A Longitudinal Comparison of Telemedicine Versus In-Person Otolaryngology Clinic Efficiency and Patient Satisfaction During COVID-19

Objectives: Telemedicine was increasingly adopted in otolaryngology as a result of the COVID-19 pandemic, but how it compares to in-person visits over the longitudinal course of the pandemic has not been characterized. This study compares telemedicine visits to in-person visits on measures of clinical efficiency and patient satisfaction. Methods: We examined all in-person and telemedicine encounters that occurred during the 13-month period from April 1, 2020 to April 30, 2021 at a pediatric otolaryngology clinic associated with a large tertiary care children’s hospital. We compared patient demographics, primary encounter diagnoses, completions, cancellations, no-shows, cycle time, and patient satisfaction. Results: A total of 19 541 (90.5%) in-person visits and 2051 (9.5%) telemedicine visits were scheduled over the study period. There was no difference in patient age or gender between the visit types. There was a difference in race (75% White or Caucasian for in-person and 73% for telemedicine, P = .007) and average travel distance (53.3 miles for in-person vs 71.0 for telemedicine, P = .000). The most common primary diagnosis was Eustachian tube dysfunction for in-person visits (11.8%) and sleep disordered breathing for telemedicine visits (13.7%). Completion rate was greater for telemedicine visits (52.4% in-person vs 62.5% telemedicine). Cancellations were greater for in-person visits (42.6% in-person vs 24.2% telemedicine), but no-shows were greater for telemedicine (5.0% in-person vs 13.3% telemedicine, all P = .000). Average cycle time was shorter for telemedicine visits (56.5 minutes in-person vs 47.6 minutes telemedicine, P = .000). Patient satisfaction with provider interactions and overall care experience was high for both visit types. Conclusions: Telemedicine was utilized more during months of heightened COVID-19 cases, with higher completion rates, fewer cancellations, shorter cycle times, saved travel distance, and comparable patient satisfaction to in-person visits. Telemedicine has the potential to remain an efficient mode of care delivery in the post-pandemic era.

Download Full-text

Multi-level QI interventions in a safety-net academic oncology clinic.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18665 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18665-e18665

Author(s):

Aparna Chakravarti Jotwani ◽

Courtney Nicole Miller-Chism ◽

Margaret Griffin Crawford ◽

Claire Mach ◽

LaToya Woods ◽

...

Keyword(s):

Patient Satisfaction ◽

Cycle Time ◽

Safety Net ◽

T Test ◽

Wait Times ◽

Patient Volume ◽

Test Analysis ◽

Cycle Times ◽

Clinic Efficiency ◽

Multi Level

e18665 Background: Clinic cycle time is a performance metric and prolonged wait times may impact patient satisfaction and/or treatment outcomes. In primary care clinics, studies show prolonged cycle times detract from patient satisfaction. Fewer studies examine specialty clinics such as oncology which require multi-faceted care. Our Harris Health System (HHS) serves a diverse county with high patient volume with physician learners and limited providers due to limited resources. Our patient satisfaction assessments previously identified prolonged wait times as an area for improvement. Our team studied and process mapped operations with the goal of improving clinic efficiency. Our primary objective is to streamline the process for our outpatient oncology appointments measured through patient cycle times. We aimed to decrease the cycle time by 25% and improve patient satisfaction. Methods: From January 2018 through December 2019, the cycle time processes for Smith Thursday Oncology Clinics in the HHS were mapped and analyzed, and sequential PDSA (Plan-Do-Study-Act) cycles were completed to reduce non-value-added time. Six-month cycle times before and after implementation of three process changes implemented were compared with t-test analysis. Next, NRC (National Research Corporation) Health patient satisfaction data for the corresponding time frames was compared with both t-test and chi-square analyses. Results: Patient cycle time from July 2018 – December 2018 was compared to July 2019 – December 2019 with a t-test analysis. Our results showed a significant (p = 0.036) reduction in cycle time. The average percent decrease in cycle time was 19%. NRC patient satisfaction data inquiries, including overall satisfaction, informed regarding appointment delays, and waiting for more than 15 minutes were reviewed for this same time frame. We found trends in all three categories showing improvements in scores with p-values of 0.483, 0.821 and 0.282 respectively. Conclusions: Through multi-level interventions we were able to significantly reduce clinic cycle times. Trends towards improvement were seen as the population assessed was in the hundreds and not thousands needed for significance. Our academic teaching model is meaningful to study as it serves a high patient volume and educates future oncologists, especially pertinent when a shortage of oncologists in anticipated in the future. Additionally, our patients receive high quality care with nursing, education and infusion services. An area for improvement is communication with patients during their cycle times and other early QI work in our clinics show patients are interested in further education. Our underserved patient population is multi-ethnic, has unassessed health literacy, and frequent language barriers. Better efficiency in the clinics and utilization of cycle time can have multiple patient benefits that warrant further work in QI.

