Emergency department patient experience: Same location, same provider, different scores by different survey methods.

BACKGROUND: Recent findings on emergency department (ED) patient experience surveys and concerns for the low response rates challenge the quality and reliability of the survey reports. We assessed the consistency of an ED patient experience survey report and identified the effects of patient demographics on ED patient experiences. METHODS: We conducted a prospective, cross-sectional study at a university-based ED from July to December 2017. We obtained ED patient experience scores from an institutional version (IS) survey and the Press Ganey Associates-distributed survey (PGA). We compared top box scores from the two reports using frequency analysis and performed multivariable logistic regressions to identify associations between IS patient demographics and scores. RESULTS: We obtained 289 PGA and 234 IS responses. The IS reported significant, higher top box scores in doctor-specific patient questions compared to PGA (all four P-values < 0.01). Female, Christian and White patients were more likely to give top box scores (OR 3.07, OR 2.22 and OR 2.41, P-value < 0.05, respectively). CONCLUSION: We found significant differences in ED patient experience scores between the IS and PGA surveys. We recommend that healthcare providers consider patient demographic variables when interpreting ED experience score reports. Multiple survey techniques and distribution methods may be adopted to best capture ED patient experiences.

A health plan's investigation of Healthy Days and chronic conditions.

OBJECTIVES: To investigate whether self-reported unhealthy days are related to 6 chronic conditions and other health indicators by using administrative claims. STUDY DESIGN: Cross-sectional study using Healthy Days survey data linked to administrative claims. METHODS: Survey respondents 65 years or older with Medicare Advantage coverage in November or December 2014 and 12 months continuous presurvey enrollment were identified. Mean physically and mentally unhealthy days were reported by chronic condition subgroups. Mean incremental unhealthy days were calculated for individuals in chronic condition subgroups and those exhibiting noncompliance with 2014 quality measures after adjusting for age, gender, provider/insurer contractual relationship, dual Medicaid/Medicare eligibility, and sum of chronic conditions. The relationship between the unhealthy days category and adjusted mean resource utilization (inpatient and outpatient visits) and total healthcare costs for the year prior to the survey was also described. RESULTS: The population averages for physically and mentally unhealthy days were 7.24 and 4.05, respectively. After adjustment, all 6 chronic conditions were associated with significantly more physically unhealthy days, and chronic obstructive pulmonary disease, depression, and diabetes were associated with significantly more mentally unhealthy days (P <.001 vs not having the condition). After adjustment, quality measure noncompliance was generally associated with incremental increases in unhealthy days. Utilization and cost generally increased with increasing unhealthy days. CONCLUSIONS: This is the first study to use administrative claims to demonstrate a relationship between Healthy Days and chronic conditions, related healthcare quality measures, utilization, and costs. Our findings underscore the validity of using Healthy Days to supplement traditional health measures in assessing health status in this population.

[Tlaloc and ascites]. / Tláloc y la ascitis.

Ascites has been a common pathological sign among prehispanic Mexican people, as a result from hepatic and cardiac ailments. In this sense it represents a significant epidemiological problem. But it also is important because is related to Tlaloc and the rain gods and goddesses. The hidropic body is a symbolic water container and have a special function: serve as a Tlaloc and related gods vehicle to transport the precious liquid. In this paper we analyze the Tlaloc role as water and alimentary substances provider and his capital importance for people survival. We also describe five different plastic ways to represent water in the body, all of them with clear relationships to Tlaloc.