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Guan T, Chen X, Li J, Zhang Y. Factors influencing patient experience in hospital wards: a systematic review. BMC Nurs 2024; 23:527. [PMID: 39090643 PMCID: PMC11295641 DOI: 10.1186/s12912-024-02054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/30/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND Patient experience plays an essential role in improving clinical effectiveness and patient safety. It's important to identify factors influencing patient experience and to improve quality of healthcare. OBJECTIVE To identify factors that influence patient experience in hospital wards. METHODS We conducted a systematic review including six databases; they were PubMed, CINAHL, Embase, PsycInfo, ProQuest, and Cochrane. Studies were included if they met the inclusion criteria. The JBI checklist was used to perform quality appraisal. We used 5 domains of the ecological model to organize and synthesize our findings to comprehensively understand the multi-level factors influencing the issue. RESULT A total of 138 studies were included, and 164 factors were identified. These factors were integrated into 6 domains. All domains but one (survey-related factors) could be mapped onto the attributes of the ecological framework: intrapersonal, interpersonal, institutional, community, and public policy level factors. All factors had mixed effect on patient experience. The intrapersonal level refers to individual characteristics of patients. The interpersonal level refers to interactions between patients and healthcare providers, such as the caring time spent by a nurse. The institutional level refers to organizational characteristics, rules and regulations for operations, such as hospital size and accreditation. The community level refers to relationships among organizations, institutions, and informational networks within defined boundaries, such as a hospital located in a larger population area. Public policy level refers to local, state, national, and global laws and policies, including health insurance policies. The sixth domain, survey-related factors, was added to the framework and included factors such as survey response rate and survey response time. CONCLUSION The factors influencing patient experience are comprehensive, ranging from intrapersonal to public policy. Providers should adopt a holistic and integrated perspective to assess patient experience and develop context-specific interventions to improve the quality of care. PROSPERO REGISTRATION NUMBER CRD42023401066.
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Affiliation(s)
- Tingyu Guan
- School of Nursing, Fudan University, Shanghai, China
- Department of Nursing, Fudan University Zhongshan Hospital, Shanghai, China
| | - Xiao Chen
- Department of Nursing, Fudan University Zhongshan Hospital, Shanghai, China
| | - Junfei Li
- School of Nursing, Fudan University, Shanghai, China
- Department of Nursing, Fudan University Zhongshan Hospital, Shanghai, China
| | - Yuxia Zhang
- Department of Nursing, Fudan University Zhongshan Hospital, Shanghai, China.
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Norman MB, Werth PM, Levy BA, Moschetti WE, Kunkel ST, Jevsevar DS. Examining the Relationship Between Value and Patient Satisfaction With Treatment in Total Joint Arthroplasty. Arthroplast Today 2024; 25:101311. [PMID: 38317707 PMCID: PMC10839615 DOI: 10.1016/j.artd.2023.101311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 10/19/2023] [Accepted: 11/26/2023] [Indexed: 02/07/2024] Open
Abstract
Background A shift toward performance, cost, outcomes, and patient satisfaction has occurred with healthcare reform promoting value-based programs. The purpose of this study was to evaluate the relationship between patient satisfaction and value with treatment in a cohort of patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA). Methods Value was determined by the relationship of treatment outcome with episodic cost. Measurements included both clinical outcomes and patient-reported outcomes. Participating surgeons took part in the modified Delphi method resulting in an algorithm measuring patient value. Treatment outcome, cost, and resultant value (outcome/cost) of both TKA and THA were evaluated using binomial logistic regression by adjusting for age, gender, body mass index, Charlson comorbidity index, tobacco, education, and income with patient-reported satisfaction as the outcome. Results This study had a total of 909 patients (TKA n = 438; THA n = 471), with an average age of 67 (TKA) and 65 (THA) years. Patient satisfaction shared a significant positive relationship with treatment outcome for TKA (odds ratio [OR] = 1.53, confidence interval [CI] = 1.35-1.73, P < .001) and THA (OR = 1.93, CI = 1.62-2.29, P < .001). Higher value was associated with a significantly higher odds of patient satisfaction for both TKA (OR = 1.39, CI = 1.25-1.54, P < .001) and THA (OR = 1.70, CI = 1.47-1.97, P < .001). Conclusions This study showed a positive relationship between treatment outcome but not cost with subsequent value and patient satisfaction. This method provides a promising approach to comprehensively evaluate outcomes, cost, and value of total joint arthroplasty procedures. This approach can help predict the probability of value-driven patient satisfaction.
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Affiliation(s)
- Mackenzie B. Norman
- Dartmouth Geisel School of Medicine, Hanover, NH, USA
- Department of Orthopaedic Surgery, Yale New Haven Health, New Haven, CT, USA
| | - Paul M. Werth
- Dartmouth Geisel School of Medicine, Hanover, NH, USA
- Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Wayne E. Moschetti
- Dartmouth Geisel School of Medicine, Hanover, NH, USA
- Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Samuel T. Kunkel
- Dartmouth Geisel School of Medicine, Hanover, NH, USA
- Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - David S. Jevsevar
- Dartmouth Geisel School of Medicine, Hanover, NH, USA
- Department of Orthopaedic Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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Burke OC, Gibbons JAB, Do HT, Y. Lai E, Bradford L, Bass AR, Amen TB, Russell LA, Mehta B, Parks M, Figgie M, Goodman S. Racial Differences in Patient Satisfaction With the Hospital Experience Undergoing Primary Unilateral Hip and Knee Arthroplasty: A Retrospective Study. Arthroplast Today 2023; 23:101212. [PMID: 37745963 PMCID: PMC10511336 DOI: 10.1016/j.artd.2023.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 09/26/2023] Open
Abstract
Background Press Ganey (PG) inpatient survey is widely used to track patient satisfaction with the hospital experience. Our aim was to use the PG survey to determine if there are racial differences in overall hospital experience and perception of nurses and surgeons following hip and knee arthroplasty. Methods We retrospectively analyzed Black and White patients from hip and knee arthroplasty registries from a single institution between July 2010 and February 2012. The overall assessment score for the hospital experience and perception of the nurse and surgeon questions from the PG inpatient survey were dichotomized as "not completely satisfied" or "completely satisfied". Multivariable logistic regression models were developed to determine the impact of race on the likelihood of being 'completely satisfied' in the hip and knee cohorts. Results There were 2517 hip and 2114 knee patients who underwent surgery and completed the PG survey, of whom 3.9% were Black and 96.0% were White. Black patients were less likely to be completely satisfied with their hospital experience compared to White patients in the hip (odds ratio 0.62, confidence interval 0.39-1.00, P = .049) and knee (odds ratio 0.52, confidence interval 0.33-0.82, P = .005) cohorts. Black patients were also less likely to be completely satisfied with multiple aspects of care they received from the nurse and surgeon in both cohorts. Conclusions We found that the PG Survey shows Black patients were less likely to be completely satisfied than White patients with the hospital experience, including their interactions with nurses and surgeons. More work is needed to understand this difference.
