Impact of physician group practice in the operations, quality of care, and service satisfaction in the non-urgent section of an emergency department in a tertiary hospital in the Philippines: a mixed methods study.

Abstract

Background: The Emergency Department (ED) is a primary source of healthcare services for patients with non-urgent conditions in the Philippines. The adaptation of physician group practice (GP) in the ED has gained popularity in the country due to its potential advantage to patient management and physicians compared to independent consultancy (IC). This study aimed to determine the impacts of GP in a non-urgent ED setting in terms of operations, quality of care, and service satisfaction compared to IC.

Methods: Historical data collection focusing on operations, service costs, patient outcomes, and satisfaction was performed between 2021 and 2022 at a tertiary for-profit private hospital in Metro Manila, Philippines. In addition, patient surveys on demographics, perception, ED accessibility, and descriptive satisfaction ratings were also administered in 2023 (n = 310). These aspects were compared between patients managed by GP and IC quantitatively using univariate descriptive statistics, Mann-Whitney U tests, and ANCOVA to compare operational metrics, financial data, and patient outcomes. Qualitative data from patient surveys were analyzed using a sequential-explanatory approach.

Results: Our analysis of the historical data showed high rates of positive outcomes for non-urgent ED patients in both GP and IC. Total (PhP587,812 vs. PhP379,699; p < 0.001) and per patient (PhP1,801 vs. PhP554; p < 0.001) operational costs were higher for the GPs. However, GPs incurred shorter mean length of stay (165.5 vs. 214.2 min; p < 0.001). There appears to be no difference in service satisfaction and overall patient outcomes between patients managed by GP or IC, although patients of GP physicians assessed the level of care of the ED to be higher (5 vs. 4; p-value = 0.019). In the quantitative and qualitative ratings, most patients provided positive citations on ED service quality, staff, structure, system, physician competency and compassion.

Conclusions: While GPs were associated with higher operational costs, they improved the ED efficiency and perceived quality of care without compromising patient outcomes. These findings support GP as a viable alternative model for improving ED operations. However, more research is needed to examine its long-term impacts.