背景:新出现的数据表明,患者满意度数据存在固有的偏见,对女医生产生负面影响。
目的:在门诊妇科护理的多机构研究中,描述PressGaney患者满意度调查与医生性别之间的关联。
方法:这是一个多站点,观察,基于人群的调查研究使用了PressGaney患者满意度调查的结果,该调查来自5个不相关的社区和学术医疗机构,在2020年1月至2022年4月期间进行了妇科门诊就诊.主要结果变量是推荐医生的可能性,个人调查反应作为分析单位。通过调查收集患者的人口统计数据,包括自我报告的年龄,性别,和种族/民族(归类为白人,亚洲人,或者在医学中代表性不足,将黑色组合在一起,西班牙裔/拉丁裔,美洲印第安人或阿拉斯加原住民,和夏威夷或太平洋岛民)。人口统计学之间的双变量比较(医生性别,患者和医生年龄四分位数,患者和医生种族)和推荐可能性使用由医生聚类的广义估计方程模型进行评估。赔率比,95%置信区间,报告了这些分析的p值,并且在p<0.05时认为结果具有统计学意义。使用SAS进行分析(版本9.4,SASInstituteInc.,凯里,NC)。
结果:数据来自130名医生的15,184次调查,大多数是女性(n=95,73%)和白人(n=98,75%),患者也主要是白人(n=10,495,69%)。一半以上的访问是种族和谐的,这意味着患者和医生都报告了相同的种族(57%)。女医生不太可能获得topbox调查评分(74%vs77%),在多变量模型中,获得topbox评分的几率降低了19%(95%CI:0.69-0.95)。患者年龄与评分有统计学意义的关系,与年龄最小的患者相比,63岁及以上的患者提供topbox评分的几率增加了三倍以上(OR=3.10,95%CI=2.12-4.52)。调整后,患者和医生的种族/种族对推荐分数的可能性的可能性有相似的影响,与白人医师和患者相比,亚裔医师和亚裔患者推荐评分的可能性较低(OR=0.89,95%CI=0.81-0.98,OR=0.62,95%CI=0.48-0.79).医学医师和患者中代表性不足的患者显示出推荐得分的可能性(OR=1.27,95%CI=1.21-1.33和OR=1.03,95%CI=1.01-1.06)。医生年龄四分位数与推荐得分的可能性无关。
结论:女性妇科医生获得最高患者满意度评分的可能性比男性低18%。使用新闻Ganey患者满意度调查结果进行基于人群的调查研究。这些问卷的结果应针对偏倚进行调整,因为它们提供了当前用于理解以患者为中心的护理的数据。
Emerging data suggest that patient satisfaction data are subject to inherent biases that negatively affect women physicians.
This
study aimed to describe the association between the Press Ganey patient satisfaction survey and physician gender in a multi-institutional
study of outpatient gynecologic care.
This was a multisite, observational, population-based survey
study using the results of Press Ganey patient satisfaction surveys from 5 unrelated community-based and academic medical institutions with outpatient gynecology visits between January 2020 and April 2022. The primary outcome variable was the likelihood to recommend a physician, and individual survey responses served as the unit of analysis. Patient demographic data were collected through the survey, including self-reported age, gender, and race and ethnicity (categorized as White, Asian, or Underrepresented in Medicine, which groups together Black, Hispanic or LatinX, American Indian or Alaskan Native, and Hawaiian or Pacific Islander). Bivariate comparisons between demographics (physician gender, patient and physician age quartile, patient and physician race) and likelihood to recommend were assessed using generalized estimating equation models clustered by physician. Odds ratios, 95% confidence intervals, and P values for these analyses are reported, and results were considered statistically significant at P<.05. Analysis was performed using SAS, version 9.4 (SAS Institute Inc., Cary, NC).
Data were obtained from 15,184 surveys for 130 physicians. Most physicians were women (n=95 [73%]) and White (n=98 [75%]), and patients were also predominantly White (n=10,495 [69%]). A little over half of all visits were race-concordant, meaning that both patient and physician reported the same race (57%). Women physicians were less likely to receive a topbox survey score (74% vs 77%) and in the multivariate model had 19% lower odds of receiving a topbox score (95% confidence interval, 0.69-0.95). Patient age had a statistically significant relationship with score, with patients aged ≥63 years having >3-fold increase in odds of providing a topbox score (odds ratio, 3.10; 95% confidence interval, 2.12-4.52) compared with the youngest patients. After adjustment, patient and physician race and ethnicity showed similar effects on the odds of a topbox likelihood-to-recommend score, with Asian physicians and Asian patients having lower odds of a topbox likelihood-to-recommend score when compared with White physicians and patients (odds ratio: 0.89 [95% confidence interval, 0.81-0.98] and 0.62 [95% confidence interval, 0.48-0.79], respectively). Underrepresented in medicine physicians and patients showed significantly increased odds of a topbox likelihood-to-recommend score (odds ratio: 1.27 [95% confidence interval, 1.21-1.33] and 1.03 [95% confidence interval, 1.01-1.06], respectively). The physician age quartile was not significantly associated with odds of a topbox likelihood-to-recommend score.
Women gynecologists were 18% less likely to receive top patient satisfaction scores compared with men in this multisite, population-based survey
study using the results of Press Ganey patient satisfaction surveys. The results of these questionnaires should be adjusted for bias given that they provide data currently being used to understand patient-centered care.