Top-box Scores Research Articles

The development of a positive deviancy strategy to identify excellence in patient experience

Rationale, aims and objectives: Patient experience is recognized as a key target of quality improvement to foster patient-centered care. Identification of excellence in patient experience could highlight behaviors that may be shared to improve quality. The objective of this study was to develop a strategy to identify positive practice deviants in patient experience at the surgeon level.Methods: Patient experience surveys were analyzed from 1707 discharged surgical patients. Multilevel hierarchical regression models were developed to predict topbox scores of global rating and physician communication. The influence of the surgeon outlier from the larger group was determined by identifying the random effect of the cluster and measuring the intra-class correlation (ICC).Results: In 2 services with greater than 20 surgeons, positive deviants were identified in the physician composite score (random surgeon effect <0.05). Removal of the surgeons from the analysis of the composite measure resulted in a 69% decrease in the ICC (7.54% to 2.3%) in the first service and a 32% decrease in the ICC (6.83% to 4.59%) in the second service and the random surgeon effect was no longer significant in either service (p>0.05).Conclusion: This study has illustrated the application of a process which can identify positive deviants at the provider level for the delivery of excellence in patient experience.

The impact of spine disease, relative to cranial disease, on perception of health and care experience: an analysis of 1484 patients in a tertiary center.

OBJECTIVEPatient-reported outcomes have been increasingly mandated by regulators and payers to evaluate hospital and physician performance. The purpose of this study is to delineate the differences in patient-reported experience of hospital care for cranial and spinal operations.METHODSThe authors selected all patients who underwent inpatient, elective cranial or spinal procedures and completed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey at a single, high-volume, tertiary care institution between October 2012 and September 2015. The association of the surgical procedure and diagnosis with various HCAHPS composite measures, calculated across 9 domains using standard top-box methodology, was investigated. Multivariable logistic regression models were fitted for outcomes that were significant with procedure type and diagnosis group on univariate analysis, adjusting for age, sex, case complexity, overall health rating, and education level.RESULTSA total of 1484 patients met criteria and returned an HCAHPS survey. Overall, patients undergoing a cranial procedure gave top-box (most favorable) scores more often in pain management measure (66.3% vs 59.6%, p = 0.01) compared with those undergoing spine surgery. Furthermore, despite better discharge scores (93.1% vs 87.1%, p < 0.001), spinal patients were less likely to report excellent health (7.4% vs 12.7%). Lastly, patients with a primary diagnosis of brain or spinal tumor compared with those with degenerative spinal disease and those with other neurosurgical diagnoses provided top-box scores more often regarding communication with doctors (82.7% vs 76.4% vs 75.2%, p = 0.04), pain management (71.8% vs 60.9% vs 59.1%, p = 0.002), and global rating (90.4% vs 84.0% vs 87.3%, p = 0.02). On multivariable analysis, spinal patients had significantly lower odds of reporting top-box scores in pain management (OR 0.67, 95% CI 0.52-0.85; p = 0.001), staff responsiveness (OR 0.68, 95% CI 0.53-0.87; p = 0.002), and global rating (OR 0.59, 95% CI 0.42-0.82; p = 0.002), and significantly higher odds of top-box scoring in discharge information (OR 2.15, 95% CI 1.45-3.18; p < 0.001) than cranial patients. Similarly, brain tumor cases were associated with significantly higher odds of top-box scoring in communication with doctors (OR 1.46, 95% CI 1.01-2.12; p = 0.04), pain management (OR 1.81, 95% CI 1.29-2.55; p < 0.001), staff responsiveness (OR 1.88, 95% CI 1.33-2.66; p < 0.001), and global rating (OR 2.00, 95% CI 1.26-3.17; p = 0.003) compared with degenerative spine cases.CONCLUSIONSSignificant differences in patient-reported experience with hospital care exist across different cranial and spine surgery patient populations. Overall, spinal patients, particularly those with degenerative spine disease, rated their health and their hospital experience lower relative to cranial patients. Identifying weaker areas of hospital performance in target populations can stimulate quality initiatives that aim to increase the overall hospital score.

Are HCAHPS Scores Higher for Private vs Double-Occupancy Inpatient Rooms in Total Joint Arthroplasty Patients?

