Concordance between Community Supervisor and Provider Ratings of Fidelity: Examination of Multi-Level Predictors and Outcomes.
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ABSTRACT:
SUBMITTER: Dickson KS
PROVIDER: S-EPMC8211028 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The purpose of the current study is to examine how nonmodifiable sociodemographic, disease, appointment, management, and survey factors correlate with provider rating. This was a retrospective cross-sectional study conducted on 29 857 patient Clinician and Group Consumer Assessment of Healthcare Providers and Systems surveys collected from January 2017 to January 2019 at a tertiary eye center. We included surveys of patients aged 18 years or older, who answered at least 4 of 6 subfield questions, and completed the survey within 90 days of the appointment. The main outcome was the odds of receiving top box score (TBS) of 10/10 on the survey question regarding overall provider rating. The results showed that the variables with higher odds of TBS included higher overall appointment attendance (odds ratio [OR]: 2.66 [95% CI: 1.23-5.75], P = .013); older patient age (OR 2.44 [95% CI: 2.08-2.87], P < .001]; higher percentage of survey questions completed (OR: 2.02 [95% CI: 1.79-2.27], P < .001); better best corrected visual acuity (OR: 1.85 [95% CI: 1.3-2.64], P = .001); optometry clinic visit (OR: 1.25 [95% CI: 1.15-1.36], P < .001); having procedures (OR: 1.19 [95% CI: 1.04-1.36], P = .013), surgery scheduled (OR: 1.18 [95% CI: 1.03-1.36], P = .020], or refraction done (OR: 1.16 [95% CI: 1.08-1.25], P < .001); being seen by male providers (OR: 1.11 [95% CI: 1.04-1.17], P = .001); and having additional eye testing performed (OR: 1.06 [95% CI: 1.00-1.13], P = .048). Variables associated with lower odds of TBS included longer time to complete survey (OR: 0.42 [95% CI: 0.3-0.58], P = .001); new patient encounter (OR: 0.62 [95% CI: 0.58-0.65], P < .001); and glaucoma (OR: 0.66 [95% CI: 0.59-0.75], P < .001), cornea (OR: 0.79 [95% CI: 0.71-0.87], P < .001), or comprehensive clinic visits (OR: 0.86 [95% CI: 0.79-0.94], P < .001). Thus, nonmodifiable factors may affect the provider rating, and these factors should be studied further and accounted for when interpreting the results of patient experience surveys.
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Project description:The objective of this study was to compare the consistency in appropriate use criteria (AUC) ratings among a broad range of practicing cardiologists and the AUC Technical Panel.AUC for coronary revascularization have been developed by selected experts.Before AUC publication, 85 cardiologists from 10 U.S. institutions assessed the appropriateness of coronary revascularization for 68 indications that had been evaluated by the AUC Technical Panel. Each indication was classified as appropriate, uncertain, or inappropriate, based on the physician group's median rating. Rates of concordance between the physician group and the AUC Technical Panel (i.e., same appropriateness category assignment) and rates of nonagreement within the physician group (? 25% of panelists' ratings outside the group's appropriateness category assessment) were determined.Overall concordance between the 2 groups was 84%. Among indications classified as appropriate by the AUC Technical Panel, concordance between the 2 groups was excellent (94% [34 of 36]); however, nonagreement within the physician group was 44% (16 of 36). Among indications classified as uncertain, there was 73% (16 of 22) concordance between the 2 groups. Among inappropriate indications, concordance was moderate (70% [7 of 10]), but nonagreement occurred frequently (70% [7 of 10]). Moreover, there was substantial variation in appropriateness ratings between individual physicians and the AUC Technical Panel (weighted kappa range: 0.05 to 0.76).Although there was good concordance in assessments of appropriateness for coronary revascularization between physicians and the AUC Technical Panel, nonagreement within the physician group was common and there was marked variation in ratings between individual physicians and the AUC Technical Panel.