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Affiliation(s)
- Orett C. Burke
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - J. Alex B. Gibbons
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
| | - Huong T. Do
- Division of Research Administration, Hospital for Special Surgery, New York, NY, USA
| | - Emily Y. Lai
- Division of Research Administration, Hospital for Special Surgery, New York, NY, USA
| | - Letitia Bradford
- Department of Orthopedics, University of Nevada, Reno, Reno, NV, USA
| | - Anne R. Bass
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Troy B. Amen
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Linda A. Russell
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Bella Mehta
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Michael Parks
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Mark Figgie
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - Susan Goodman
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
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Long H, Zeng C, Shi Y, Wang H, Xie D, Lei G. Length of stay and inpatient charges of total knee arthroplasty in China: analysis of a national database. Chin Med J (Engl) 2023; 136:2050-2057. [PMID: 37218077 PMCID: PMC10476770 DOI: 10.1097/cm9.0000000000002220] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND There are limited data on the resource utilization of total knee arthroplasty (TKA) in China. This study aimed to examine the length of stay (LOS) and inpatient charges of TKA in China, and to investigate their determinants. METHODS We included patients undergoing primary TKA in the Hospital Quality Monitoring System in China between 2013 and 2019. LOS and inpatient charges were obtained, and their associated factors were further assessed using multivariable linear regression. RESULTS A total of 184,363 TKAs were included. The LOS decreased from 10.8 days in 2013 to 9.3 days in 2019. The admission-to-surgery interval decreased from 4.6 to 4.2 days. The mean inpatient charges were 61,208.3 Chinese Yuan. Inpatient charges reached a peak in 2016, after which a gradual decrease was observed. Implant and material charges accounted for a dominating percentage, but they exhibited a downward trend, whereas labor-related charges gradually increased. Single marital status, non-osteoarthritis indication, and comorbidity were associated with longer LOS and higher inpatient charges. Female sex and younger age were associated with higher inpatient charges. There were apparent varieties of LOS and inpatient charges among provincial or non-provincial hospitals, hospitals with various TKA volume, or in different geographic regions. CONCLUSIONS The LOS following TKA in China appeared to be long, but it was shortened during the time period of 2013 to 2019. The inpatient charges dominated by implant and material charges exhibited a downward trend. However, there were apparent sociodemographic and hospital-related discrepancies of resource utilization. The observed statistics can lead to more efficient resource utilization of TKA in China.
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Affiliation(s)
- Huizhong Long
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Chao Zeng
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan 410008, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Ying Shi
- China Standard Medical Information Research Center, Shenzhen, Guangdong 518054, China
| | - Haibo Wang
- China Standard Medical Information Research Center, Shenzhen, Guangdong 518054, China
- Clinical Trial Unit, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510080, China
| | - Dongxing Xie
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
| | - Guanghua Lei
- Department of Orthopedics, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha, Hunan 410008, China
- Hunan Engineering Research Center for Osteoarthritis, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
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Abdelaal MS, Wiafe BM, Khan IA, Magnuson JA, Saxena A, Smith EB, Lonner JH, Star AM, Good RP, Sharkey PF. Robotic-Assisted Total Knee Arthroplasty: What are Patients' Perspectives, Understanding and Expectations? J Arthroplasty 2023; 38:1726-1733.e4. [PMID: 36924858 DOI: 10.1016/j.arth.2023.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/06/2023] [Accepted: 03/09/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The rate of using robotic-assisted total knee arthroplasty (RA-TKA) has increased markedly. Understanding how patients view the role of robotics during total knee arthroplasty (TKA) informs shared decision making and facilitate efforts to appropriately educate patients regarding the risks and benefits of robotic assistance. METHODS A self-administered questionnaire was completed by 440 potential TKA patients at the time of their surgery scheduling. Participants answered 25 questions regarding RA-TKA, socioeconomic factors, and their willingness to pay (WTP) for RA-TKA. Logistic regressions were used to determine if population characteristics and surgeon preferences influenced the patients' perceptions of RA-TKA. RESULTS There were 39.7% of respondents who said that they had no knowledge regarding RA-TKA. Only 40.7% of participants had expressed a desire for RA-TKA to be used. There were 8.7% who were WTP extra for the use of RA-TKA. Participants believed that the main 3 benefits of RA-TKA compared to conventional methods were: more accurate implant placement (56.2%); better results (49.0%); and faster recovery (32.1%). The main 3 patient concerns were harm from malfunction (55.2%), reduced surgeon role in the procedure (48.1%), and lack of supportive research (28.3%). Surgeon preference of RA-TKA was associated with patient's willingness to have RA-TKA (odds ratio 4.60, confidence interval 2.98-7.81, P < .001), and with WTP extra for RA-TKA (odds ratio 2.05, confidence interval: 1.01-4.26, P = .049). CONCLUSION Patient knowledge regarding RA-TKA is limited. Nonpeer-reviewed online information may make prospective TKA candidates vulnerable to misinformation and aggressive advertising. The challenge for orthopaedic surgeons is to re-establish control and reliably educate patients about the proven advantages and disadvantages of this emerging technology.