BackgroundPrivate hospital rooms have a number of potential advantages compared to shared rooms, including reduced noise and increased control over the hospital environment. However, the association of room type with patient experience metrics in total joint arthroplasty (TJA) patients is currently unclear. MethodsFor private versus shared rooms, we compared our institutional Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores in patients who underwent primary TJA over a 2-year period. Regression model odds ratios (ORs) were adjusted for surgeon, date of surgery, and length of stay. ResultsPatients in private rooms were more likely to report a top-box score for overall hospital rating (85.6% vs 79.4%, OR = 1.53, P = .011), hospital recommendation (89.3% vs 83.0%, OR = 1.78, P = .002), call button help (76.0% vs 68.7%, OR = 1.40, P = .028), and quietness (70.4% vs 59.0%, OR = 1.78, P < .001). There were no significant differences on surgeon metrics including listening (P = .225), explanations (P = .066), or treatment with courtesy and respect (P = .396). ConclusionFor patients undergoing TJA, private hospital rooms were associated with superior performance on patient experience metrics. This association appears specific for global and hospital-related metrics, with little impact on surgeon evaluations. With the utilization of HCAHPS data in value-based initiatives, placement of TJA patients in private rooms may lead to increased reimbursement and higher hospital rankings. Level of EvidenceLevel III, retrospective cohort.

Novel Multidisciplinary Comprehensive Clinic Program Improves Patient Compliance, Patient Satisfaction and Health Maintainance Outcomes in the Outpatient Setting for Patients with Severe Sickle Cell Disease

IntroductionSickle Cell Disease (SCD) is the most common genetic disease identified in newborns in the United States. It results from a single amino acid substitution in the beta globin protein. This results in severe chronic complications, long-term end-organ damage and reduced life expectancy.Evidence Based Health Maintenance (HM) recommendations (HMR) provide the best framework for reducing chronic complications of SCD. Many barriers to healthcare utilization exists for patients with SCD and patients are often unable to access HMR. The decrease in comprehensive care often leads to poor compliance and outcomes. To address this we established a novel patient centered comprehensive SCD clinic (CSCDC).MethodsCSCDC occurs the third Wednesday of every month. Sub-specialists commit to CSCDC and subspecialty clinic slots are reserved. Available services: Cardiology, Radiology, Ophthalmology, Pulmonology, Nephrology, Social Work, Immunizations. Other services are available as needed. Lunch and group patient education are provided.There are 188 SCD patients in our program (the cohort). This includes HbSS, HbSC and HbSB thalassemia only. Patients electronic charts are reviewed to determine HM needs. Families are contacted by phone 4-6 weeks prior to the scheduled CSCDC. The HM needs are reviewed with families. The family has an opportunity to adjust work, school and other personal commitments in advance of the clinic date. Family and SCD clinic commits to the CSCDC date. Clinic flexibility is allowed.Electronic medical records and Qlik Sense Software (Qlik ,Randor PA) were used to determine visit numbers and clinic no show rates (NSR). Patient initiated same day cancellations are included in the NSR. NSR date range was January 2016-July 2018. First we determined NSR for all SCD related clinic visits for the cohort (NSR-SCD). Then we determined NSR for the cohort on CSCDC dates only (NSR-CSCDC). We then divided the cohort into three groups based on NSR-SCD. Low, middle and high NSR. We then compared NSR-SCD and NSR-CSCDC for each group. The two proportion Z test was used to calculate p valuesVolunteers unrelated to CSCDC contacted patients by telephone. Prior IRB approval was obtained. Family participation was voluntary and limited to families with CSCDC attendance. Parents or patients (18 years and older) were asked to answer questions. The questions evaluated 1.Patient overall satisfaction with CSCDC, 2.Likely to return to CSCDC, 3.Likely to recommend CSCDC and 4.Did CSCDC improve the patients individual SCD management.CSCDC dates Aug 2015-July 2018 were used to select the sub-cohort of patients that attended two or more CSCDC clinics. We determined if the HM evaluations occurred according to published guidelines.ResultsThere was a statistically significant decrease in NSR for patients attending CSCDC vs the general SCD clinic. The cohort consisted of 188 patients, 1243 clinic visits and 322 no shows(NS). In CSCDC there were 134 patients, 182 clinic visits and 18 NS. NSR-SCD vs NSR-CSCDC was 25.9% vs 9.9% (p 0.000002).(Table 1)When the cohort was divided into NSR subgroups. NSR decrease was most significant for the high NSR sub group.For high and middle NSR, NSR-SCD vs NSR-CSCDC were 50.8% vs 28.8% (p 0.002759) and 19.8% vs 4.2% (p 0.001187) respectively.(Table 2)The low subgroup had 0% NSR. Patients with the historically highest NSR had significant decrease in their NSR during CSCDC.There were 170 phone contacts and 122 responses for a 72% response rate. Families were asked to grade their answers in a range of 1-5 with 5 being the highest (top box). Results: 86%, 91% and 92% top box scores for CSCDC patient reporting “extremely satisfied” with CSCDC, “extremely likely” to recommend CSCDC and “extremely likely” to return to CSCDC respectively. 97% responded “yes” that CSCDC improved their individual family SCD care.CSCDC increased adherence to standard HMR. Total patient visits for the time range was 236. There were 56 patients (24%) who attended at least 2 CSCDC. 62% of these repeat attendees received health maintenance evaluations within 4-8 weeks of the recommended time.ConclusionOur CSCDC demonstrates increase in SCD patient compliance with clinic visits, high patient satisfaction and high level of HM adherence to standard. We believe this is an effective model for SCD comprehensive care and this data may be useful to initiate evaluation of a larger patient cohort. DisclosuresNo relevant conflicts of interest to declare.

