Evaluating the impact of social deprivation on Press Ganey® Outpatient Medical Practice Survey Scores

Abstract Background Social deprivation has been shown to affect access to health care services, and influences outcomes for a variety of physical and psychological conditions. However, the impact on patient satisfaction remains less clear. The objective of this study was to determine if social deprivation is an independent predictor of patient satisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey (PGOMPS). Methods We retrospectively reviewed unique new adult patient (≥ 18 years of age) seen at a tertiary academic hospital and rural/urban outreach hospitals/clinics between January 2014 and December 2017. Satisfaction was defined a priori as achieving a score above the 33rd percentile. The 2015 Area Deprivation Index (ADI) was used to determine social deprivation (lower score signifies less social deprivation). Univariate and multivariable binary logistic regression were used to determine the impact of ADI on PGOMPS total and provider sub-scores while controlling for variables previously shown to impact scores (wait time, patient age, sex, race, specialty type, provider type, and insurance status). Results Univariate analysis of PGOMPS total scores revealed a 4% decrease in odds of patient satisfaction per decile increase in ADI (p < 0.001). Patients within the most deprived quartile were significantly less likely to report satisfaction compared to the least deprived quartile (OR 0.79, p < 0.001). Multivariable analysis revealed that the odds of achieving satisfaction decreased 2% for each decile increase in ADI on the Total Score (p < 0.001), independent of other variables previously shown to impact scores. For PGOMPS Provider Sub-Score, univariate analysis showed that patients in the lowest ADI quartile were significantly less likely be satisfied, as compared to the least deprived quartile (OR 0.77; 95% CI 0.70–0.86; p < 0.001). A 5% decrease in a patient being satisfied was observed for each decile increase in ADI (OR 0.95; 95% CI 0.94–0.96; p < 0.001). Conclusions Social deprivation was an independent predictor of outpatient visit dissatisfaction, as measured by the Press Ganey® Outpatient Medical Practice Survey. These results necessitate consideration when developing health care delivery policies that serve to minimize inequalities between patients of differing socioeconomic groups

Mid-Spring Burning Reduces Spotted Knapweed and Increases Native Grasses during a Michigan Experimental Grassland Establishment

The definitive version is available at www.blackwell-synergy.com Infestations of the exotic perennial Spotted knapweed (Centaurea maculosa Lam.) hinder the restoration and management of native ecosystems on droughty, infertile sites throughout the Midwestern United States. We studied the effects of annual burning on knapweed persistence on degraded, knapweed-infested gravel-mine spoils in western Michigan. Our experiment included 48, 4-m2 plots seeded to native warm-season grasses in 1999 using a factorial arrangement of initial herbicide and fertility treatments. Beginning in 2003, we incorporated fire as an additional factor and burned half of the plots in late April or May for three years (2003-2005). Burning increased the dominance of warm-season grasses and decreased both biomass and dominance of knapweed in most years. Burning reduced adult knapweed densities in all three years of the study, reduced seedling densities in the first two years, and reduced juvenile densities in the last two years. Knapweed density and biomass also declined on the unburned plots through time, suggesting that warm-season grasses may effectively compete with knapweed even in the absence of fire. By the end of the study, mean adult knapweed densities on both burned (0.4-m2) and unburned plots (1.3-m2) were reduced to levels where the seeded grasses should persist with normal management, including the use of prescribed fire. These results support the use of carefully timed burning to help establish and maintain fire-adapted native plant communities on knapweed-infested sites in the Midwest by substantially reducing knapweed density, biomass, and seedling recruitment, and by further shifting the competitive balance toward native warm-season grasses

The responsiveness of the PROMIS instruments and the qDASH in an upper extremity population

Abstract Background This study evaluated the responsiveness of several PROMIS patient-reported outcome measures in patients with hand and upper extremity disorders and provided comparisons with the qDASH instrument. Methods The PROMIS Upper Extremity computer adaptive test (UE CAT) v1.2, the PROMIS Physical Function (PF) CAT v1.2, the PROMIS Pain Interference (PI) CAT v1.1 and the qDASH were administered to patients presenting to an orthopaedic hand clinic during the years 2014–2016, along with anchor questions. The responsiveness of these instruments was assessed using anchor based methods. Changes in functional outcomes were evaluated by paired-sample t-test, effect size, and standardized response mean. Results There were a total of 255 patients (131 females and 124 males) with an average age of 50.75 years (SD = 15.84) included in our study. Based on the change and no change scores, there were three instances (PI at 3 months, PI >3 months, and qDASH >3 months follow-ups) where scores differed between those experiencing clinically meaningful change versus no clinically meaningful change. Effect sizes for the responsiveness of all instruments were large and ranged from 0.80–1.48. All four instruments demonstrated high responsiveness, with a standardized response mean ranging from 1.05 to 1.63. Conclusion The PROMIS UE CAT, PF CAT, PI CAT, and qDASH are responsive to patient-reported functional change in the hand and upper extremity patient population