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Affiliation(s)
- Mohammad S Abdelaal
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Bright M Wiafe
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Irfan A Khan
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Justin A Magnuson
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Arjun Saxena
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Eric B Smith
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Jess H Lonner
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew M Star
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert P Good
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Peter F Sharkey
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania
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Yang P, He R, Lei K, Liu L, Yang L, Guo L. Clinical evaluation of the first semi-active total knee arthroplasty assisting robot made in China: a retrospective propensity score-matched cohort study. Int J Surg 2023; 109:1552-1560. [PMID: 37131329 PMCID: PMC10389537 DOI: 10.1097/js9.0000000000000322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 02/24/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The precision of overall alignment and knee morphotype after robot-assisted total knee arthroplasty has been fully confirmed. This study aims to conduct a clinical evaluation of the first China-made semi-active total knee arthroplasty assisting robot. METHODS After a 1 : 2 propensity score matching, that is, a matched cohort study, patients were matched to the robot group (52 cases) and the conventional group (104 cases). The robot group received osteotomy according to preoperative planning, while the conventional group adopted preoperative planning based on the full-length radiograph and received conventional osteotomy. Perioperative clinical indicators, such as operation time, tourniquet time, hospitalization days, intraoperative bleeding, and hemoglobin level of the two groups were recorded; radiological indicators of postoperative prosthesis position, including hip-knee-ankle angle, frontal femoral component angle, frontal tibial component angle, lateral femoral component angle, and lateral tibial component angle were also recorded; deviations and outliers of the radiological indicators were calculated. RESULTS Compared with the conventional group, the operation time and tourniquet time of the robot group were longer, and the postoperative hemoglobin level decreased less, the differences were statistically significant; the lateral tibial component angle of the conventional group was 80.9°±3.6°, which was smaller than 86.7 °±2.3° of the robot group, the difference was statistically significant ( P <0.001); except for lateral femoral component angle, the absolute deviations of the radiological indicators in the robot group were significantly smaller than that in the conventional group ( P ≤0.001); the outliers of the radiological indicators in the robot group were significantly smaller than that in the conventional group with a statistical difference ( P <0.05). CONCLUSION Compared with the conventional group, the operation time of the robot group was relatively longer, but the perioperation blood loss was less. The robot group could better control the posterior inclination of the tibial prosthesis, and the absolute deviations and outliers of the prosthesis position were relatively smaller. There was no difference in short-term clinical score between the two groups.
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Affiliation(s)
| | | | | | | | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Sutak AK, Ryan SP, Hong CS, Vovos TJ, Wellman SS, Jiranek WA, Seyler TM. The Effect of Medical Education on Patient Satisfaction: An Asset or a Liability? Orthopedics 2022; 45:276-280. [PMID: 35576485 DOI: 10.3928/01477447-20220511-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies have investigated the influence of trainee involvement on inpatient satisfaction scores in the postoperative joint arthroplasty setting. This study compares Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey scores at academic and private health care centers to assess the impact of trainees on patient satisfaction. From 2013 to 2017, 3454 HCAHPS surveys were collected at the investigating institution from patients who underwent primary total hip and total knee arthroplasty. Surveys were categorized based on the inpatient practice setting-academic hospitals included orthopedic residents and medical students who were involved in perioperative care, whereas private settings did not have trainee involvement. Patient demographics, including age, body mass index, sex, and American Society of Anesthesiologists score, were retrospectively collected. A total of 2454 HCAHPS surveys from 2 academic hospitals and 1000 surveys from a private hospital were collected. Patients at the academic hospitals were more likely to report that symptoms to look out for were clearly explained (odds ratio, 1.882; P=.001), whereas patients from the private hospital were more likely to report that the hospital was always quiet at night (odds ratio, 1.271; P=.005). The overall satisfaction score was not significantly different between the academic and private settings (78.9 vs 80.2, respectively; P=.111). The overall hospital satisfaction score for patients undergoing primary total hip and knee arthroplasty was not significantly different between private and academic medical facilities. Thus, this study supports the idea that training future orthopedic surgeons will not negatively impact patient satisfaction scores in a way that affects reimbursement. [Orthopedics. 2022;45(5):276-280.].
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Jardaly A, Torrez TW, McGwin G, Gilbert SR. Comparing complications of outpatient management of slipped capital femoral epiphysis and Blount’s disease: A database study. World J Orthop 2022; 13:373-380. [PMID: 35582157 PMCID: PMC9048495 DOI: 10.5312/wjo.v13.i4.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/10/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Currents trends in pediatric orthopaedics has seen an increase in surgeries being successfully completed in an outpatient setting. Two recent examples include slipped capital femoral epiphysis (SCFE) and Blount’s disease. Surgical indications are well-studied for each pathology, but to our knowledge, there is an absence in literature analyzing safety and efficacy of inpatient vs outpatient management of either condition. We believed there would be no increase in adverse outcomes associated with outpatient treatment of either conditions.
AIM To investigate whether outpatient surgery for SCFE and Blount’s disease is associated with increased risk of adverse outcomes.
METHODS The 2015-2017 American College of Surgeons National Surgical Quality Improvement Program Pediatric Registries were used to compare patient characteristics, rates of complications, and readmissions between outpatient and inpatient surgery for SCFE and Blount’s disease.