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Project description:ImportanceThe Centers for Medicare & Medicaid Services (CMS) Hospital Compare star ratings are widely used summaries of hospital quality that can influence patient choice and organizational reputation.ObjectiveTo identify the changes in hospital ratings and rankings associated with alternative methodological choices in the calculation of the 2021 CMS Hospital Compare star ratings.Design setting and participantsThis cross-sectional study used publicly available 2021 Hospital Compare data for 3339 US hospitals from the October 2020 data release. Change in apparent hospital performance was assessed, arising when plausible alternatives to current methods are used for calculating star ratings in relation to individual measure standardization, domain derivation, and domain weighting. Three example changes were examined in detail, with more comprehensive changes considered using Monte Carlo simulation. Changes in centile of hospital ranks and in star rating overall were examined, as well as separately in CMS peer groupings defined by the number of reported quality domains.Main outcomes and measuresProportion of hospitals receiving a different star rating under the alternative technical specifications than under the current (2021) CMS approach and mean absolute change in centile rank of hospitals under alternative technical specifications compared with the current (2021) CMS approach.ResultsA total of 3339 US hospitals were included in the analysis. Of the specific changes to current specifications considered, the alternative method of standardization was associated with the most substantial changes, with 55.4% (95% CI, 53.7%-57.1%) of hospitals having their star rating reclassified. The change in domain weights was associated with the smallest differences, but even that resulted in reclassification of the star rating in approximately 1 in 4 (24.5%; 95% CI, 23.0%-26.0%) hospitals. In the simulation study, which covered a range of possible changes, on average half of hospitals (51.8%; IQR, 44.2%-59.7%) were assigned a different star rating from that produced by the current specification, usually into an adjacent star category.Conclusions and relevanceIn this cross-sectional study of data on US hospitals, CMS Hospital Compare star ratings were found to be highly sensitive to how performance ratings are calculated, demonstrating the need for transparent justification of the technical approaches used in calculating composite performance ratings.
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Project description:Objective We determine whether racial concordance between postpartum patients and obstetric providers (dyads) impacts the perception of quality of care among people undergoing intrapartum obstetrical procedures.Study design This is a prospective cohort study of postpartum people who underwent operative vaginal or cesarean deliveries in the second stage of labor. Participants were asked to identify the race of their primary provider and complete the Interpersonal Processes of Care (IPC) survey, which assesses communication, patient-centered decision-making, and interpersonal style. The association of participant-identified patient-provider racial concordance with IPC scores was determined. The primary outcome was the IPC subdomain related to discrimination, and secondary outcomes included other IPC subdomains and IPC results by participant racial identity (Black, LatinX vs. White). Sociodemographic and biomedical data were extracted from the medical record. Bivariable analyses were performed.Results Of 168 patients who were approached, 107 (63.6%) agreed to participate and 87 (81.3%) completed the survey. The majority (n=49) identified a racially discordant provider. Participants in racially concordant dyads were more likely to be older, White, use English as a primary language, complete a higher degree of education, and have a higher household income when compared with racially discordant dyads. Intrapartum outcomes were not significantly different between groups. Median IPC subtest scores were not significantly different between groups or between racial/ethnic identities.Conclusion There were no significant differences in perceptions of IPC between racially concordant versus discordant dyads. However, there is an ongoing need to further clarify measures of quality of care in high-acuity obstetrical situations to remediate ongoing racial and ethnic disparities in adverse health outcomes.Key points· Racial concordance between patient and clinician has been associated with improved quality of care.. · There are limited data on racial concordance and perceptions of operative obstetrical care (e.g., operative vaginal delivery).. · Racial concordance was not associated with differences in patient-perceived quality of care associated with operative obstetrics..
