xRead Article 1 - Electronic Consults in Otolaryngology

this study is the large sample size and power. Additionally, while our data comes from an academic otolaryngology department, this study included both pediatric and adult patients in general and specialty clinics, in both an academic hospital and outpatient satellite setting, making these results more broadly applicable. However, in this study we did not have su $ cient provider representation to obtain subspecialty speci " c information, as certain subspecialties may have only been represented by 1 or 2 providers. This is a potential area of future research, as there is currently no subspecialty speci " c data in the literature apart from pediatric otolaryngology. Another strength of this study is the use of a well-validated and standardized survey instrument. Furthermore, the Press Ganey is a widely used common metric for patient satisfaction, which allows for comparison between other studies. However, there are several limitations of the Press Ganey survey. One is the high ceiling e # ect because most patients give high satisfaction scores, which was seen in this study. This forms a highly skewed distribution of survey results, which may limit sensitivity of results and risks an oversimpli " cation of a complex outcome variable. Another limitation is a substantial selection bias inherent to this survey-based study. One concern with the Press Ganey is the low response rate. Previous Press Ganey based survey studies from our institution have reported response rates ranging from 8.9% to 16.5%. Interestingly, Lee et al. reported that Press Ganey response rates at our institution were decreasing over time, from 19.1% in 2011 to 12.6% in 2014. This was even more pronounced for minorities. Additionally, the Press Ganey survey is only distributed in English, further limiting the diversity of the study population. As the survey is distributed via email, which limits responses to the socioeconomic stratum of patients with reliable computer access. Finally, patients are given up to several weeks to submit the survey, which introduces the risk of recall bias. Further studies are needed to explore the causal relationship between the correlations found in this study, namely the e # ects of age, trainee presence, and race on patient satisfaction. This study identi " es important patient demographics and factors for providers to be aware of in their practice in order to maximize experience for all patients. While some of these elements are non-modi " able, there are encouraging data that there are a wide variety of simple things providers can do to improve satisfaction in these scenarios. For instance, while increased wait time was associated with decreased satisfaction, data demonstrate that increased time spent with the provider, or time spent focusing on therapeutic interventions and health education over general history taking, mitigated this negative e # ect. Other studies demonstrated that factors such as eye 33,47 49 40,44 34,52 30