RESULTS Total 1788 SCFE database entries were included, 30% were performed in an outpatient setting. In situ pinning was used in 98.5% of outpatient surgeries and 87.8% of inpatient surgeries (P < 0.0001). Inpatients had a greater percent of total complications than outpatients 2.57% and 1.65% respectively. Regarding Blount’s disease, outpatient surgeries constituted 41.2% of the 189 procedures included in our study. The majority of inpatients were treated with a tibial osteotomy, while the majority of outpatients had a physeal arrest (P < 0.0001). Complications were encountered in 7.4% of patients, with superficial surgical site infections and wound dehiscence being the most common. 1.6% of patients had a readmission. No differences in complication and readmission risks were found between inpatients and outpatients.
CONCLUSION The current trend is shifting towards earlier discharges and performing procedures in an outpatient setting. This can be safely performed for a large portion of children with SCFE and Blount’s disease without increasing the risk of complications or readmissions. Osteotomies are more commonly performed in an inpatient setting where monitoring is available.
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Affiliation(s)
- Achraf Jardaly
- Department of Orthopaedics, Hughston Foundation/Hughston Clinic, Columbus, GA 31909, United States
| | - Timothy W Torrez
- Department of Orthopedics, University of Alabama, Birmingham, AL 35205, United States
| | - Gerald McGwin
- Department of Epidemiology, Center of Clinical and Translational Science, University of Alabama at Birmingham, Birmingham, AL 35205, United States
| | - Shawn R Gilbert
- Department of Pediatric Orthopaedics, University of Alabama at Birmingham, Birmingham, AL 35233, United States
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Mojica ES, Hurley ET, Markus DH, Bloom DA, Mannino BJ, Stein SM, Jazrawi LM, Campbell KA. Female Gender Is Associated with Lower Satisfaction with Postoperative Telemedicine Visits in Sports Medicine. Telemed J E Health 2022; 28:1658-1663. [PMID: 35333658 DOI: 10.1089/tmj.2021.0428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Telemedicine is a relatively new adjunct in orthopedic care but it has emerged from the periphery, driven in part by the COVID-19 pandemic. Although it has drastically increased in use, little is known of the factors that drive satisfaction with telemedicine. The purpose of the current study was to evaluate the patient's satisfaction with postoperative telemedicine visits in those undergoing knee or shoulder arthroscopy, and to analyze the factors associated with satisfaction with telemedicine. Methods: A prospective study was performed to evaluate satisfaction comparing postoperative telemedicine and in-office visits, in those undergoing shoulder and knee arthroscopy. Multiple factors were analyzed for correlation with satisfaction via multi-linear regression, including demographics such as gender, education, age, and race. Patients were also evaluated for preference for future visits with reference to the group in which they were placed. Results: Overall, 215 patients were included with a subgroup analysis of 93 patients receiving telemedicine visits. Patients reported overall similar satisfaction with telemedicine visits after shoulder and knee arthroscopy, with a high level of satisfaction seen in both. Female sex was found to be associated with decreasing satisfaction with telemedicine visits (p = 0.036). In addition, as a whole, the cohort was found to prefer future visits to be the same as the group they were placed in, but females statistically did not have this preference for their familiar group and were skewed toward the preference of in-person visits (p = 0.377). Conclusions: Our study found that female patients were less likely to be satisfied with postoperative telemedicine visits after knee or shoulder arthroscopy. Further, females were also less likely to indicate preference for future telemedicine visits. In contrast, education, history of prior surgery, age, and race were not associated with postoperative satisfaction.
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Affiliation(s)
- Edward S Mojica
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Eoghan T Hurley
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
- Department of Surgery, National University of Ireland Galway, Galway, Ireland
| | - Danielle H Markus
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - David A Bloom
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Brian J Mannino
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Spencer M Stein
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Laith M Jazrawi
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
| | - Kirk A Campbell
- Department of Orthopedic Surgery, New York University Langone Health, New York, New York, USA
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Naveen NB, Deckard ER, Ziemba-Davis M, Hanson LF, Warth LC, Meneghini RM. Patellar tilt does not affect patient reported outcomes after modern total knee arthroplasty. Knee 2022; 34:167-177. [PMID: 34933237 DOI: 10.1016/j.knee.2021.11.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/19/2021] [Accepted: 11/25/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The focus of patella maltracking after total knee arthroplasty (TKA) has traditionally been on patella polyethylene damage and failure mechanisms rather than functional outcomes. The purpose of this study was to evaluate the effect of patellar tilt on patient reported outcomes (PROMS) after primary TKA performed with patellar resurfacing. METHODS A retrospective review using a single implant design was performed. Patella tilt was radiographically measured according to a standardized protocol. PROMS related to pain, function, and satisfaction were evaluated preoperatively and at minimum 1-year follow-up. RESULTS A total of 468 TKAs were included for analysis. Mean age and BMI were 64 years and 35 kg/m2; respectively while 63% of patients were female. The median follow-up period was 12.7 months. Overall, patellar tilt was corrected from a median of 5.0 degrees preoperatively to a median of 3.0 degrees postoperatively. Preoperative, postoperative, and the change in patellar tilt had no significant effects on PROMS at minimum 1-year follow-up (p ≥ 0.092). Satisfaction in knee function while getting out of bed was higher for patients with approximately the same patellar tilt before and after TKA compared to patients with an increase in lateral patellar tilt (95% vs 80%, p = 0.025). CONCLUSIONS The range of patellar tilt studied in this cohort had little to no effect on PROMS. However, suboptimal patellar tracking may potentiate edge loading of the polyethylene and contribute to implant damage in the long-term. These results are helpful to focus efforts on the tibiofemoral articulation as the predominant determinant of patient outcomes.
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Affiliation(s)
- Neal B Naveen
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Evan R Deckard
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mary Ziemba-Davis
- Indiana University Health Physicians, IU Health Hip & Knee Center, Fishers, IN, USA
| | - Logan F Hanson
- Otsego Memorial Hospital Orthopaedic and Rehab Center, Gaylor, MI, USA
| | - Lucian C Warth
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Health Physicians, IU Health Hip & Knee Center, Fishers, IN, USA
| | - R Michael Meneghini
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN, USA; Indiana University Health Physicians, IU Health Hip & Knee Center, Fishers, IN, USA.