Download Full-text

The Impact of Hospital Accreditation on the Patient Satisfaction of In-Patient Department Services

International Journal of Emerging Research in Management and Technology ◽

10.23956/ijermt.v6i8.169 ◽

2018 ◽

Vol 6 (8) ◽

pp. 368

Author(s):

Zuber Mujeeb Shaikh

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Care Delivery ◽

Tertiary Care ◽

Care Hospital ◽

Significant Difference ◽

Before And After ◽

The Impact ◽

Survey Questionnaires ◽

Patient Department

Patient satisfaction is as important as other clinical health measures and is a chief means of assessing the strength of health care delivery. The current competitive environment has driven health care organisations to concentrate on patient satisfaction as a means to acquire and keep market share. If you don’t recognise what your strengths and weaknesses are, you can’t compete effectively. Objectives: To study the impact of National Accreditation Board for Hospitals & Healthcare Providers (NABH) Accreditation, India on the patient satisfaction of In-Patient Department Services. Methods: It is a quantitative, descriptive and inferential research based case study in which sample of a population was studied by structured satisfaction survey questionnaires (before and after the accreditation) in a private tertiary care hospital in Secunderabad, Telangana State, India to determine its characteristics, and it is then inferred that the population has the same or different characteristics. Significance of Research: It was observed initially before the accreditation that there was a lower satisfaction rate in in-patient department services, which was affecting the study hospitals’ business. Hypothesis: Null Hypothesis (H0) and Alternative Hypothesis (H1) were used and tested to compare the before and after impact of accreditation by applying to each question of the questionnaire. Study Design: The closed ended questionnaire was developed considering the in-patient services process by incorporating the six dimensions of quality Safe, Timely, Effective, Efficient, Equitable, and Patient-centred (STEEP) and tested prior to implementing. Questionnaires were given to the patients for completion upon discharge two months before and two months after the accreditation. Study Population: Simple random sampling method was selected, and the researcher had involved conscious patients of all age groups and gender. Data Collections: Primary data were collected from the survey questionnaires. Secondary data were collected from relevant published journals, articles, research papers, academic literature and web portals. Conclusion: It is very evident from this research that at the 5 % level of significance, the chi-square test indicates that there is a significant difference in the satisfaction with respect to the overall experience in the hospital between before the accreditation group and after accreditation group with p-value <0.001.The responses of satisfaction has improved from N=421 (Satisfied=245, Highly satisfied= 176) from N=241 (Satisfied = 124, Highly satisfied= 117).

Download Full-text

Clinical spectrum of colonic diverticulosis: a tertiary care experience in Saudi Arabia

International Journal of Medicine in Developing Countries ◽

10.24911/ijmdc.51-1594026501 ◽

2020 ◽

pp. 1

Author(s):

Abed AlLehbi ◽

Abdullah AlMtawa ◽

Adel Alqutub ◽

Khalid Alsayari ◽

Ahmed Alomair ◽

...

