Quality and Value in an Evolving Health Care Landscape

Kamal, Robin N.

doi:10.1016/j.jhsa.2016.05.016

Cited by 26 publications

(9 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Patients who rate their care as satisfying are more likely to adhere to clinician recommendations, keep office appointments, and refrain from formal complaints and lawsuits (1,10,11). Satisfaction is a multidimensional and complex concept that represents a distillation of perceptions and values (what matters most) (1,2,12). Provision of high-quality clinical services alone is not sufficient for patient satisfaction (1).…”

Section: Introductionmentioning

confidence: 99%

Factors Associated With Patient Satisfaction Measured Using a Guttman-Type Scale

Versluijs

Brown

Rao

et al. 2020

Journal of Patient Experience

View full text Add to dashboard Cite

Patient experience measures such as satisfaction are increasingly tracked and incentivized. Satisfaction questionnaires have notable ceiling effects that may limit learning and improvement. This study tested a Guttman-type (iterative) Satisfaction Scale (GSS) after a musculoskeletal specialty care visit in the hope that it might reduce the ceiling effect. We measured floor effects, ceiling effects, skewness, and kurtosis of GSS. We also assessed factors independently associated with GSS and the top 2 possible scores. In this cross-sectional study, 164 patients seeing an orthopedic surgeon completed questionnaires measuring (1) a demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit (GSS). Bivariate and multivariable analyses sought associations of the explanatory variable with total GSS and top 2 scores of GSS. Accounting for potential confounding using multivariable analysis, lower satisfaction was independently associated with greater symptoms of depression (β: −0.03; 95% CI: −0.05 to −0.00; P = .047). The top 2 scores of the GSS were independently associated with women (compared to men: odds ratio [OR]: 2.12, 99% CI: 1.01-4.45, P = .046) and lower level of education (masters’ degree compared to high school; OR: 0.16, 95% CI: 004-0.61, P = .007). The GSS had no floor effect, a ceiling effect of 38%, a skewness of −0.08, and a kurtosis of 1.3. The 38% ceiling effect of the iterative (Guttman-style) satisfaction measure is lower than ordinal satisfaction scales, but still undesirably high. Alternative approaches for reducing the ceiling effect of patient experience measures are needed.

show abstract

Section: Introductionmentioning

confidence: 99%

Factors Associated With Patient Satisfaction Measured Using a Guttman-Type Scale

Versluijs

Brown

Rao

et al. 2020

Journal of Patient Experience

View full text Add to dashboard Cite

show abstract

“…T he shift toward value-based health care involving total joint arthroplasty (TJA) has necessitated the establishment of metrics that are aimed at determining whether a surgical outcome is satisfactory [1][2][3][4][5][6] . Quantification of such outcomes can be used to measure quality, allowing for a more comprehensive assessment of value 7,8 .…”

mentioning

confidence: 99%

Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty

Kunze

Fontana

MacLean

et al. 2021

Journal of Bone and Joint Surgery

View full text Add to dashboard Cite

Background: It is essential to quantify an acceptable outcome after total joint arthroplasty (TJA) in order to understand quality of care. The purpose of this study was to define patient acceptable symptom state (PASS) thresholds for the Knee injury and Osteoarthritis Outcome Score, Joint Replacement (KOOS JR) and the Hip disability and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) after TJA.Methods: A receiver operating characteristic (ROC) curve analysis, leveraging 2-year satisfaction of "moderate improvement" or better as the anchor, was used to establish PASS thresholds among 5,216 patients who underwent primary total hip arthroplasty and 4,036 who underwent primary total knee arthroplasty from 2007 to 2012 with use of an institutional registry. Changes in PASS thresholds were explored by stratifying and recalculating these thresholds by age at the time of surgery (<70 or ‡70 years of age), sex (men or women), body mass index (BMI; <30 or ‡30 kg/m 2 ), and baseline Short Form-36 (SF-36) physical and mental component scores (<50 or ‡50). Results:The HOOS JR PASS threshold was 76.7 (area under the ROC curve [AUC] = 0.91), which was achieved by 4,334 patients (83.1%). The KOOS JR PASS threshold was 63.7 (AUC = 0.89), which was achieved by 3,461 patients (85.8%). Covariate stratification demonstrated that PASS thresholds were higher in men compared with women, and in those with higher preoperative SF-36 physical and mental scores ( ‡50) compared with lower SF-36 scores (<50). Results differed between instruments for BMI and age: higher BMI was associated with a lower PASS threshold for the HOOS JR but a higher PASS threshold for the KOOS JR. The HOOS JR PASS threshold was higher in patients who were <70 years of age compared with those who were ‡70 years of age, but was equivalent for the KOOS JR. Conclusions:The PASS thresholds for the HOOS JR and KOOS JR at 2 years after TJA were 76.7 and 63.7, respectively.The PASS thresholds were associated with certain preoperative covariates, suggesting that an acceptable symptom state after TJA is influenced by patient-specific factors.