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Sun H, Zheng K, Zhang W, Li N, Zhang L, Zhou J, Xu Y, Li R. [Early effectiveness of computer navigation-assisted total knee arthroplasty]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1273-1280. [PMID: 34651480 DOI: 10.7507/1002-1892.202102070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To estimate the early effectivenss of computer navigation-assisted total knee arthroplasty (TKA) by comparing with traditional TKA. Methods The clinical data of 89 patients (100 knees) underwent primary TKA between October 2017 and July 2018 were analyzed retrospectively, including 44 patients (50 knees) who completed the TKA under the computer-assisted navigation system as the navigation group and 45 patients (50 knees) treated with traditional TKA as the control group. There was no significant difference between the two groups ( P>0.05) in gender, age, body mass index, diagnosis, side, disease duration, Kellgren-Lawrence classification of osteoarthritis, and preoperative American Hospital for Special Surgery (HSS) score, range of motion (ROM), hip-knee-ankle angle (HKA) deviation. The operation time, incision length, difference in hemoglobin before and after operation, postoperative hospital stay, and the complications were recorded and compared between the two groups. The HSS score, ROM, and joint forgetting score (FJS-12) were used to evaluate knee joint function in all patients. Unilateral patients also underwent postoperative time of up and go test and short physical performance battery (SPPB) test. At 1 day after operation, the HKA, mechanical lateral distal femoral angle (mLDFA), mechanical medial proximal tibial angle (mMPTA), sagittal femoral component angle (sFCA), and sagittal tibial component angle (sTCA) were measured and calculated the difference between the above index and the target value (deviation); and the joint line convergence angle (JLCA) was also measured. Results The operations of the two groups were successfully completed, and the incisions healed by first intention. The operation time and incision length of the navigation group were longer than those of the control group ( P<0.05); the difference in difference of hemoglobin before and after the operation and the postoperative hospital stay between groups was not significant ( P>0.05). Patients in the two groups were followed up 27-40 months, with an average of 33.6 months. Posterior tibial vein thrombosis occurred in 1 case in each of the two groups, and 1 case in the control group experienced repeated knee joint swelling. The HSS scores of the two groups gradually increased after operation ( P<0.05); HSS scores in the navigation group at 1 and 2 years after operation, and knee ROM and FJS-12 scores at 2 years were significantly higher than those in the control group ( P<0.05). There was no significant difference in the postoperative time of up and go test and SPPB results between the two groups at 7 days after operation ( P>0.05); the postoperative time of up and go test of the navigation group was shorter than that of the control group at 2 years ( t=-2.226, P=0.029), but there was no significant difference in SPPB ( t=0.429, P=0.669). X-ray film measurement at 1 day after operation showed that the deviation of HKA after TKA in the navigation group was smaller than that of the control group ( t=-7.392, P=0.000); among them, the HKA deviations of 50 knees (100%) in the navigation group and 36 knees (72%) in the control group were less than 3°, showing significant difference between the two groups ( χ 2=16.279, P=0.000). The JLCA and the deviations of mLDFA, mMPTA, sFCA, and sTCA in the navigation group were smaller than those in the control group ( P<0.05). Conclusion Compared with traditional TKA, computer navigation-assisted TKA can obtain more accurate prosthesis implantation position and lower limb force line and better early effectiveness. But there is a certain learning curve, and the operation time and incision length would be extended in the early stage of technology application.
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Affiliation(s)
- Houyi Sun
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Kai Zheng
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Weicheng Zhang
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Ning Li
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Lianfang Zhang
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Jun Zhou
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Yaozeng Xu
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
| | - Rongqun Li
- Department of Orthopeadics, the First Affiliated Hospital of Soochow University, Suzhou Jiangsu, 215000, P.R.China
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Erden A, Emirzeoğlu M. Factors Affecting the Satisfaction Levels of Patients who Underwent Orthopedic Knee Surgery in the Early Postoperative Period. J Patient Exp 2021; 8:23743735211043392. [PMID: 34632052 PMCID: PMC8493309 DOI: 10.1177/23743735211043392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this study was to investigate the effects of biopsychosocial parameters in the early postoperative period on the satisfaction of patients. Seventy-seven patients (female/male: 61/16, age: 40.28 ± 17.67 years) who underwent arthroscopic meniscectomy (n = 43), anterior cruciate ligament reconstruction (n = 25) and total knee arthroplasty (n = 9) were included in this study. The satisfaction levelwas evaluated using the Orthopedics Service Inpatient Satisfaction Survey (OTISS). In addition, the pain intensity, anxiety, depression, and independence level in daily living activities of the patients were evaluated. There was a very weak negative correlation between the anxiety and the satisfaction level with the physiotherapist and secretary (r: -0.274, p: 0.016; r:-0.265, p: 0.020). A very weak negative correlation was found between the pain intensity at activity and satisfaction with the nurse (r: -0.227, p: 0.048). There were very weak correlations between feeding and satisfaction with the physiotherapist (r: 0.292, p: 0.010), secretary (r: 0.285, p: 0.012), doctor (r: -0.269, p: 0.018), nurse (r: 0.300, p: 0.008) general satisfaction (r: 0.251, p: 0.028) and OTISS total score (r: -0.305, p: 0.007). In conclusion, the pain intensity, anxiety, and independence level in the early postoperative period were related to the satisfaction levels of patients who have undergone orthopedic knee surgery.