Keyword(s):

Saudi Arabia ◽

Tertiary Care ◽

Clinical Spectrum ◽

Colonic Diverticulosis ◽

Care Experience

Download Full-text

A Study on prescribing pattern of drugs in orthopaedic in-patient department at a tertiary care hospital in Guntur region

International Journal of Pharmaceutical Research and Life Sciences ◽

10.26452/ijprls.v8i2.1290 ◽

2020 ◽

Vol 8 (2) ◽

pp. 60-70

Author(s):

Anjani Teja Ch ◽

Ramesh babu K ◽

Leela subramanyam S ◽

Janani Y ◽

Eswar Sai Kiran K ◽

...

Keyword(s):

Tertiary Care Hospital ◽

Care Delivery ◽

Tertiary Care ◽

Essential Medicine ◽

Care Hospital ◽

Age Group ◽

Common Condition ◽

Prescribing Pattern ◽

Prescribing Indicators ◽

Bed Days

The descriptive observational study was conducted over six months among inpatients of the orthopaedics department. The aim is to observe the prescribing pattern of drugs, to find out the percentage of analgesics given and most commonly prescribed analgesic, to compare the prescribed drugs whether they are in NLEM, WHO list and calculate DDD/100 Bed-days and to analyze the drugs for WHO prescribing drugs. A total of 250 patients were included in the study. Out of this, 168 were male, and 82 were female. Most of the patients were in the age group of 31-40[45 in number with 18%]. The most common condition was found to fracture [113 in number with 95.2%]. Commonly prescribed drugs were analgesics 447 with 26.76%. Among all the NSAID's, PCM was most commonly prescribed analgesic with 34.4%. The highest no, of drugs was found to be 4drugs/prescription with 24%. Monthly one analgesic was prescribed per prescription with 38.8%. Utilization of analgesics in term of DDD/100 Bed-days was 55.26; Drugs will be evaluated per prescription as per prescribing indicators of WHO was done, the average no. of drugs per prescription was found to be 0.45, percentage of drugs prescribed by generic name was found to be 13.3%, percentage of encounters with antibiotics prescribed were found to be 94.4%, In ratio percentage of drugs prescribed from the national list of essential medicine was found to be 92.6%. This study would help to facilitate better health care delivery.

Download Full-text

Are Communities Willing to Transition Into Learning Health Care Communities? A Community-Based Participatory Evaluation of Stakeholders’ Receptivity

Qualitative Health Research ◽

10.1177/1049732321998643 ◽

2021 ◽

pp. 104973232199864

Author(s):

Nabil Natafgi ◽

Olayinka Ladeji ◽

Yoon Duk Hong ◽

Jacqueline Caldwell ◽

C. Daniel Mullins

Keyword(s):

Health Care ◽

Health Care Delivery ◽

Health Care Professionals ◽

Care Delivery ◽

Lessons Learned ◽

Community Members ◽

Community Based ◽

Care Community ◽

Care Experience ◽

National Initiative

This article aims to determine receptivity for advancing the Learning Healthcare System (LHS) model to a novel evidence-based health care delivery framework—Learning Health Care Community (LHCC)—in Baltimore, as a model for a national initiative. Using community-based participatory, qualitative approach, we conducted 16 in-depth interviews and 15 focus groups with 94 participants. Two independent coders thematically analyzed the transcripts. Participants included community members (38%), health care professionals (29%), patients (26%), and other stakeholders (7%). The majority considered LHCC to be a viable model for improving the health care experience, outlining certain parameters for success such as the inclusion of home visits, presentation of research evidence, and incorporation of social determinants and patients’ input. Lessons learned and challenges discussed by participants can help health systems and communities explore the LHCC aspiration to align health care delivery with an engaged, empowered, and informed community.

Download Full-text

SURVEY ON PATIENT SATISFACTION AND KNOWLEDGE ON REGIONAL ANAESTHESIA.