Physician impact on the patient and family experience in a pediatric otolaryngology practice.

On the Press Ganey (PG) survey, the item "likelihood of recommending practice" is a proxy for patient satisfaction because only the most satisfied patients will recommend a practice to friends and family. The objective of this study is to determine which other items on the PG survey best correlate with "likelihood of recommending practice" as a measure of patient satisfaction in pediatric otolaryngology. Retrospective analysis of a survey database. The PG survey, consisting of 24 questions scaled from 1 to 5 representing (1) very poor, (2) poor, (3) fair, (4) good, and (5) very good, was sent to 28 different pediatric otolaryngology practices. Using the Pearson correlation coefficient, the statistical relationship of each PG survey question was analyzed in its association to the PG question "likelihood of recommending practice." Factors with a correlation coefficient greater than 0.65 were considered significant. Ten of 24 questions on the PG survey correlated with a top "likelihood of recommending practice" score. Eight of these 10 items were from the Care Provider category and were related to the physician-patient/family interaction. Patient satisfaction surveys are utilized as a quality metric of the patient and family experience. These scores serve as one of several measures that affect reimbursement. The results demonstrate that most of the factors correlated with "likelihood of recommending practice" are provider-based. In conclusion, the physician-patient interaction strongly influences the potential for a practice to earn top box scores on the PG item "likelihood of recommending practice" and thereby achieve the highest patient satisfaction. NA. Laryngoscope, 129:2610-2613, 2019.

"Please Help Me See the Dragon I Am Slaying": Implementation of a Novel Patient-Pathologist Consultation Program and Survey of Patient Experience.

Pathologists evaluate human disease and teach medical students, residents, and clinicians. Historically recognized as the "doctor's doctor," pathologists are well suited to be a direct patient resource of individualized, accurate information. To develop and implement a pathology consultation service whereby patients review their tissue slides directly with pathologists. A pathologist conducted patient consultations, reviewing biopsy or surgery findings on a multiheaded microscope or computer screen. The pathologist evaluated patients' understanding of their disease and invited patients to ask specific questions. We recorded patient demographic data and assessed utilization with a short patient satisfaction survey using 6 questions with a 5-point Likert scale and 2 questions for open response. A total of 31 patients came for consultation; 39% (12 of 31) were accompanied by a friend or family member. Patients' median age was 59 years, with a strong female predominance (90%; 28 of 31). The majority of patients had breast cancer (58%; 18 of 31) or hematologic malignancy (19%; 6 of 31). Of the 31 patients, the survey response rate was 58% (18 of 31). Top-box scoring demonstrated program support, with 89% (16 of 18) of respondents strongly recommending the experience to another patient. Additionally, 78% (14 of 18) strongly agreed that they felt more empowered after seeing their disease. Mean scores for Likert-based questions all were higher than 4.0. To our knowledge, this study is the first report of direct patient-pathologist consultation. Early data suggest that the program may provide effective patient-specific education. The high response rate and favorable assessment of the program suggest that it may be a valuable resource for some patients.

