Background New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter. Objective This study aimed to determine if patient satisfaction differs between video and in-person visits. Methods In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre–COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively. Results We experienced an 8729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs 92.5%; P<.001). In adjusted analyses, video visits (parameter estimate [PE] 2.18; 95% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE –2.05; 95% CI –2.66 to –1.22), female gender (PE –0.73; 95% CI –0.96 to –0.50), and new visit type (PE –0.75; 95% CI –1.00 to –0.49) were associated with lower patient satisfaction. Conclusions Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine.

Key Points Question Is the US Hospital Readmissions Reduction Program associated with a greater decrease in unplanned readmissions after targeted surgical procedures when compared with similar nontargeted procedures? Findings In this nationwide, all-payer cohort study of 6 687 007 weighted index surgical admissions, implementation of the Hospital Readmissions Reduction Program was associated with a decrease of 0.018% per month in the risk-adjusted readmission rate after targeted procedures, while the readmission rate after nontargeted procedures remained constant, a difference that was statistically significant. Meaning Readmission trends appear to be consistent with hospitals’ response to the possibility of Hospital Readmissions Reduction Program penalties after total hip arthroplasty and total knee arthroplasty.

Abstract-Despite advances in software modularity, security, and reliability, offline patching remains the predominant form of updating or protecting commodity software. Unfortunately, the mechanics of hot patching (the process of upgrading a program while it executes) remain understudied, even though such a capability offers practical benefits for both consumer and mission-critical systems. A reliable hot patching procedure would serve particularly well by reducing the downtime necessary for critical functionality or security upgrades. Yet, hot patching also carries the risk -real or perceived -of leaving the system in an inconsistent state, which leads many owners to forego its benefits as too risky. In this paper, we propose a novel method for hot patching ELF binaries that supports (a) synchronized global data and code updates and (b) reasoning about the results of applying the hot patch. We propose a format, which we call a Patch Object, for encoding patches as a special type of ELF relocatable object file. Our tool, Katana, automatically creates these patch objects as a by-product of the standard source build process. Katana also allows an end-user to apply the Patch Objects to a running process. In essence, our method can be viewed as an extension of the Application Binary Interface (ABI), and we argue for its inclusion in future ABI standards.