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Multicenter Study
. 2019 Nov;34(11):2536-2541.
doi: 10.1007/s11606-019-05336-5. Epub 2019 Sep 13.

Variation in Patient Experience Across the Clinic Day: a Multilevel Assessment of Four Primary Care Practices

Lindsey M Philpot  1 , Bushra A Khokhar  2 , Jordan K Rosedahl  2 , Tiffany A Sinclair  2 , Rajeev Chaudhry  2   3 , Jon O Ebbert  2   3
Affiliations
Multicenter Study

Variation in Patient Experience Across the Clinic Day: a Multilevel Assessment of Four Primary Care Practices

Lindsey M Philpot et al. J Gen Intern Med. 2019 Nov.

Abstract

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.

Keywords: appointment time; care team communication; patient experience; primary care; surveys; teamwork.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
LOESS plot demonstrating relationship of clinic session time with overall likelihood to recommend a clinical practice.
See this image and copyright information in PMC

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References

    1. Petterson SM, Liaw WR, Phillips RL, Jr, Rabin DL, Meyers DS, Bazemore AW. Projecting US primary care physician workforce needs: 2010-2025. Ann Fam Med. 2012;10(6):503–509. doi: 10.1370/afm.1431. - DOI - PMC - PubMed
    1. Greenfield S, Kaplan SH, Ware JE, Jr, Yano EM, Frank HJ. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3(5):448–457. doi: 10.1007/BF02595921. - DOI - PubMed
    1. Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009;47(8):826–834. doi: 10.1097/MLR.0b013e31819a5acc. - DOI - PMC - PubMed
    1. Perzynski AT, Caron A, Margolius D, Sudano JJ. Primary Care Practice Workplace Social Capital: A Potential Secret Sauce for Improved Staff Well-Being and Patient Experience. J Patient Exp. 2018. - PMC - PubMed
    1. Fullam F, Garman AN, Johnson TJ, Hedberg EC. The use of patient satisfaction surveys and alternative coding procedures to predict malpractice risk. Med Care. 2009;47(5):553–559. doi: 10.1097/MLR.0b013e3181923fd7. - DOI - PubMed

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