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Project description:ObjectiveTo help inform decisions regarding the equitable implementation of obesity interventions, we examined whether interventions were equitably reaching the most vulnerable communities, identified communities that received fewer interventions than expected, and estimated the effect of 'dose' of interventions on obesity prevalence.MethodsWe created a database to identify and characterize obesity-related interventions implemented in Los Angeles County from 2005 to 2015 linked to community-level sociodemographic and obesity prevalence data. We ran generalized linear models with a Gamma distribution and log link to determine if interventions were directed toward vulnerable communities and to identify communities that received fewer interventions than expected. We ran fixed-effects models to estimate the association between obesity prevalence and intervention strategy count among preschool-aged children enrolled in the Special Supplemental Nutrition Assistance Program for Women Infants and Children.ResultsWe found that interventions targeted vulnerable communities with high poverty rates and percentages of minority residents. The small cluster of communities that received fewer interventions than expected tended to have poor socioeconomic profiles. Communities which received more intervention strategies saw greater declines in obesity prevalence (β = -0.023; 95 % CI: -0.031, -0.016).ConclusionsIt is important to determine if interventions are equitably reaching vulnerable populations as resources to tackle childhood obesity become available. Evaluating the population impact of multiple interventions implemented simultaneously presents methodological challenges in measuring intervention dose and identifying cost-effective strategies. Addressing these challenges must be an important research priority as community-wide interventions involve multiple intervention strategies to reduce health disparities.
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Project description:BackgroundBangladesh has improved maternal and child health, but healthcare indicators and access still need enhancement. Factors that contribute to increased antenatal care (ANC) need to be explored to inform healthcare policies. The study examined whether community-level (supply-side) predictors outperform individual/family-level (demand-side) predictors for the desired number of ANC services.MethodsThis cross-sectional study collected primary data from 630 pregnant and lactating women (PLW) in seven upazilas in Rangpur and Nilphamari districts of Bangladesh in 2022. The individual/family and community-level factors as predictors of desired antenatal care services were investigated using a semi-structured questionnaire. Various statistical techniques including the Student t-test, z-test, Chi-square test, and logistic regression model were employed in analyzing the data.ResultsOut of the total 630 participants, the majority were literate women who belong to higher pregnancy order and received benefits from SSNPs. In addition to this, these women did not earn and neither were the empowered. The outcome variable was the receiving status of 4+ ANC services by PLWs, which varied by different covariates. The desired 4+ ANC service received by 73 % PLWs. The significant (p < 0.05) predictors of receiving 4+ ANC services were secondary-level education (95 % CI:0.97-7.55), knowledge on danger signs (95 % CI:1.02-1.48), empowered women (95 % CI:0.99-2.69), community clinics as place of services (95 % CI:1.52-3.49), sources of information through SMS (95 % CI:2.63-7.04) and fully functional community clinic (95 % CI:1.0-2.347). The statistical evidence through the values of pseudo R2 of the reduced models of community level (0.09), individual level (0.03) and family level (0.01) revealed that the community level predictors are more influential than individual/family level predictors.ConclusionThe findings indicate that community level predictors played a dominant role in receiving the 4+ ANC services in Bangladesh. In short, the well-functioning of community clinics in tandem with government forums/bodies and awareness raising through SMS messages, are sufficient for ensuring the desired number of ANC services in rural areas of Bangladesh.
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Project description:The Centers for Medicare and Medicaid Services recently released a five star rating system as part of 'Dialysis Facility Compare' to help patients identify and choose high performing clinics in the US. Eight dialysis-related measures determine ratings. Little is known about the association between surrounding community sociodemographic characteristics and star ratings. Using data from the U.S. Census and over 6000 dialysis clinics across the country, we examined the association between dialysis clinic star ratings and characteristics of the local population: 1) proportion of population below the federal poverty level (FPL); 2) proportion of black individuals; and 3) proportion of Hispanic individuals, by correlation and regression analyses. Secondary analyses with Quality Incentive Program (QIP) scores and population characteristics were also performed. We observed a negligible correlation between star ratings and the proportion of local individuals below FPL; Spearman coefficient, R = -0.09 (p<0.0001), and a stronger correlation between star ratings and the proportion of black individuals; R = -0.21 (p<0.0001). Ordered logistic regression analyses yielded adjusted odds ratio of 0.91 (95% confidence interval [0.80-1.30], p = 0.12) and 0.55 ([0.48-0.63], p<0.0001) for high vs. low level of proportion below FPL and proportion of black individuals, respectively. In contrast, a near-zero correlation was observed between star ratings and the proportion of Hispanic individuals. Correlations varied substantially by country region, clinic profit status and clinic size. Analyses using clinic QIP scores provided similar results. Sociodemographic characteristics of the surrounding community, factors typically outside of providers' direct control, have varying levels of association with clinic dialysis star ratings.
