Variation in Patient Experience Across the Clinic Day: a Multilevel Assessment of Four Primary Care Practices

Background Patient satisfaction with healthcare is associated with clinical outcomes, provider satisfaction, and success of healthcare organizations. As the clinic day progresses, provider fatigue, deterioration with communication within the care team, and appointment spillover may decrease patient experience. Objective To understand the relationship between likelihood to recommend a primary care practice and scheduled appointment time across multiple practice settings. Design Retrospective cohort. Participants A retrospective cohort was created of all patients seen within four primary care practices between July 1, 2016, and September 30, 2017. Main Measures We looked at scheduled appointment time against patient likelihood to recommend a practice as a measure of overall patient experience collected routinely for clinical practice improvement by the Press Ganey Medical Practice Survey®. Adjusted mixed effects logistic regression models were created to understand the relationship between progressing appointment time on patient likelihood to recommend a practice. We constructed locally weighted smoothing (LOESS) curves to understand how reported patient experience varied over the clinic day. Results We had a response rate of 14.0% ( n = 3172), 80.2% of whom indicated they would recommend our practice to others. Appointment time scheduling during the last hour (4:00–4:59 PM) had a 45% lower odds of recommending our practice when compared to the first clinic hour (adjusted OR = 0.55, 95% CI 0.35–0.86) which is similar when controlling for patient-reported wait time (aOR = 0.59, 95% CI 0.37–0.95). LOESS plots demonstrated declining satisfaction with subsequent appointment times compared with the first session hour, with no effect just after the lunch hour break. Conclusions In primary care, appointment time of day is associated with patient-reported experience.