Patient Age, Race and Emergency Department Treatment Area Associated with "Topbox" Press Ganey Scores

• Published in: The western journal of emergency medicine Vol. 21; no. 6; pp. 117 - 124
• Main Authors: Lee, Moon O, Altamirano, Jonathan, Garcia, Luis C, Gisondi, Michael A, Wang, N Ewen, Lippert, Suzanne, Maldonado, Yvonne, Gharahbaghian, Laleh, Ribeira, Ryan, Fassiotto, Magali
• Format: Journal Article
• Language: English
• Published: United States University of California Digital Library - eScholarship 19.10.2020; Department of Emergency Medicine, University of California, Irvine School of Medicine; eScholarship Publishing, University of California
• Subjects: Adolescent; Adult; Age; Age Distribution; Aged; Aged, 80 and over; Continental Population Groups; Emergencies - epidemiology; Emergency Department Administration; Emergency Service, Hospital - statistics & numerical data; Emergency Treatment - methods; Ethnicity; Female; Humans; Male; Middle Aged; Odds Ratio; Patient satisfaction; Patient Satisfaction - statistics & numerical data; Physicians - statistics & numerical data; Surveys and Questionnaires; United States - epidemiology; Young Adult; United States
• ISSN: 1936-900X; 1936-9018; 1936-9018
• DOI: 10.5811/westjem.2020.8.47277

Hospitals commonly use Press Ganey (PG) patient satisfaction surveys for benchmarking physician performance. PG scores range from 1 to 5, with 5 being the highest, which is known as the "topbox" score. Our objective was to identify patient and physician factors associated with topbox PG scores in the emergency department (ED). We looked at PG surveys from January 2015-December 2017 at an academic, urban hospital with 78,000 ED visits each year. Outcomes were topbox scores for the questions: "Likelihood of your recommending our ED to others"; and "Courtesy of the doctor." We analyzed topbox scores using generalized estimating equation models clustered by physician and adjusted for patient and physician factors. Patient factors included age, gender, race, ethnicity, and ED area where patient was seen. The ED has four areas based on patient acuity: emergent; urgent; vertical (urgent but able to sit in a recliner rather than a gurney); and fast track (non-urgent). Physician factors included age, gender, race, ethnicity, and number of years at current institution. We analyzed a total of 3,038 surveys. For "Likelihood of your recommending our ED to others," topbox scores were more likely with increasing patient age (odds ratio [OR] 1.07; 95% confidence interval [CI], 1.03-1.12); less likely among female compared to male patients (OR 0.81; 95% CI, 0.70-0.93); less likely among Asian compared to White patients (OR 0.71; 95% CI, 0.60-0.83); and less likely in the urgent (OR 0.71; 95% CI, 0.54-0.93) and vertical areas (OR 0.71; 95% CI 0.53-0.95) compared to fast track. For "Courtesy of the doctor," topbox scores were more likely with increasing patient age (OR 1.1; CI, 1.06-1.14); less likely among Asian (OR 0.70; 95% CI, 0.58-0.84), Black (OR 0.66; 95% CI, 0.45-0.96), and Hispanic patients (OR 0.68; 95% CI, 0.55-0.83) compared to White patients; and less likely in urgent area (OR 0.69; 95% CI, 0.50-0.95) compared to fast track. Increasing patient age was associated with increased likelihood of topbox scores, while Asian patients, and urgent and vertical areas had decreased likelihood of topbox scores. We encourage hospitals that use PG topbox scores as financial incentives to understand the contribution of non-service factors to these scores.