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Project description:Monitoring treatment fidelity is essential to check if patients receive adequate doses of treatment and to enhance our theoretical understanding of how psychosocial treatments work. Developing valid and efficient measures to assess fidelity is a priority for dissemination and implementation efforts. The present study reports on the psychometric properties of the Provider-Rated TranS-C Checklist-a provider-reported fidelity measure for the Transdiagnostic Sleep and Circadian Intervention (TranS-C). Adults with severe mental illness (SMI; N = 101) seeking treatment in a community mental health setting received eight sessions of TranS-C. Therapists completed the Provider-Rated TranS-C Checklist at the end of each treatment session (N = 808) to indicate which modules they delivered during that session. To assess convergent validity, independent raters scored modules delivered from audio recordings of a subset of sessions (n = 257) for the modules delivered using the Independent-Rater TranS-C Checklist. Using exploratory factor analysis, a unidimensional scale composed of TranS-C's modules was identified. Provider-Rated TranS-C Checklist scores were positively associated with the Independent-Rater TranS-C Checklist scores demonstrating convergent validity. Results indicate that the Provider-Rated TranS-C Checklist yields reliable and valid scores of providers' delivery of TranS-C.
| S-EPMC7431680 | biostudies-literature
Project description:ImportanceThe Press Ganey Outpatient Medical Practice Survey is used to measure the patient experience. An understanding of the patient- and physician-related determinants of the patient experience may help identify opportunities to improve health care delivery and physician ratings.ObjectiveTo evaluate the associations between the patient experience as measured by scores on the Press Ganey survey and patient-physician racial/ethnic and gender concordance.Design, setting, and participantsA cross-sectional analysis of Press Ganey surveys returned for outpatient visits within the University of Pennsylvania Health System between 2014 and 2017 was performed. Participants included adult patient and physician dyads for whom surveys were returned. Data analysis was performed from January to June 2019.ExposuresPatient-physician racial/ethnic and gender concordance.Main outcomes and measuresThe primary outcome was receipt of the maximum score for the "likelihood of your recommending this care provider to others" question in the Care Provider domain of the Press Ganey survey. Secondary outcomes included each of the remaining 9 questions in the Care Provider domain. Generalized estimating equations clustering on physicians with exchangeable intracluster correlations and cluster-robust standard errors were used to investigate associations between the outcomes and patient-physician racial/ethnic and gender concordance.ResultsIn total, 117 589 surveys were evaluated, corresponding to 92 238 unique patients (mean [SD] age, 57.7 [15.6] years; 37 002 men [40.1%]; 75 307 White patients [81.6%]) and 747 unique physicians (mean [SD] age 45.5 [10.6] years; 472 men [63.2%]; 533 White physicians [71.4%]). Compared with racially/ethnically concordant patient-physician dyads, discordance was associated with a lower likelihood of physicians receiving the maximum score (adjusted odds ratio [OR], 0.88; 95% CI, 0.82-0.94; P < .001). Black (adjusted OR, 0.73; 95% CI, 0.68-0.78; P < .001) and Asian (adjusted OR, 0.55; 95% CI, 0.50-0.60; P < .001) patient race were both associated with lower patient experience ratings. Patient-physician gender concordance was not associated with Press Ganey scores (adjusted OR, 1.00; 95% CI, 0.96-1.04; P = .90).Conclusions and relevanceIn this study, higher Press Ganey survey scores were associated with racial/ethnic concordance between patients and their physicians. Efforts to improve physician workforce diversity are imperative. Delivery of health care in a culturally mindful manner between racially/ethnically discordant patient-physician dyads is also essential. Furthermore, Press Ganey scores may differ by a physician's patient demographic mix; thus, care must be taken when publicly reporting or using Press Ganey scores to evaluate physicians on an individual level.
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