10.36106/gjra/2707974 ◽

2021 ◽

pp. 32-34

Author(s):

Sravanthi GNS ◽

Ravi Madhusudhana

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Regional Anaesthesia ◽

Tertiary Care ◽

Care Quality ◽

Care Hospital ◽

Health Care Quality Assurance ◽

Patient’S Satisfaction ◽

Post Operative Nausea ◽

Study Participants

Background: Health care quality assurance was gained importance since the 18th century and patient's satisfaction about the surgery and anaesthesia plays an important role in this. And hence proper assessment of the patient satisfaction for the anaesthesia is essential to alter and deliver the needed service. Objective: Toevaluate the patient's satisfaction including pre-op visit, intra-op awareness, post-op pain management and impression on anaesthetic team. Methodology: This was a cross sectional study conducted among 214 patient receiving regional anaesthesia in a tertiary care hospital, Pondicherry. Results: The overall satisfaction about the information about the anaesthesia was seen among 61.7% of the participants. 67.3% and 89.7% of the study participants had overall satisfaction about the pain and post-operative nausea and vomiting therapy. 72% of the study participants were satised with the department and 64.9% would recommend anaesthesia service to others. Conclusion: The satisfaction of the patient plays a pivotal role in the overall quality of health care. The perception of anaesthesia has shown to be poor in studies and hence steps to alleviate such fears should be addressed properly.

Download Full-text

Evaluation of Patient Experience from Telemedicine Use for an Anesthesiology Pain Division: Time, Cost, and Patient Satisfaction Analysis (Preprint)

10.2196/preprints.33926 ◽

2021 ◽

Author(s):

Laleh Jalilian ◽

Irene Wu ◽

Jakun Ing ◽

Xuezhi Dong ◽

George Pan ◽

...

Keyword(s):

Patient Satisfaction ◽

Pain Management ◽

Travel Time ◽

Medical Center ◽

Academic Medical Center ◽

Cost Savings ◽

Travel Distance ◽

Patient Cost ◽

Academic Medical ◽

Pain Patients

BACKGROUND An increasing number of patients require outpatient and interventional pain management. To help meet the rising demand for anesthesia pain subspecialty care in rural and metropolitan areas, healthcare providers have utilized telemedicine for pain management of both interventional and chronic pain patients. OBJECTIVE This study describes telemedicine implementation for pain management at an academic pain division in a large metropolitan area. The study estimates patient cost savings from telemedicine, before and after the California COVID-19 "Safer at Home" directive, and patient satisfaction with telemedicine for pain management care. METHODS This was a retrospective, observational case series study of telemedicine use in a pain division at an urban academic medical center. From August 2019 to June 2020, we evaluated 1,398 patients and conducted 2,948 video visits for remote pain management care. We utilize publicly available IRS Statistics of Income data to estimate hourly earnings by zip code in order to estimate patient cost savings. We estimate median travel time, travel distance, direct cost of travel, and time-based opportunity savings and report patient satisfaction scores. RESULTS Telemedicine patients avoided an estimated median roundtrip driving distance of 26 miles and a median travel time of 69 minutes during afternoon traffic conditions. Within sample, the median hourly earnings was $28/hr. Patients saved a median of $22 on gas and parking and a total of $52 per telemedicine visit based on estimated hourly earnings and travel time. Patients evaluated serially with telemedicine for medication management saved a median of $156 over three visits. 91% of patients surveyed (n = 313) were satisfied with their telemedicine experience. CONCLUSIONS Telemedicine use for pain management reduced travel distance, travel time, and travel and time-based opportunity costs for pain patients. We achieved the successful implementation of telemedicine across a pain division in an urban academic medical center with high patient satisfaction and patient cost savings.

