Variation in Patient Experience Across the Clinic Day: a Multilevel Assessment of Four Primary Care Practices
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Robert D. and Patricia E. Kern Mayo Clinic Center for the Science of Health Care Delivery,, Mayo Clinic, Rochester, MN, USA; 2Community Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
BACKGROUND: Patient satisfaction with healthcare is associated with clinical outcomes, provider satisfaction, and success of healthcare organizations. As the clinic day progresses, provider fatigue, deterioration with communication within the care team, and appointment spillover may decrease patient experience. OBJECTIVE: To understand the relationship between likelihood to recommend a primary care practice and scheduled appointment time across multiple practice settings. DESIGN: Retrospective cohort. PARTICIPANTS: A retrospective cohort was created of all patients seen within four primary care practices between July 1, 2016, and September 30, 2017. MAIN MEASURES: We looked at scheduled appointment time against patient likelihood to recommend a practice as a measure of overall patient experience collected routinely for clinical practice improvement by the Press Ganey Medical Practice Survey®. Adjusted mixed effects logistic regression models were created to understand the relationship between progressing appointment time on patient likelihood to recommend a practice. We constructed locally weighted smoothing (LOESS) curves to understand how reported patient experience varied over the clinic day. RESULTS: We had a response rate of 14.0% (n = 3172), 80.2% of whom indicated they would recommend our practice to others. Appointment time scheduling during the last hour (4:00–4:59 PM) had a 45% lower odds of recommending our practice when compared to the first clinic hour (adjusted OR = 0.55, 95% CI 0.35–0.86) which is similar when controlling for patient-reported wait time (aOR = 0.59, 95% CI 0.37–0.95). LOESS plots demonstrated declining satisfaction with subsequent appointment times compared with the first session hour, with no effect just after the lunch hour break. CONCLUSIONS: In primary care, appointment time of day is associated with patient-reported experience. KEY WORDS: primary care; patient experience; surveys; appointment time; care team communication; teamwork.
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-019-05336-5) contains supplementary material, which is available to authorized users. Received December 17, 2018 Revised July 5, 2019 Accepted August 16, 2019
J Gen Intern Med DOI: 10.1007/s11606-019-05336-5 © Society of General Internal Medicine 2019
INTRODUCTION
An estimated 462 million visits to primary care providers occur annually in the USA, and numbers are expected to climb to 565 million by 2025.1 Patient experience is considered a measure of healthcare quality, and measures of patient experience are becoming increasingly requested by both government and nongovernment payers, and public reporting and healthcare ranking organizations. Administrators and providers in primary care practices need to consider patient experience in designing
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