Creative strategies to address challenges in access.

215 Background: The Cancer Center is structured across multiple campuses with clinics at three different locations. Patients, providers and referring offices encountered difficulty accessing services and encountered a fragmented structure and a non-standardized process. Patient and provider calls often resulted in multiple transfers. Referring providers and patients frequently left a voicemail for new patient appointments. There was no standardized process for addressing urgent clinical calls from patients. This led to delays in access for new patient appointments, delays in patient care and poor patient experience scores. Overall telephone statistics went untracked. Methods: A multidisciplinary team was organized and tasked with the creation of a centralized Cancer Contact Center (CCC). In August 2015 the CCC became a reality with the vision of “One Call Resolution” for anybody needing access to the services of the Cancer Center. Single telephone and fax numbers were created and all staff were placed together in one location. Three distinct job roles made up the CCC: Telephone Operators, as the main point of initial contact; New Patient Coordinators, to facilitate new patient referrals, record collection and scheduling; and Lead Nurses to provide clinical oversight and guidance. Processes were put in place to ensure standardization and consistent outcomes. Operator guidelines were conceived and an articulated approach to managing patient clinical concerns was planned. Clinical triage of these concerns initially involved the Telephone Operators, RN Case Managers and Lead Nurses. Later, clinical triage evolved into the creation of a specific triage line and Triage Nurses for clinical questions and to further ensure patient safety. Results: Patient experience scores relating to telephone accessibility for patients have increased from a 56.9 Top Box score to a 67.5 score. Telephone answer rates have been sustained above 95%. Conclusions: The creation of a centralized Cancer Contact Center has enabled all calls, referrals and clinical triage to be initially managed in one location under a standardized process with sustainable results.

90 Improvement of Emergency Department Workflow and Their Effects on Patient Satisfaction

Many efforts have been made to improve emergency department (ED) workflow and combat crowding, including implementations of physician-in-triage model and ED observation units. Recent findings have suggested that more severe ED crowding is associated with worsened patient experiences. We assessed patient experiences following their designated treatment areas: triage, an observation unit or ED. Additionally, we determined the effect of patients’ pain management on their overall satisfaction within all units of the ED. We conducted a prospective, cross-sectional study at a university-based ED from July 2017 to April 2018. We obtained ED patient experience scores using emergency department Patient Experience of Care survey. We used compared frequency analysis and Chi-square test to correlate top box scores between patient satisfaction scores and their specific location within the ED units. We obtained 371 responses; 61 (16.44%) and 53 (14.29%) of these patients were seen in the triage and observation units, respectively. We found that patients seen in triage gave significantly higher top box scores overall, as well when asked about their physician’s concern to keep them informed about their treatment, when compared to non-triage patients (p-value < 0.05). Patients in the observation unit reported that physicians took the time to listen significantly more than ED patients. (p-value < 0.05) Additionally, patients from all ED units who were satisfied with their pain management (score 8+) reported significantly higher top box scores for all physician-patient interaction questions (p-value < 0.0001). We found significant differences in ED patient experience scores between patients seen in triage, the observational unit, and the main ED unit. Better pain management was associated with higher patient satisfaction score.

185 Everyone Loves a Popsicle: A Simple and Affordable Intervention to Improve Patient Satisfaction

Value-based purchasing (VBP) is a quality incentive program under the Affordable Care Act that is funded by a 2% reduction from diagnosis-related group (DRG) payments for the 2018 fiscal year. One-quarter of this fund is determined by patient and caregiver-centered experience and care coordination. Therefore, patient satisfaction scores have become an increasingly important component of health care delivery. Few studies have sought to identify low-cost interventions that improve patient experience and subsequently patient satisfaction scores. Here, we aim to explore the impact of popsicle administration in pediatric emergency department (ED) patients on Press Ganey satisfaction scores. A prospective trial was conducted at a tertiary academic pediatric ED and one mid-sized community ED between January 2018 to March 2018. The intervention was to give a popsicle to all eligible patients 0-14 years of age on even-numbered days (popsicle days) versus conventional practice on odd-numbered days. Press Ganey top box scores (response to the question was a “5” or the highest value) between even- and odd-numbered days were then compared using 2-sample t and chi-square tests. Among the 152 pediatric patients included (0-14 years of age), 84 surveys were filled out on even days and 68 surveys were filled out on odd days. Baseline demographics were similar between the groups with an average age of 7.3 ± 6.0 years and no statistical difference between the number of male and female patients. Overall, there was a significant increase in patient satisfaction scores on popsicle administration days for questions that asked about physician’s concern for comfort 74% versus 58% (p < 0.05), physician’s courtesy 77% versus 62% (p < 0.04), and physician taking time to listen 74% versus 57% (p < 0.03). No statistical difference was observed for questions that asked about overall rating of care 64% versus 61% (p= 0.64), likelihood of recommending 66 versus 59% (p=0.37), or informed of treatment 74% versus 60% (p=0.07). Offering popsicles to all eligible pediatric emergency department patients resulted in an increase in Press Ganey patient satisfaction score regarding physician’s concern for comfort, courtesy, and listening. Further studies should increase sample size, assess subsets of age groups, and assess economic rate of return for this and other low-cost interventions that might significantly impact perceived health care quality.