Download Full-text

Abstract P145: Screening Rates for the Diagnostic Workup of Resistant Hypertension

Hypertension ◽

10.1161/hyp.70.suppl_1.p145 ◽

2017 ◽

Vol 70 (suppl_1) ◽

Author(s):

Gilad M Jaffe ◽

Gomathi Krishnan ◽

Margaret Stedman ◽

Glenn M Chertow ◽

John T Leppert ◽

...

Keyword(s):

Heart Failure ◽

Resistant Hypertension ◽

Care Delivery ◽

Tertiary Care ◽

Laboratory Data ◽

Antihypertensive Agents ◽

Screening Tests ◽

Activity Levels ◽

Antihypertensive Medications ◽

Secondary Causes

Resistant hypertension is a common clinical condition associated with higher rates of cardiovascular disease, kidney disease, and death. Among individuals with resistant hypertension, secondary causes of hypertension occur in about 20% of cases, but the rates of screening are unknown. We assessed the practice pattern of these guidelines in a major primary and tertiary care academic institution in Northern California. Using the electronic health record, we identified individuals between the years of 2008 and 2014 who were prescribed three separate classes of antihypertensive agents and had follow-up laboratory data within 24 months. We excluded individuals with known causes of secondary hypertension such as hyperaldosteronism, renal artery stenosis, fibromuscular dysplasia, adrenal disease, and end-stage renal disease. We also excluded individuals with diagnosed heart failure, who may have been prescribed selected medications for heart failure instead of hypertension. This cohort of 37,073 individuals with presumed resistant hypertension had a mean age of 58.5 years (SD 15.8), was 51.7% male, and 56.4% Caucasian, 6.3% Black, and 12.4% Asian. Among these individuals, only 520 had a serum aldosterone, and only 447 had both aldosterone and plasma renin activity levels measured. These data infer that the recommended initial screening tests for secondary causes of resistant hypertension - notably primary and secondary hyperaldosteronism - are conducted in only 1.2% of individuals. A detailed chart review of a representative sample of this cohort will be also be conducted. Thus far, these data suggest that there is significant under-screening of reversible causes of resistant hypertension. Furthermore, an electronic implementation strategy to prompt screening for secondary causes may be warranted to reduce blood pressure, optimize use of antihypertensive medications, and lower cardiovascular risk. A similar analysis will be performed in the Veterans Affairs database to evaluate screening rates in health-care delivery systems enriched with African Americans.

Download Full-text

Prevalence and Risk Factors of work Related Musculo Skeletal Disorders (wrmsd’s) Among Doctors - A Cross Sectional Study

10.47363/jpmrs/2021(3)136 ◽

2021 ◽

pp. 1-4

Author(s):

Biju Azariah ◽

◽

Geethu Babu ◽

Keyword(s):

Risk Factors ◽

Service Sector ◽

Care Delivery ◽

Tertiary Care ◽

Health Sector ◽

High Volume ◽

Cross Sectional Study ◽

Working Environment ◽

Cross Sectional ◽

Work Related

Work related musculoskeletal disorders (WRMSDs) have not only shown to impact the physical and pschycological comfort of the employee but also deteriorate the prospects of any production or service sector. The prevalence of WRMSDs, though studied extensively in various sectors, has been understudied in health sector, especially among doctors. This study which evaluated the prevalence and risk factors of these disorders among fifty cancer treating Radiation Oncologist at a Tertiary Care Cancer Centre in India had exposed out an alarming 68% prevalence of these disorders in the study population, with neck pain being the commonest site of these Muscloskeletal Disorders (MSDs). Several factors which could impact the development of MSDs were analysed. This higher incidence of MSDs is presumed to be because of extreme physical and mental stress of working in a high volume cancer care centre, persistent unhealthy postures during work, inadequate micropauses between works and uncomfortable working atmosphere. Adequate physician patient ratio, restricting the patient load, providing good physician friendly working environment and adequate mandatory breaks might significantly reduce the incidence of these disorders and can prevent the sagging of health care delivery.

Download Full-text