Zakare-Fagbamila Rasheedat T, Park Christine, Dickson Wes, Cheng Tracy Z, Gottfried Oren N
1Department of Neurosurgery, University of Florida, Gainesville, Florida.
2Department of Neurosurgery, Duke University Medical Center.
J Neurosurg Spine. 2020 Feb 21;33(1):95-105. doi: 10.3171/2019.12.SPINE191257. Print 2020 Jul 1.
Most clinics collect routine data on performance metrics on physicians for outpatient visits. However, the relationship of these metrics with patient experience is unclear. The goal of this study was to investigate the relationships between the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey (CG-CAHPS), the standard patient experience survey, and clinic performance metrics to understand the determinants of patient satisfaction and identify targets for improving patient experience.
The authors performed a retrospective single-institution cohort review of spine surgeon metrics over 15 months including demographics, waiting-room times, in-room times, lead times, timely note closure, timely MyChart responses, and monthly patient volume. Kruskal-Wallis tests and mixed-model regression were used to determine the predictors of 3 domains of patient satisfaction-Global, Access, and Communication.
Over 15 months, 22 surgeons conducted 27,090 visits. The average clinic visit total time was 85.17 ± 25.75 minutes. Increased wait times were associated with poor Global (p = 0.008), Access (p < 0.001), and Communication scores (p = 0.003) in univariate analysis. Every 10-minute increase in waiting time was associated with a 3%, 9.8%, and 2.4% decrease in Global, Access, and Communication scores, respectively. Increased in-room time was also an independent predictor of poor Access scores (p < 0.001). In multivariate analysis, increased wait times were negative predictors of Global (p = 0.005), Access (p < 0.001), and Communication (p = 0.002) scores.
Excessive waiting-room time significantly impacts unexpected dimensions of the patient experience and impacts communication with patients. Understanding the complex relationship between the factors that inform the patient experience will help target effective interventions to improve clinic efficiency and patient satisfaction.
大多数诊所收集医生门诊绩效指标的常规数据。然而，这些指标与患者体验之间的关系尚不清楚。本研究的目的是调查医疗服务提供者与系统临床医生及团体调查（CG-CAHPS）（标准患者体验调查）与诊所绩效指标之间的关系，以了解患者满意度的决定因素，并确定改善患者体验的目标。
作者对15个月内脊柱外科医生的指标进行了一项回顾性单机构队列研究，包括人口统计学、候诊时间、诊室内时间、准备时间、及时完成记录、及时回复MyChart以及每月患者量。使用Kruskal-Wallis检验和混合模型回归来确定患者满意度三个领域（总体、就医便利性和沟通）的预测因素。
在15个月内，22名外科医生进行了27090次就诊。平均门诊总时间为85.17±25.75分钟。在单变量分析中，候诊时间增加与总体（p = 0.008）、就医便利性（p < 0.001）和沟通得分（p = 0.003）较差相关。候诊时间每增加10分钟，总体、就医便利性和沟通得分分别下降3%、9.8%和2.4%。诊室内时间增加也是就医便利性得分较低的独立预测因素（p < 0.001）。在多变量分析中，候诊时间增加是总体（p = 0.005）、就医便利性（p < 0.001）和沟通（p = 0.002）得分的负预测因素。
过长的候诊时间会显著影响患者体验的多个方面，并影响与患者的沟通。了解影响患者体验的因素之间的复杂关系将有助于确定有效的干预措施，以提高诊所效率和患者满意度。
