Stanford University School of Medicine, Department of Emergency Medicine, Stanford, California.
Stanford University School of Medicine, Office of Faculty Development and Diversity, Stanford, California.
West J Emerg Med. 2020 Oct 19;21(6):117-124. doi: 10.5811/westjem.2020.8.47277.
Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. PG scores range from 1 to 5, with 5 being the highest, which is known as the "topbox" score. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED).
We looked at PG surveys from January 2015-December 2017 at an academic, urban hospital with 78,000 ED visits each year. Outcomes were topbox scores for the questions: "Likelihood of your recommending our ED to others"; and "Courtesy of the doctor." We analyzed topbox scores using generalized estimating equation models clustered by physician and adjusted for patient and physician factors. Patient factors included age, gender, race, ethnicity, and ED area where patient was seen. The ED has four areas based on patient acuity: emergent; urgent; vertical (urgent but able to sit in a recliner rather than a gurney); and fast track (non-urgent). Physician factors included age, gender, race, ethnicity, and number of years at current institution.
We analyzed a total of 3,038 surveys. For "Likelihood of your recommending our ED to others," topbox scores were more likely with increasing patient age (odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03-1.12); less likely among female compared to male patients (OR 0.81; 95% CI, 0.70-0.93); less likely among Asian compared to White patients (OR 0.71; 95% CI, 0.60-0.83); and less likely in the urgent (OR 0.71; 95% CI, 0.54-0.93) and vertical areas (OR 0.71; 95% CI 0.53-0.95) compared to fast track. For "Courtesy of the doctor," topbox scores were more likely with increasing patient age (OR 1.1; CI, 1.06-1.14); less likely among Asian (OR 0.70; 95% CI, 0.58-0.84), Black (OR 0.66; 95% CI, 0.45-0.96), and Hispanic patients (OR 0.68; 95% CI, 0.55-0.83) compared to White patients; and less likely in urgent area (OR 0.69; 95% CI, 0.50-0.95) compared to fast track.
Increasing patient age was associated with increased likelihood of topbox scores, while Asian patients, and urgent and vertical areas had decreased likelihood of topbox scores. We encourage hospitals that use PG topbox scores as financial incentives to understand the contribution of non-service factors to these scores.
医院通常使用盖洛普（PG）患者满意度调查来衡量医生的绩效。PG 评分范围为 1 到 5，5 分为最高分，即“最高分”。我们的目的是确定与急诊室（ED）中最高分相关的患者和医生因素。
我们查看了 2015 年 1 月至 2017 年 12 月期间在一家拥有 78000 次 ED 就诊量的学术性城市医院的 PG 调查。结果是最高分在以下问题上的得分：“您是否有可能向他人推荐我们的 ED”；以及“医生的礼貌程度”。我们使用广义估计方程模型分析最高分，模型按医生聚类，并根据患者和医生因素进行调整。患者因素包括年龄、性别、种族、民族和患者就诊的 ED 区域。ED 根据患者的紧急程度分为四个区域：紧急；紧急；垂直（紧急但可以坐在躺椅上而不是轮床上）；和快速通道（非紧急）。医生因素包括年龄、性别、种族、民族以及在当前机构的工作年限。
我们分析了总共 3038 份调查。对于“您是否有可能向他人推荐我们的 ED”，年龄较大的患者得分较高的可能性更大（优势比[OR]1.07；95%置信区间[CI]，1.03-1.12）；与男性患者相比，女性患者得分较低的可能性较小（OR 0.81；95%CI，0.70-0.93）；与白人患者相比，亚洲患者得分较低的可能性较小（OR 0.71；95%CI，0.60-0.83）；与快速通道相比，紧急（OR 0.71；95%CI，0.54-0.93）和垂直区域（OR 0.71；95%CI，0.53-0.95）得分较低。对于“医生的礼貌程度”，得分较高的可能性更大与患者年龄的增加有关（OR 1.1；CI，1.06-1.14）；与亚洲人（OR 0.70；95%CI，0.58-0.84）、黑人（OR 0.66；95%CI，0.45-0.96）和西班牙裔患者（OR 0.68；95%CI，0.55-0.83）相比，白人患者得分较低的可能性较小；与快速通道相比，紧急区域（OR 0.69；95%CI，0.50-0.95）得分较低。
患者年龄的增加与最高分得分的增加有关，而亚洲患者以及紧急和垂直区域的最高分得分较低的可能性较小。我们鼓励使用 PG 最高分作为财务激励措施的医院了解这些分数中非服务因素的贡献。