show abstract

“…17 The definition of quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. 18 Patient satisfaction is one of the most used measures, as shown by the increase in the number of tools created to assess satisfaction in recent years. Some authors go further by considering patient satisfaction as one of the primary results of health care.…”

Section: Discussionmentioning

confidence: 99%

Importance of fasting abbreviation and analgesia in the satisfaction and recovery of elderly patients with hip and femur fractures. retrospective study with 1,001 patients

Imbelloni¹,

Ventura²,

Brasileiro³

et al. 2023

JACCOA

View full text Add to dashboard Cite

Background and objectives: There are several ways to assess patient satisfaction, as it is a standard indicator of the quality of care provided. The aim of this study was to evaluate whether the abbreviation of fasting with 200 ml CHO, the intake of the same beverage in the PACU, the return to oral feeding in the ward, and postoperative analgesia can improve comfort and satisfaction with anesthesia in elderly patients. with hip and femur fracture. Methods: A retrospective trial carried out in a Brazilian public health hospital (SUS), with 1,001 patients physical status ASA I-III submitted to hip and femur fracture surgery. The following items were evaluated: preoperative fasting time, evaluation of thirst and hunger upon arrival in the operating room, time of CHO administration in the PACU, time of reintroduction of oral feeding in the ward, and at this moment, the degree of satisfaction with the anesthetic conduct, abbreviation of fasting and early feeding. A satisfaction assessment was performed with YES and NO answers regarding the pre-anesthetic visit, the fasting abbreviation, the use of CHO in PACU, refeeding in the ward, and postoperative analgesia. Family members were also asked to return immediately to the ward, without intravenous hydration and without going through the ICU. Results: All patients had the fasting abbreviation between 1:20 h and 4:00 h. None of the 1,001 patients reported being thirsty when they arrived in the operating room, against only 26 patients reporting being hungry. The time of administration of dextrinomaltose in PACU ranged from 20 minutes to 5:45 h, and the reintroduction of oral feeding in the ward ranged from 4 h to 8:15 h. Analgesia with lumbar plexus block with a neurostimulator and levobupivacaine before or after providing mean analgesia of 22±4 h, with a minimum time of 13 h and a maximum of 34 h. All patients were able to be discharged from the hospital on the second postoperative day. Conclusion: This study with 1,001 patients clearly shows that in hospitalized elderly, the liberal use of CHO before surgery and immediately in PACU, and better quality analgesia is an easy and practical way to increase patient comfort and satisfaction with anesthesia care and with better outcomes.

show abstract

Quality and Value in an Evolving Health Care Landscape

Cited by 26 publications

References 19 publications

Factors Associated With Patient Satisfaction Measured Using a Guttman-Type Scale

Factors Associated With Patient Satisfaction Measured Using a Guttman-Type Scale

Defining the Patient Acceptable Symptom State for the HOOS JR and KOOS JR After Primary Total Joint Arthroplasty

Importance of fasting abbreviation and analgesia in the satisfaction and recovery of elderly patients with hip and femur fractures. retrospective study with 1,001 patients

Contact Info

Product

Resources

About