Background
New York City was the international epicenter of the COVID-19 pandemic. Health care providers responded by rapidly transitioning from in-person to video consultations. Telemedicine (ie, video visits) is a potentially disruptive innovation; however, little is known about patient satisfaction with this emerging alternative to the traditional clinical encounter.
Objective
This study aimed to determine if patient satisfaction differs between video and in-person visits.
Methods
In this retrospective observational cohort study, we analyzed 38,609 Press Ganey patient satisfaction survey outcomes from clinic encounters (620 video visits vs 37,989 in-person visits) at a single-institution, urban, quaternary academic medical center in New York City for patients aged 18 years, from April 1, 2019, to March 31, 2020. Time was categorized as pre–COVID-19 and COVID-19 (before vs after March 4, 2020). Wilcoxon-Mann-Whitney tests and multivariable linear regression were used for hypothesis testing and statistical modeling, respectively.
Results
We experienced an 8729% increase in video visit utilization during the COVID-19 pandemic compared to the same period last year. Video visit Press Ganey scores were significantly higher than in-person visits (94.9% vs 92.5%; P<.001). In adjusted analyses, video visits (parameter estimate [PE] 2.18; 95% CI 1.20-3.16) and the COVID-19 period (PE 0.55; 95% CI 0.04-1.06) were associated with higher patient satisfaction. Younger age (PE –2.05; 95% CI –2.66 to –1.22), female gender (PE –0.73; 95% CI –0.96 to –0.50), and new visit type (PE –0.75; 95% CI –1.00 to –0.49) were associated with lower patient satisfaction.
Conclusions
Patient satisfaction with video visits is high and is not a barrier toward a paradigm shift away from traditional in-person clinic visits. Future research comparing other clinic visit quality indicators is needed to guide and implement the widespread adoption of telemedicine.
Key Points
Question
Is the US Hospital Readmissions Reduction Program associated with a greater decrease in unplanned readmissions after targeted surgical procedures when compared with similar nontargeted procedures?
Findings
In this nationwide, all-payer cohort study of 6 687 007 weighted index surgical admissions, implementation of the Hospital Readmissions Reduction Program was associated with a decrease of 0.018% per month in the risk-adjusted readmission rate after targeted procedures, while the readmission rate after nontargeted procedures remained constant, a difference that was statistically significant.
Meaning
Readmission trends appear to be consistent with hospitals’ response to the possibility of Hospital Readmissions Reduction Program penalties after total hip arthroplasty and total knee arthroplasty.
PURPOSE: Accountable care organizations (ACOs) are a delivery and payment model designed to encourage integrated, high-value care. We designed a study to test the association between ACOs and two recommended cancer screening tests, colonoscopy for colorectal cancer and mammography for breast cancer. METHODS: Using the random 20% sample of Medicare claims, beneficiaries were attributed to ACO or non-ACO cohorts on the basis of providers’ enrollment in the Medicare Shared Savings Program. An inverse probability of treatment weighting was used to balance patient characteristics between ACO and non-ACO cohorts. A propensity score–weighted, difference-in-differences analysis was then performed using the same provider groups in 2010—pre-ACO—as a baseline. A secondary analysis for older—nonrecommended—age ranges was performed. RESULTS: Prevalence of colonoscopy in recommended age ranges in ACOs from 2010 to 2014 increased from 15.3% (95% CI, 14.9% to 15.6%) to 17.9% (95% CI, 17.3% to 18.5%). This differed significantly from the change in non-ACOs (difference in differences, 1.2%; P < .001). Among women in ACOs, mammography prevalence rose from 53.7% (95% CI, 53.0% to 54.4%) to 54.9% (95% CI, 54.2% to 55.7%). In contrast to colonoscopy, the difference in mammography prevalence was not significantly different in ACO versus non-ACOs (difference in differences, 0.49%; P < .13). A similar pattern was also observed in older—nonrecommended—age ranges with significant difference in differences (ACO v non-ACO) in colonoscopy, but not mammography. CONCLUSION: The impact of ACOs on cancer screening varies between screening tests. Our results are consistent with a greater effect of ACOs on high-cost, high-complexity screening services, which may be more sensitive to integrated care delivery models.
Abstract-Despite advances in software modularity, security, and reliability, offline patching remains the predominant form of updating or protecting commodity software. Unfortunately, the mechanics of hot patching (the process of upgrading a program while it executes) remain understudied, even though such a capability offers practical benefits for both consumer and mission-critical systems. A reliable hot patching procedure would serve particularly well by reducing the downtime necessary for critical functionality or security upgrades. Yet, hot patching also carries the risk -real or perceived -of leaving the system in an inconsistent state, which leads many owners to forego its benefits as too risky. In this paper, we propose a novel method for hot patching ELF binaries that supports (a) synchronized global data and code updates and (b) reasoning about the results of applying the hot patch. We propose a format, which we call a Patch Object, for encoding patches as a special type of ELF relocatable object file. Our tool, Katana, automatically creates these patch objects as a by-product of the standard source build process. Katana also allows an end-user to apply the Patch Objects to a running process. In essence, our method can be viewed as an extension of the Application Binary Interface (ABI), and we argue for its inclusion in future ABI standards.
Overdiagnosis and Overtreatment of low-grade prostate cancer (PCa) reflects poor quality of care and prompted changes to guidelines over the past decade. We used the National Cancer Database to characterize Gleason Grade Group (GG)1PCa diagnosis trends and assess facility-level treatment variability. Between 2010-2019, GG1 PCa incidence significantly declined from 45% to 25% at biopsy and from 33% to 9.8% at radical prostatectomy (RP) pathology. Active surveillance (AS) uptake significantly increased to 49% and 62% among non-academic and academic sites. Decreasing rates of definitive therapies were identified: among academic sites, RP decreased from 61.1% to 25.3% and radiation therapy (RT) from 25.2% to 12%, while among non-academic sites, RP decreased from 53.6% to 28% and RT from 37.8% to 21.9%, p < .001 for all trends. Declines in the diagnosis and treatment of low-grade disease demonstrate an encouraging shift in PCa epidemiology. However, heterogeneity in AS utilization remains and reflects opportunities for improvement.
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