Patient factors influencing outpatient satisfaction in patients presenting with shoulder pain

Patient-based evaluation of health care has been gaining attention in the past 2 decades. The purpose of this study was to evaluate patient satisfaction in a shoulder outpatient clinic and determine which factors impact satisfaction levels. Fifty-nine outpatients with shoulder complaints from December 2017 to January 2018 were included. Patient satisfaction was measured using the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey, and 2 methods of calculation were implemented: top-box and average scores. The impacts of age, gender, diagnosis, duration with the provider, Patient-Reported Outcomes Measurement Information System score, Pain Catastrophizing Scale score, pain visual analog scale (VAS) score, and function VAS score on patient satisfaction were analyzed. Patients were divided into more satisfied and less satisfied groups, and logistic regression analysis was performed to determine which factors affect patient satisfaction. The median total average and top-box scores were 95.2% and 90%, respectively. Similarly, in the analysis of all variables, average scores were always higher than top-box scores. The function VAS score and Patient-Reported Outcomes Measurement Information System score significantly influenced satisfaction. When patients were divided into more satisfied and less satisfied groups, the odds of having a less satisfied score among patients with a function VAS score of less than 5 was 5.5 times that of patients with a score of 5 or greater (odds ratio of 5.06 [95% confidence interval, 1.55-16.46] with P = .01 for univariate and adjusted odds ratio of 5.53 [95% confidence interval, 1.14-26.76] with P = .03 for multivariate). Despite being calculated from the same question set, using the average-score method for the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey generally yields higher scores than the top-box method. Among patients with shoulder pathology, function of the shoulder, as measured on a VAS, was the most significant factor influencing patient satisfaction in the outpatient setting.

A Pilot Study of Inpatient Satisfaction Rating of Surgical Resident Care

To describe inpatient satisfaction with surgical resident care given the increasing importance of patient satisfaction as a quality metric. Surgical inpatients were invited to complete a survey that addressed their satisfaction with and attitudes regarding surgical resident care. The survey was based on the Consumer Assessment of Healthcare Providers and Systems Surgical Care Survey (S-CAHPS). Patients were required to positively identify photos of resident physicians prior to providing ratings. Adapted S-CAHPS items were scored using the "top-box" method. Massachusetts General Hospital, a tertiary academic center. General surgery inpatients recovering from elective, major abdominal surgery were recruited on postoperative days 2 to 4. Ninety-one percent of approached patients participated (102/112, mean age = 62.9, 51.6% male). Patients positively identified both seniors and interns 88% of the time. Thirteen seniors and 19 interns were rated, with 1 to 14 evaluations per trainee. Overall quality of care ratings for seniors and interns were 9.35 and 9.09, respectively (0-10 scale, 10 = "best possible care"). Sixty-three percent of senior resident evaluations and 60% of intern evaluations received a score of 10. The proportion of residents receiving top-box scores ranged from 59.5% to 97.7% depending on the item. Forty percent of senior resident and 38% of intern evaluations received top-box scores for all 8 items. Over 96% of patients reported strong or moderate agreement with the statements "I feel it is important to help in the education of future surgeons." Surgical inpatients willingly completed ratings about their surgery residents, typically can recognize their resident physicians, and rate quality of care highly. Despite many high ratings, there is room for improvement in some S-CAHPS domains. These results indicate patients are a valuable source of feedback regarding a resident's progress in several core competencies such as interpersonal skills, communication, professionalism, and patient care.