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Affiliation(s)
- Arzu Erden
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey
| | - Murat Emirzeoğlu
- Faculty of Health Science, Department of Physiotherapy and Rehabilitation, Karadeniz Technical University, Trabzon, Turkey
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Mercier MR, Galivanche AR, David WB, Malpani R, Pathak N, Hilibrand AS, Rubin LE, Grauer JN. Hospital Consumer Assessment of Healthcare Providers and Systems survey response rates are significantly affected by patient characteristics and postoperative outcomes for patients undergoing primary total knee arthroplasty. PLoS One 2021; 16:e0257555. [PMID: 34582475 PMCID: PMC8478166 DOI: 10.1371/journal.pone.0257555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/03/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey measures patients' satisfaction of their hospital experience. A minority of discharged patients return the survey. Underlying bias among who ultimately returns the survey (non-response bias) after total knee arthroplasty (TKA) may affect results of the survey. Thus, the objective of the current study is to assess the relationship between patient characteristics and postoperative outcomes on HCAHPS survey nonresponse. METHODS All adult patients at a single institution undergoing inpatient, elective, primary TKA between February 2013 and May 2020 were selected for analysis. Following discharge, all patients had been mailed the HCAHPS survey. The primary outcome analyzed in the current study is survey return. Patient characteristics, surgical variables, and 30-day postoperative outcomes were analyzed. Univariate and multivariate analyses were performed to identify factors independently associated with return of the HCAHPS survey. RESULTS Of 4,804 TKA patients identified, 1,498 (31.22%) returned HCAHPS surveys. On multivariate regression analyses controlling for patient factors, patients who did not return the survey were more likely to have a higher American Society of Anesthesia score (ASA score of 4 or higher, OR = 2.37; P<0.001), and be partially or totally dependent (OR = 2.37; P = 0.037). Similarly, patients who did not return the survey were more likely to have had a readmission (OR = 1.94; P<0.001), be discharged to a place other than home (OR = 1.52; P<0.001), or stay in the hospital for longer than 3 days (OR = 1.43; P = 0.004). DISCUSSION Following TKA, HCAHPS survey response rate was only 31.22% and completion of the survey was associated with several demographic and postoperative variables. These findings suggest that HCAHPS survey results capture a non-representative fraction of the true TKA patient population. This bias is necessary to consider when using HCAHPS survey results as a metric for quality of healthcare and federal reimbursement rates.
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Affiliation(s)
- Michael R. Mercier
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Anoop R. Galivanche
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Wyatt B. David
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Rohil Malpani
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Neil Pathak
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Ari S. Hilibrand
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Lee E. Rubin
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
| | - Jonathan N. Grauer
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, United States of America
- * E-mail:
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Opioid requirements in primary versus revision reverse shoulder arthroplasty. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 32:1509-1515. [PMID: 34559303 DOI: 10.1007/s00590-021-03121-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study is to evaluate the inpatient pain medication use of patients who had a revision shoulder arthroplasty procedure performed and compare them to a cohort of patients who had a primary reverse total shoulder arthroplasty (rTSA) performed to determine whether revision shoulder arthroplasty requires more pain medication.. METHODS A retrospective review was performed on patients undergoing revision arthroplasty (n = 75) and primary rTSA (n = 340). Inpatient medication records were reviewed to tabulate the visual analog pain (VAS) all narcotic medication use, and total morphine equivalent units (MEUs) were calculated for the duration of the inpatient stay. RESULTS There was no significant difference between groups regarding age, sex, body mass index, Charlson Comorbidity Index, American Society of Anesthesiologists score, preoperative narcotic pain medication use, tobacco use, postoperative VAS scores or hospital length of stay. There were no predictors of total postoperative MEUs identified. Overall, patients in the revision arthroplasty group received significantly less total MEUs than those in the primary rTSA group, 134.96 MEUs vs. 69.79 MEUs, respectively (p < .0005). CONCLUSION The perceived notion that revision shoulder arthroplasty is more painful may cause providers to be more inclined to increase narcotic use, or use more invasive pain control techniques. Based on these data, we found that revision shoulder arthroplasty did not require an increased opioid requirement, longer length of stay or increase VAS, suggesting that these patients can often be managed similarly to primary rTSA.
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Frane N, Stapleton EJ, Petrone B, Atlas A, Lutsky L, Cohn RM. Patient Satisfaction After Lower Extremity Total Joint Arthroplasty: An Analysis of Medical Comorbidities and Patient Demographics. J Patient Exp 2021; 8:23743735211018089. [PMID: 34179447 PMCID: PMC8205331 DOI: 10.1177/23743735211018089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)
survey has received increased attention to determine which demographics may
influence patient satisfaction after Total Hip and Knee Arthroplasty. The
purpose of this study was to evaluate the various effects that patient-specific
factors, medical comorbidities, and demographics had on patient satisfaction.
Two thousand and ninety-two patients underwent lower extremity total joint
arthroplasty at our institution between 2014 and 2018. Nine hundred twenty-three
of these patients responded to their HCAHPS survey (44%). Most patients (609,
66%) underwent primary total knee arthroplasty followed by 244 (26.4%) total hip
arthroplasties, 35 (3.8%) revision total knee arthroplasties, 28 (3.0%)
bilateral total knee arthroplasties, and 7 (0.8%) revision total hip
arthroplasties. Increasing age and length of stay were associated with a
decrease in patient satisfaction whereas patients who were married reported
higher satisfaction. Patients discharged to a rehabilitation facility had a 12%
decrease in top-box response rate compared to those discharged home. Contrary to
our hypothesis, specific procedure type and the presence of comorbidities failed
to predict patient satisfaction. The results of this study shed light on the
intricate relationship between patient satisfaction and patient-specific
factors. Furthermore, health care workers can counsel patients on expected
satisfaction when considering total hip and knee arthroplasty.
