Braun Tara L, Kaufman Matthew G, Hernandez Cristina, Monson Laura A
From the *Baylor College of Medicine; and †Texas Children's Hospital, Houston, TX.
Ann Plast Surg. 2017 Sep;79(3):253-258. doi: 10.1097/SAP.0000000000001118.
Adolescents with macromastia face serious physical, emotional, and social burdens because of their large breast size. Studies have shown that reduction mammoplasty results in improvement in physical symptoms and quality of life for these patients. Shared medical appointments (SMAs), defined as individual patient-physician encounters that occur in a group setting, have been successfully applied to clinics for adult patients seeking breast reduction for this condition. We decided to apply the SMA model to our clinic for preoperative evaluation of adolescent patients with macromastia. The purpose of this article is to describe how our clinic implemented SMAs, evaluate changes in clinic efficiency, measure patient quality of life before surgery, and assess patient and provider satisfaction with the SMA model.From February to June 2016, our department instituted SMAs for preoperative evaluation of female adolescent patients with macromastia. We measured days from referral to appointment for 25 patients who attended SMAs and compared this with a retrospective cohort of 21 patients who attended traditional visits from 2013 to 2015.Clinic efficiency was measured in new patients per hour. During SMAs, we also administered the BREAST-Q, Pediatric Quality of Life Inventory, and patient and provider satisfaction surveys. Mean days between referral and office visit was reduced from 75.3 with traditional visits to 40.3 with shared appointments, although this finding was not statistically significant (P = 0.69). New patients per hour increased from 1.33 with traditional visits to 3 with SMAs, without reducing time spent on education or with the surgeon. The mean preoperative BREAST-Q scores were less than 40 for the 4 tested domains, and the mean (SD) total Pediatric Quality of Life Inventory score was 56.7 (14.8). Patients and the provider reported high satisfaction with SMAs, and the provider wishes to continue using SMAs in the clinic.In conclusion, SMAs resulted in high patient and provider satisfaction and increased clinic efficiency, without sacrificing time spent on education or with the surgeon. Low quality-of-life scores demonstrate a need for these patients to be evaluated and treated for their condition. Measuring patient-reported outcomes with validated surveys and improving clinic efficiency without sacrificing patient care have the potential to increase value at our institution.
患有巨乳症的青少年由于乳房过大，面临着严重的身体、情感和社会负担。研究表明，乳房缩小成形术可改善这些患者的身体症状和生活质量。共享医疗预约（SMA）被定义为在集体环境中进行的个体患者与医生的会面，已成功应用于为患有这种疾病寻求乳房缩小术的成年患者的诊所。我们决定将SMA模式应用于我们的诊所，用于对患有巨乳症的青少年患者进行术前评估。本文的目的是描述我们的诊所如何实施SMA，评估诊所效率的变化，测量手术前患者的生活质量，并评估患者和提供者对SMA模式的满意度。2016年2月至6月，我们科室为患有巨乳症的女性青少年患者进行术前评估设立了SMA。我们测量了25名参加SMA的患者从转诊到预约的天数，并将其与2013年至2015年参加传统就诊的21名患者的回顾性队列进行比较。诊所效率以每小时的新患者数量来衡量。在SMA期间，我们还进行了BREAST-Q、儿童生活质量量表以及患者和提供者满意度调查。从转诊到门诊就诊的平均天数从传统就诊时的75.3天减少到共享预约时的40.3天，尽管这一发现无统计学意义（P = 0.69）。每小时的新患者数量从传统就诊时的1.33名增加到SMA时的3名，且没有减少用于教育或与外科医生交流的时间。在4个测试领域中，术前BREAST-Q平均得分均低于40分，儿童生活质量量表的平均（标准差）总得分是56.7（14.8）。患者和提供者对SMA的满意度很高，提供者希望在诊所继续使用SMA。总之，SMA带来了很高的患者和提供者满意度，并提高了诊所效率，同时没有牺牲用于教育或与外科医生交流的时间。低生活质量得分表明需要对这些患者的病情进行评估和治疗。通过经过验证的调查来测量患者报告的结果，并在不牺牲患者护理的情况下提高诊所效率，有可能增加我们机构的价值。
