The impact of 1-star physician ratings on new patient volume.

OBJECTIVES: To quantify the impact of 1-star reviews across multiple physician rating websites (PRWs) on new patient volume. STUDY DESIGN: Retrospective analysis of 1.12 million new patient appointments and 12,882 physician reviews from a proprietary data set from a large single-specialty practice in the New York and New Jersey area. METHODS: We compiled new patient appointments scheduled and kept between January 1, 2015, and April 25, 2018, and the reviews of the practice's affiliated physicians from 10 PRWs. Assuming that reviews are read prior to appointment creation, an ordinary least squares regression model was run with a time series analysis to compare patient volume in the period immediately prior to the posting of a 1-star review with patient volume in the period immediately after a 1-star review was posted. An additional sensitivity analysis was performed at 4, 6, 8, 10, 12, 14, and 16 weeks to validate a robust effect. RESULTS: The majority of reviews on PRWs were overwhelmingly positive, with only 6.7% of reviews (n = 733) rating a physician with 1 star. A mean of 6.2 new patient appointments were made per half-day session. The mean new patient volume decreased 2.3% to 2.6% following a 1-star review, with effects of the 1-star review affecting patient volume for at least 16 weeks. CONCLUSIONS: Given the limited yet longitudinal negative impact of 1-star reviews and the growing influence of PRWs, physicians should consider the magnitude of the effect as they consider responding to bad reviews.

An Endoscopic View of Multiple Hemangiomas of the Small Intestine.

Small intestinal hemangiomas may present as a severe gastrointestinal hemorrhage associated with a hematologic emergency. In the emergent setting, this may result in more extensive intestinal resection than would otherwise be necessary with elective intervention. The widespread application of capsule endoscopy and double-balloon enteroscopy presents an opportunity to diagnose small bowel hemangiomas prior to symptomatic onset. In one of the first published cases of multiple small intestinal hemangiomas, we highlight the importance of maintaining a broad differential and pursuing a thorough workup, including small bowel imaging, in patients with complaints of chronic abdominal pain and anemia.

Acute ischemic strokes in patients with developmental disabilities: A cross-sectional analysis.

OBJECTIVE: Patients with developmental disabilities (DD) are frequently excluded from acute ischemic stroke (AIS) randomized control trials. We sought to evaluate the impact of having DD on this patient cohort. METHODS: The National Inpatient Sample was analyzed to explore the impact of AIS and treatment on discharge dispositions in patients with DD. Clinical characteristics, treatments, and outcomes were compared to fully-abled patients with AIS. RESULTS: 1,605,723 patients with AIS were identified from 2010-2019, of whom 4094 (0.30%) had a DD. AIS patients with DD were younger (60.31 vs 70.93 years, p < 0.01), less likely to be Caucasian (66.37%vs 68.09%, p = 0.01), and had higher AIS severity (0.63 vs 0.58, p < 0.01). Tissue plasminogen activator (tPA) was administered in 99,739 (6.2%) fully-abled patients and 196 (4.79%) of patients with DD (p < 0.01). Endovascular thrombectomy (EVT) was performed in 21,066 (1.31%) of fully-abled patients and 35 (0.85%) of patients with DD (p < 0.01). The presence of developmental disabilities were predictive of lower rates of tPA (OR:0.71,CI:0.56-0.87,p < 0.01) and EVT (OR:0.24,CI:0.16-0.36,p < 0.01). In a propensity score-matched cohort of all AIS patients who underwent EVT, there was no difference in functional outcome (p = 0.41), in-hospital mortality (0.10), and LOS (p = 0.79). CONCLUSION: AIS patients with DD were less likely to receive tPA and EVT compared to fully-abled patients. Individuals with DD had higher mortality and worse discharge disposition. There was no significant difference in post-EVT outcomes between fully-abled patients and patients with developmental disabilities. In the absence of prospective clinical trials, population based cross-sectional analyses such as the present study provide valuable clinical insight.

Secret Shopper Analysis Shows Getting Psychiatry Appointment in New York City is Well Kept Secret.

OBJECTIVE: The Mental Health Parity and Addiction Equity Act prevents payors from imposing more stringent limitations on mental health and substance disorder benefits than medical and surgical benefits. In this study, we assess a New York City insurer's parity compliance based on the accuracy and validity of network-provided information and a consider legal framework to address this. METHODS: A "secret shopper" analysis was performed, in which researchers attempted to contact the 192 psychiatrist providers listed in the 2019 online directory of United Healthcare psychiatry providers. RESULTS: Only 3.1% of calls resulted in researchers booking an appointment. 50.5% of calls resulted in "no response", 18.75% connected to psychiatrists not accepting new patients, and 8.8% of listed providers stated they were not in the United Healthcare network. CONCLUSIONS: Erroneous directory information exacerbates the issue of access to mental health treatment. Enforcement policy should hold insurers accountable for the reliability of their online directories.

Delayed Operation as a Major Risk Factor for Mortality Among Elderly Patients with Ventral Hernia Admitted Emergently: An Analysis of 33,700 Elderly Patients.

BACKGROUND: Elderly patients admitted emergently for ventral hernia may have high rates of complications, including morbidity and mortality. The goal of this study was to retrospectively assess risk factors for in-hospital mortality for elderly patients admitted emergently with a primary diagnosis of ventral hernia. METHODS: Elderly patients with ventral hernia that required emergency admission were analyzed using the National Inpatient Sample database, 2005-2014. Demographics, clinical data, and outcomes were collected. The relationship between mortality and the predictors was assessed using a stratified analysis, multivariable logistic regression model, and multivariable generalized additive model. RESULTS: A total of 33,700 elderly patients were analyzed. The mean (SD) age for males and females was 75 (7.25) and 76.25 (7.75) years, respectively (p<0.001). Approximately 70% of the patients were females. The mean (SD) hospital length of stay (HLOS) was 6.3 (6.5) and 11.6 (13.7) days in survived vs. deceased patients (p<0.001), respectively. Gangrene was present in 1.5% of survivors vs. 5.6% of deceased (p<0.001) patients. Intestinal obstruction was observed in 78% of survivors vs. 88% of deceased patients (p<0.001). Of the 8,554 cases managed non-operatively, 2.1% died. In contrast, in the 25,163 patients who were operated upon, the mortality rate was 2.9%. The mean (SD) HLOS was 7.39 (7.41) days in patients who had an operation vs. 3.82 (3.48) days in those who did not (p<0.0001). Time to operation was 1.12 (1.97) days in survivors vs. 1.81 (3.02) days in deceased patients (p<0.001). In the final multivariable logistic regression model for patients who underwent an operation, delayed operation, elderly male, frailty, invasive diagnostic procedures and presence of gangrene or obstruction were the main risk factors for mortality. In the final model for patients who did not have an operation, age, frailty, presence of gangrene or obstruction and HLOS were the main risk factors for mortality. CONCLUSION: A delayed operation in elderly males and frail patients with intestinal obstruction or gangrene admitted emergently due to ventral hernia significantly increases mortality in this setting.