Progression of Emergency Medicine Resident Patient Experience Scores by Level of Training.

Background:Patient satisfaction surveys are vital to measuring a patient’s experience of care. How scores of patients managed by emergency medicine (EM) residents change as residents progress through training is not known.Objectives:To evaluate whether EM residents’ patient satisfaction scores improve as residency training progresses, similar to clinical skill improvement.Methods:A retrospective cross-sectional study evaluated the correlation of patient satisfaction scores with EM resident year of training from 2015 through 2017. We evaluated for a change in score over time for the 4 “physician questions” and the “overall” score.Results:We evaluated 1684 Press Ganey surveys linked to 40 EM resident physicians during the study period. The mean top box scores for the 4 physician questions (concern for comfort [P = .72], courtesy [P = .55], informative about treatment [P = .46], and listening [P = .91]) and overall assessment of emergency department care (P = .51) were not significantly improved over the course of resident.Conclusion:We did not observe a difference in EM residents’ patient experience scores as their level of training progressed. Comprehensive patient experience training for residents might be needed.

Impact of patient characteristics on the Canadian Patient Experiences Survey–Inpatient Care: survey analysis from an academic tertiary care centre

ObjectiveTo determine the role of patient demographics, care domains and self-perceived health status in the analysis and interpretation of results from the Canadian Patient Experience Survey–Inpatient Care.DesignCross-sectional survey.SettingSingle large Canadian...

Improving Response Rates and Representation of Hard-to-Reach Groups in Family Experience Surveys

ObjectiveMost US hospitals conduct patient experience surveys by mail or telephone after discharge to assess patient/family centeredness of care. Pediatric response rates are usually very low, especially for black, Latino, and low-income respondents. We investigated whether day of discharge surveying using tablets improves response rates and respondent representativeness. MethodsThis was a quasi-experimental study of parents of patients discharged from 4 units of a children's hospital. Parents were assigned to receive the Child Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) via an audio-enabled tablet before discharge or via mail at approximately 1 week postdischarge. Intervention and control conditions alternated by week. We compared response rates, child/respondent characteristics, and mean top-box scores between tablet and mail only arms. ResultsAdministering Child HCAHPS on a tablet was administratively feasible and did not interfere with the discharge process (median completion time, 12.4 minutes). The response rate was 71.1% (424 of 596) for tablet versus 16.3% (96 of 588) for mail only. Although the tablet response rate was higher in every subgroup, tablet respondents were more likely to be fathers (20.4% vs 6.4%; P = .006), more likely to have a high school education or less (17.5% vs 8.4%; P = .002), less likely to be white (56.8% vs 71.9%; P = .006), and more likely to be publicly insured (31.4% vs 19.8%; P = .02). Tablet scores were significantly higher than mail only scores for 3 of 17 measures. ConclusionsThe response rate for day of discharge tablet survey administration was >4-fold higher than with single-wave mail-only administration, with greater participation of hard-to-reach groups. These findings suggest tablet administration before discharge shows great promise for real-time feedback and QI and may transform the field of inpatient survey administration.

Health literacy and quality of physician-trauma patient communication: Opportunity for improvement.

Although physician-patient communication and health literacy (HL) have been studied in diverse patient groups, there has been little focus on trauma patients. A quality improvement project was undertaken at our Level I trauma center to improve patient perception of physician-patient communication, with consideration of the effect of HL. We report the first phase of this project, namely the reference level of satisfaction with physician-patient communication as measured by levels of interpersonal care among patients at an urban Level I trauma center. Level I trauma center patients were interviewed during hospitalization (August 2016 to January 2017). Short Assessment of Health Literacy tool was used to stratify subjects by deficient versus adequate HL. Interpersonal Processes of Care survey was administered to assess perception of physician-patient communication. This survey allowed patients to rate physician-patient interaction across six domains: "clarity," "elicited concerns," "explained results," "worked together (on decision making)," "compassion and respect," and "lack of discrimination by race/ethnicity." Each is scored on a five-point scale. Frequencies of "top-box" (5/5) scores were compared for significance (p < 0.05) between HL-deficient and HL-adequate patients. One hundred ninety-nine patients participated. Average age was 42 years, 33% female. Forty-nine (25%) patients had deficient HL. The majority of patients in both groups rated communication below 5/5 across all domains except "compassion and respect" and "lack of discrimination by race/ethnicity." Health literacy-deficient patients were consistently less likely to give physicians top-box scores, most notably in the "elicited concerns" domain (35% vs. 54%, p = 0.012). Health literacy-deficient patients appear relatively less satisfied with physician communication, particularly with respect to perceiving that their concerns are being heard. Overall, however, the majority of patients in both groups were unlikely to score physician communication in the "top box." Efforts to improve physician-trauma patient communication are warranted, with attention directed toward meeting the needs of HL-deficient patients. Prognostic/Epidemiologic, level I.

