Patient satisfaction reported by in-visit and after-visit surveys

Patient experience measurement has become a basic requirement for every healthcare provider organization. Yet, when the timing and mode of survey administration are considered, there is skepticism about the usefulness of ‘after- visit’ patient experience surveys to measure satisfaction and identify opportunities to improve service or health care quality. The aim of this observational study was to compare patient satisfaction among those who rated the patient experience at the conclusion of their outpatient appointment while still in the office, to that among those who rated the patient experience up to one month after their outpatient appointment via a mailed survey. Two sampling strategies were used to collect patient experience data from patients of the University of Maryland Family and Community Medicine practice: a postal survey to collect data from patients approximately 30 days after their visit (the After-Visit survey), and a within-visit survey to collect data from patients during their visit (the In-Visit survey). Nineteen survey questions measured comparable constructs between the After-Visit and In-Visit. This study did not find any significant differences between the data sources for any of these questions. The study showed that patient satisfaction could be assessed within a visit or by mail 30 days later without a statistically significant effect on mean responses

Black and white women in Maryland receive different treatment for cervical cancer.

PURPOSE: Despite an overall decrease in incidence, the death rate from cervical cancer in the United States remains higher in black women than their white counterparts. We examined the Maryland Cancer Registry (MCR) to determine treatment factors that may explain differences in outcomes between races in the state of Maryland. METHODS: Incident cervical cancers in the MCR 1992-2008 were examined. Demographics, tumor characteristics and treatments were compared between races and over time. RESULTS: Our analysis included 2034 (1301 white, 733 black) patients. Black women were more likely to have locally advanced or metastatic disease at diagnosis (p<0.01). They were more likely to receive any radiation or chemotherapy combined with radiation and less likely to receive surgery (p<0.01). When adjusted for stage and insurance status black women had 1.50 (95% CI 1.20-1.87) times the odds of receiving radiation and 1.43 (95% CI 1.11-1.82) times the odds of receiving chemotherapy. Black women with cervical cancer had 0.51 times the adjusted odds (95% CI 0.41-0.65) of receiving surgery compared to white women. Racial differences in treatment did not change significantly over time. CONCLUSIONS: Surgical treatment for newly diagnosed cervical cancer in the state of Maryland was significantly less common amongst black women than white during our study period. Equivalent treatments are not being administered to white and black patients with cervical cancer in Maryland. Differences in care may contribute to racial disparities in outcomes for women with cervical cancer

Differences in treatments received between races.

<p>White patients were more likely to receive surgery. Black patients were more likely to receive chemotherapy, chemotherapy and radiation, and radiation without brachytherapy. Categories are not mutually-exclusive nor exhaustive. Error bars represent standard error of population proportion. EBRT: external beam radiation therapy. *Statistically significant difference between races (chi-square test p-value<0.05).</p

Annual incidence of cervical cancer in Maryland by race for women 20 and older, 1992–2008.

<p>Annual incidence of cervical cancer in Maryland by race for women 20 and older, 1992–2008.</p

Adjusted^a odds ratios for receiving a particular treatment, among white or black patients, 1999–2008.

<p>EBRT: external beam radiation therapy.</p>a<p>Logistic regression models included variables for race, stage, and insurance type. A separate regression model was built for each treatment. Those missing data for stage or insurance type were included as a separate category. Those missing particular treatment data were excluded from the relevant regression models.</p><p>OR (95% CI): odds ratio (95% confidence interval).</p><p>*Odds ratio shows statistically significant effect (p<0.05 via logistic regression).</p

Unadjusted treatment differences between 1999–2003 and 2004–2008.

<p>RT: radiation therapy; EBRT: external beam radiation therapy; Brachy: brachytherapy.</p><p>*P - value excludes those missing data for particular variable.</p><p>**Breslow-Day test for interaction between race and time period regarding the effect on treatment receipt, excluding those missing data for particular variable.</p><p>Column percentages exclude those with missing data. Non-missing categories add up to 100%, except due to rounding.</p

Patient characteristics between 1999–2008.

<p>*Chi-square test, except where noted, excluding those missing data.</p>t<p>Student’s t-test.</p><p>Column percentages exclude those with missing data. Non-missing categories add up to 100%, except due to rounding.</p