17 years (IQR 15–22); 457 (88%) patients were male and 61 (12%) were female. 320 (81%) of 393 patients with a health-care provider assessment were considered recovered from myocarditis by their health-care provider, although at the last health-care provider follow-up, 104 (26%) of 393 patients were prescribed daily medication related to myocarditis. Of 249 individuals who completed the quality-of-life portion of the patient survey, four (2%) reported problems with self-care, 13 (5%) with mobility, 49 (20%) with performing usual activities, 74 (30%) with pain, and 114 (46%) with depression. Mean weighted quality-of-life measure (0·91 [SD 0·13]) was similar to a pre-pandemic US population value (0·92 [0·13]) and significantly higher than an early pandemic US population value (0·75 [0·28]; p<0·0001). Most patients had improvements in cardiac diagnostic marker and testing data at follow-up, including normal or back-to-baseline troponin concentrations (181 [91%] of 200 patients with available data), echocardiograms (262 [94%] of 279 patients), electrocardiograms (240 [77%] of 311 patients), exercise stress testing (94 [90%] of 104 patients), and ambulatory rhythm monitoring (86 [90%] of 96 patients). An abnormality was noted among 81 (54%) of 151 patients with follow-up cardiac MRI; however, evidence of myocarditis suggested by the presence of both late gadolinium enhancement and oedema on cardiac MRI was uncommon (20 [13%] of 151 patients). At follow-up, most patients were cleared for all physical activity (268 [68%] of 393 patients).InterpretationAfter at least 90 days since onset of myocarditis after mRNA COVID-19 vaccination, most individuals in our cohort were considered recovered by health-care providers, and quality of life measures were comparable to those in pre-pandemic and early pandemic populations of a similar age. These findings might not be generalisable given the small sample size and further follow-up is needed for the subset of patients with atypical test results or not considered recovered.FundingUS Centers for Disease Control and Prevention.

Telemedicine and Multiple Sclerosis: A Survey of Health Care Providers Before and During the COVID-19 Pandemic.

Telemedicine provides a gateway to specialty care that, otherwise, patients with multiple sclerosis (MS) could have difficulty accessing. Studies have shown that telemedicine provides a valid alternative to in-person visits. There are limited data on the strengths and limitations of telemedicine from the perspective of MS providers. After reviewing the literature and pilot testing questions about telemedicine in provider focus groups, a 34-question survey was created on the Qualtrics web platform. A stratified sample of MS providers throughout the United States was recruited to participate. The survey initiated in November 2019 and closed in November 2020. Survey participants (N = 94) included neurologists (43.0%), advanced practice providers (28.0%), nurses (14.0%), mental health providers (7.0%), social workers (3.0%), rehabilitation providers (4.0%), and pharmacists (1.0%). Clinical video telemedicine (CVT) was the most commonly used platform, and 76.6% of respondents indicated that they used telemedicine to care for patients with MS. As a result of the COVID-19 pandemic, the rate of telemedicine use increased from 44.4% to 84.2%. Most health care providers (93.0%) were "very satisfied" or "somewhat satisfied" with their most recent telemedicine visit, and 94.4% of providers reported a desire to continue using telemedicine, although 84.6% found it difficult to perform a full examination. There was a large uptick in the use of telemedicine when the COVID-19 pandemic forced clinics to cease in-person visits. Providers predominantly used CVT; store-and-forward telemedicine and remote patient monitoring have fewer technical issues than CVT and seem to be underused.