Family Experiences of Pediatric Inpatient Care in Alberta, Canada: Results From the Child HCAHPS Survey.

Patient experience surveys provide feedback regarding the perceived quality of health care services. Unfortunately, many surveys have tended to be focused on an adult population, resulting in a lack of validated instruments for pediatric populations. In 2015, Alberta Health Services implemented the Child Hospital Consumer Assessment of Healthcare Providers and Systems (Child HCAHPS) survey. Our objectives in the current study were to describe the use of the Child HCAHPS survey in Alberta, Canada, and to present preliminary results. Parents and/or guardians completed a modified version of the Child HCAHPS survey via telephone within 6 weeks of their child's discharge from 1 of 14 hospitals (2 stand-alone pediatric and 12 adult). For each of the survey composites and stand-alone items, the mean "top box" score is reported, reflecting the most positive response option. Overall results were reported, as were comparisons in top box scores between stand-alone pediatric and adult facilities. From October 2015 to March 2017, 3389 surveys were completed. Overall, mean top box scores ranged from 41.5% ("preventing mistakes and helping you report concerns") to 95.8% ("keeping you informed about your child's care in the emergency department"). Stand-alone pediatric hospitals tended to outperform the adult ones, particularly in global ratings of care, parental involvement in decision-making, and communication between parents and providers. With our findings, we indicate areas in which pediatric inpatient care is being delivered well, as well as targeted areas for quality improvement. Our results may be highlighted in future comparisons among others who have adopted the Child HCAHPS.

Key drivers of patient satisfaction in lumbar spine surgery.

OBJECTIVE The Patient Experience of Care, composed of 9 dimensions derived from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, is being used by the Centers for Medicare & Medicaid Services to adjust hospital reimbursement. Currently, there are minimal data on how scores on the constituent HCAHPS items impact the global dimension of satisfaction, the Overall Hospital Rating (OHR). The purpose of this study was to determine the key drivers of overall patient satisfaction in the setting of inpatient lumbar spine surgery. METHODS Demographic and preoperative patient characteristics were obtained. Patients selecting a top-box score for OHR (a 9 or 10 of 10) were considered to be satisfied with their hospital experience. A baseline multivariable logistic regression model was then developed to analyze the association between patient characteristics and top-box OHR. Then, multivariable logistic regression models adjusting for patient-level covariates were used to determine the association between individual components of the HCAHPS survey and a top-box OHR. RESULTS A total of 453 patients undergoing lumbar spine surgery were included, 80.1% of whom selected a top-box OHR. Diminishing overall health status (OR 0.63, 95% CI 0.43-0.91) was negatively associated with top-box OHR. After adjusting for potential confounders, the survey items that were associated with the greatest increased odds of selecting a top-box OHR were: staff always did everything they could to help with pain (OR 12.5, 95% CI 6.6-23.7), and nurses were always respectful (OR 11.0, 95% CI 5.3-22.6). CONCLUSIONS Patient experience of care is increasingly being used to determine hospital and physician reimbursement. The present study analyzed the key drivers of patient experience among patients undergoing lumbar spine surgery and found several important associations. Patient overall health status was associated with top-box OHR. After adjusting for potential confounders, staff always doing everything they could to help with pain and nurses always being respectful were the strongest predictors of overall satisfaction in this population. These findings highlight opportunities for quality improvement efforts in the spine care setting.