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Affiliation(s)
- Nicholas Frane
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Plainview, NY, USA
| | - Erik J Stapleton
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Plainview, NY, USA
| | - Brandon Petrone
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Plainview, NY, USA
| | - Aaron Atlas
- New York Institute of Technology College of Osteopathic Medicine, Glen Head, NY, USA
| | - Larry Lutsky
- Karsnoff Quality Management Institute, New Hyde Park, NY, USA
| | - Randy M Cohn
- Department of Orthopaedic Surgery, Zucker School of Medicine at Hofstra/Northwell, Plainview, NY, USA
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Matar RN, Shah NS, Vincent JC, Rayos Del Sol S, Grawe BM. Factors that influence inpatient satisfaction after shoulder arthroplasty. J Shoulder Elbow Surg 2021; 30:e165-e172. [PMID: 32750529 DOI: 10.1016/j.jse.2020.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 07/03/2020] [Accepted: 07/19/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is important to distinguish satisfaction regarding the outcome of care and satisfaction with the delivery of care. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys are modern assessments of hospitals and providers of delivery of care. The purpose of this study was to report inpatient satisfaction according to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) scores after shoulder arthroplasty and to determine factors that influence them, as well as their correlation with surgical expectations, pain perception, quality of life, surgical setting, and functional outcomes. METHODS All patients scheduled for a shoulder arthroplasty were prospectively asked to complete a demographic and initial shoulder assessment form, a shoulder surgery expectations survey, a pain catastrophizing scale, the SF-12 (12-item Short Form) survey, and a resiliency form (Resilience Scale 11). Patient satisfaction was measured with the CG-CAHPS and HCAHPS surveys. Legacy forms, patient-specific factors, type of surgery performed, location of surgery, length of hospital stay, and discharge disposition were evaluated on their ability to predict these survey scores. Linear regression was used to calculate correlations and predictions of continuous variables, and logistic regression was used to compared the satisfied vs. unsatisfied cohorts. RESULTS The average HCAHPS and CG-CAHPS satisfaction scores for the population were 74.7 ± 20.7 and 82.1 ± 19.4, respectively. Nonsmokers had a mean HCAHPS score of 77.7 ± 22.0, whereas current smokers reported a mean of 59.6 ± 5.2 (P = .03). Patients who were discharged home had a mean HCAHPS score of 77.3 ± 21.9, whereas those discharged to a skilled nursing facility reported a mean of 59.3 ± 6.6 (P = .05). These same groups also had significantly higher odds of being satisfied with the hospital. No significant differences or higher odds were seen for comparisons between overall CG-CAHPS satisfaction and any of the patient-specific factors tested. There was no significant correlation between age, length of stay, pain (pain catastrophizing scale), resiliency (Resilience Scale 11), expectations (shoulder surgery expectations survey), or function (SF-12) and both the HCAHPS and CG-CAHPS satisfaction scores. CONCLUSION Overall, 37 patients (74%) had CG-CAHPS scores that indicated satisfaction and 34 patients (68%) had HCAHPS scores that indicated satisfaction. Nonsmokers and patients discharged home after surgery report higher levels of inpatient hospital (HCAHPS) satisfaction after shoulder arthroplasty. Patients with high preoperative surgical expectations, pain perception, and resiliency are not generally more satisfied with the hospital or clinician. Preoperative diagnosis, location of surgery, and length of stay do not reliably impact satisfaction with the hospital or clinician. Inpatient HCAHPS and CG-CAHPS satisfaction does not correlate with legacy functional outcome measures and, therefore, may not be predictive of long-term functional outcomes.
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Affiliation(s)
- Robert N Matar
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA.
| | - Nihar S Shah
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Jonathan C Vincent
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Shane Rayos Del Sol
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Brian M Grawe
- Department of Orthopaedics and Sports Medicine, University of Cincinnati Medical Center, Cincinnati, OH, USA
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Patient Factors and Perioperative Outcomes Affect Hospital Consumer Assessment of Healthcare Providers and Systems Survey Response Rates After Primary Total Hip Replacement. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202104000-00001. [PMID: 33798127 DOI: 10.5435/jaaosglobal-d-21-00052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a federally mandated survey that assesses patient satisfaction after hospitalization. It has been noted that a minority of patients actually return the survey. Potential bias in who does and does not respond to the survey (nonresponse bias) after total hip arthroplasty (THA) may affect the survey results. METHODS All adult patients undergoing inpatient elective primary THA between February 2013 and May 2020 at a single institution were selected for retrospective analysis. After discharge, all had been mailed the HCAHPS survey, and the primary outcome for the current study was survey return. Patient characteristics and 30-day perioperative outcomes were assessed. Univariate and multivariate analyses were performed to determine correlations between the above variables and HCAHPS survey return status. RESULTS Of 3,310 THA patients analyzed, 1,049 (31.69%) returned the HCAHPS surveys. On multivariate regression analyses, patients who did not return the survey were more likely to have a higher American Society of Anesthesia score (score of three or higher, odds ratio [OR] = 2.27; P < 0.001), be more functionally dependent (OR = 2.69; P = 0.005), or be Black/African American (OR = 3.40; P < 0.001). Similarly, patients who did not return the survey were more likely to have had any adverse event (OR = 1.80; P = 0.012), major adverse event (OR = 2.88; P = 0.007), readmission (OR = 2.13; P < 0.001), be discharged to a place other than home (OR = 1.71; P < 0.001), or stay in the hospital for longer than 3 days (OR = 1.89; P < 0.001). DISCUSSION After THA, the HCAHPS survey response rate was only 31.69% and completion of the survey correlated with demographic and perioperative variables. These findings suggest that the HCAHPS survey results should be interpreted as a skewed sample of the true surgical patient population. Nonresponse bias is an important factor to consider when evaluating healthcare quality, patient satisfaction survey results, and their effects on federal hospital reimbursement rates.