3:00 PM Abstract No. 141 Interventional radiology patient throughput: application of lean sigma methodology and real-time delay dashboard to improve operations and patient experience

Implementation of large scale EMRs are problematic for optimization of patient experience. A large interventional radiology center performing up to 1000 procedures every month developed a customized, unique, unit-specific patient delay dashboard with real-time feedback to mitigate patient delays. Due to various inefficiencies and limitations, 28% of outpatients are delayed more than 60 minutes past their scheduled procedure start time. The purpose of this project is to achieve a 50% short-term reduction in patient delays greater than 60 minutes and a long-term 50% decrease in delays overall. Additional areas of focus include patient experience e-survey scores, procedure room downtime, reduced PACU capacity, denied insurance days, and financial cost. A multidisciplinary team utilized Lean Sigma methodology for this quality improvement project. A computer application was developed to calculate delays using daily EMR data extracts sent via sftp to our data base. The app supplies a real-time color-coded patient delay dashboard which is prominently displayed on flat screens throughout the department, and alerts staff to individual patient delays in real time with green, yellow, orange, and red lights. A bundled set of interventions targeted preprocedure care coordination and scheduling, outpatient prerounding, reduction of the PT/INR requirement, and the development of an IR bedside service. Patient delays were reduced by 27% in the > 60 minute category (p>0.05) from a baseline 5-month period in January 2016 to a corresponding period in May 2017. Top box scores for timeliness improved 21% on patient e-surveys (n = 802). An anticipated reduction in hospital insurance denied days, due to improved throughput, facilitated funding to open an additional procedure suite and add the bedside services team. Interventions resulted in significant improvement in patient delays, patient experience scores, and denied days. The invention, design, and implementation of a real-time unit-specific dashboard supplied by a data dump from the EMR was invaluable in helping to promote team awareness and transparency regarding delays and throughput.

Determination of Key Drivers of Patient Experience in a Midsize Pediatric Hematology-Oncology Ambulatory Clinic.

Patient perception of care is positively associated with better medical outcomes, clinician job satisfaction, and fewer malpractice claims and also has significant downstream economic impact for healthcare organizations. A sparse amount of data exists regarding provider and practice characteristics driving high levels of patient experience in the pediatric hematology-oncology (PHO) ambulatory setting. The aims of this study were to determine key drivers of high care provider ratings and of the likelihood of recommending our ambulatory PHO practice. Patient experience was measured using the Consumer Assessment of Healthcare Providers and Systems Clinician & Group Survey (CG-CAHPS). The study outcomes were to determine the survey items most associated with top-box scores for "Rate This Provider" and for "Likelihood of Your Recommending Our Practice to Others." The survey items Explanations the care provider gave you about your problem or condition and Concern the care provider showed for your questions or worries were most strongly correlated with high provider ratings. How well the staff worked together to care for you and Friendliness/courtesy of nurse/assistant were most strongly correlated with the likelihood of recommending the practice. High provider ratings were most associated with the physician's ability to explain problems and conditions to families. Staff teamwork and nursing attitude were most associated with patient recommendations of the PHO practice. By identifying key drivers of high provider and practice ratings by patients in the PHO ambulatory setting, a targeted approach with a focus on physician-specific communication attributes, teamwork, and nursing attitude can be deployed to improve the patient experience.

Evaluation of patient satisfaction in pediatric dermatology.

There remains a lack of investigation into which factors patients and families value the most in their experience at pediatric dermatology clinics. Most of the current literature on quality improvement in dermatology does not encompass the pediatric population. To determine the drivers that are most predictive of a positive patient experience, we observed the indirect relationship between several factors of the patient experience and their role in patient satisfaction. Patient satisfaction surveys were distributed after their visits to patients at four pediatric dermatology clinics in one children's academic health system. Data were collected and organized into the top 30 survey variables with which patients expressed satisfaction on a 5-point Likert scale. Pearson product-moment correlation coefficients (r) for each variable with regard to "likelihood of your recommending our practice to others" were calculated. A total of 516 families completed patient satisfaction surveys. Analyses of top box scores showed that the strongest predictors of patient satisfaction were the likelihood of recommending care provider (r=.77, P=<.001), cheerfulness of practice (r=.76, P=<.001), care provider spoke using clear language (r=.73, P=<.001), patient confidence in care provider (r=.70, P=<.001), and our sensitivity to patient needs (r=.70, P=<.001). The patient-physician relationship, along with the environment of the practice and its sensitivity to patients' personal needs, contributes most to the patient experience in pediatric dermatology. Identifying such variables that shape patients' assessments of their experience can guide future quality improvement plans in the specialty.