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Mahure SA, Teo GM, Long WJ. Differences in Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Scores for a Single Surgeon Comparing Two Institutions: An Unfair Reimbursement Metric. J Arthroplasty 2021; 36:403-411. [PMID: 33039193 DOI: 10.1016/j.arth.2020.08.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Emphasis on value-based purchasing links physician financial remuneration to patient-derived outcome scores. Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys aim to provide a uniform comparison tool. Of the 22 different survey questions, only 3 (13.6%) focus on experience related to doctors. We sought to determine how HCAHPS scores differ for a single surgeon performing more than 500 total joint arthroplasties annually, divided almost equally between two centers. METHODS HCAHPS data from 2015 to 2018 for a single, fellowship-trained arthroplasty surgeon were collected from two different hospitals. More than 200 cases were performed at each center with the same staff. One center is a large metropolitan academic-teaching hospital, and the other is a suburban private hospital. The purpose of the study was to determine if differences existed regarding HCHAPS scores between the two institutions. RESULTS A significant difference was found between institutions regarding questions pertaining to "hospital environment," "admission process," and "hospital staff concern for pain," with more patients responding favorably in Institution Two than Institution One. CONCLUSION Patient perceptions and ratings of overall experience differ significantly between hospitals even when surgery is performed by a single surgeon. These results lend credence to the fact that surgeons should not be unduly penalized for the hospital in which they operate, and financial remuneration involving HCAHPS scores must be approached with caution. This unfair system could potentially drive surgeons to perform the majority of their cases in the hospital system with higher scores in the nonphysician related domains as this would affect overall patient satisfaction, and thus, financial compensation.
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Affiliation(s)
- Siddharth A Mahure
- University Langone Orthopaedic HospitalDepartment of Orthopaedic Surgery, New York, NY; Department of Orthopaedic Surgery, New York University Langone Orthopaedic Hospital, New York, NY
| | - Greg M Teo
- Insall Scott Kelly Institute, New York, NY
| | - William J Long
- Department of Orthopaedic Surgery, New York University Langone Orthopaedic Hospital, New York, NY; Insall Scott Kelly Institute, New York, NY
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Liu M, Hu L, Guo R, Wang H, Cao M, Chen X, Liu Y. The Influence of Patient and Hospital Characteristics on Inpatient Satisfaction at Beijing District-Level Hospitals. Patient Prefer Adherence 2021; 15:1451-1460. [PMID: 34234418 PMCID: PMC8253896 DOI: 10.2147/ppa.s314910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/04/2021] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Patient satisfaction is a key indicator of healthcare quality and hospital performance. This study aims to assess inpatient satisfaction at district-level hospitals and explore the determinants of inpatient satisfaction. PATIENTS AND METHODS A total of 1458 adults from inpatient departments of 47 district-level hospitals in 16 districts across Beijing were recruited with a multi-stage stratified sample at Beijing in 2019. Univariate analysis and multivariate logistic regression were used to identify the influence of patient and institutional characteristics on inpatient satisfaction in four domains - administrative process, hospital environment, medical care, hospitalization expenses, and overall satisfaction. RESULTS Of the 1458 participants, 577 (39.6%) were men, 581 (39.8%) were over 60 years of age. The average value of satisfaction score measured by a 5-point Likert scale were 4.37, 4.00, 4.44, 3.89, and 4.33 for the four domains and overall satisfaction. Patient and institutional characteristics were strongly associated with inpatient satisfaction. Patients with higher educational level were more satisfied with administrative process (P<0.05). Elder patients and patients with worse self-reported health status were less satisfied with hospital environment (P<0.05). Female, higher monthly family income and Urban Employees Basic Medical Insurance were positively associated with patient satisfaction in hospitalization expenses (P<0.05). And patients receiving care in suburban hospitals were less satisfied with administrative process, hospital environment and overall satisfaction (P<0.05). Patients receiving care in Traditional Chinese Medicine hospitals were more satisfied with medical care and expenses but less satisfied with environment (P<0.05). Chronic disease and hospital grade were not significantly associated with satisfaction in all domains. CONCLUSION Patient satisfaction was influenced by demographic characteristics and hospital features. These determinants should be considered in hospital evaluation.
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Affiliation(s)
- Meicen Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Linlin Hu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
- Correspondence: Linlin Hu Chinese Academy of Medical Sciences and Peking Union Medical College, 5 Dongdansantiao, Dongcheng District, Beijing, 100730, People’s Republic of ChinaTel +86-13-661229049Fax +86-65105830 Email
| | - Ran Guo
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Huanqian Wang
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Man Cao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Xinyue Chen
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, People’s Republic of China
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Bloomfield RA, Broberg JS, Williams HA, Lanting BA, McIsaac KA, Teeter MG. Machine learning and wearable sensors at preoperative assessments: Functional recovery prediction to set realistic expectations for knee replacements. Med Eng Phys 2020; 89:14-21. [PMID: 33608121 DOI: 10.1016/j.medengphy.2020.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/30/2020] [Accepted: 12/22/2020] [Indexed: 11/19/2022]
Abstract
Unmet expectations contribute to a high patient dissatisfaction rate following total knee replacement but clinicians currently do not have the tools to confidently adjust expectations. In this study, supervised machine learning was applied to multi-variate wearable sensor data from preoperative timed-up-and-go tests. Participants (n=82) were instrumented three months after surgery and patients showing relevant improvement were designated as "responders" while the remainder were labelled "maintainers". Support vector machine, naïve Bayes, and random forest binary classifiers were developed to distinguish patients using sensor-derived features. Accuracy, sensitivity, specificity, and area under the receiver-operator curve (AUC) were compared between models using ten-fold out-of-sample testing. A high performance using only sensor-derived functional metrics was obtained with a random forest model (accuracy = 0.76 ± 0.11, sensitivity = 0.87 ± 0.08, specificity = 0.57 ± 0.26, AUC = 0.80 ± 0.14) but highly sensitive models were observed using naïve Bayes and SVM models after including patient age, sex, and BMI into the feature set (accuracy = 0.72, 0.73 ± 0.09, 0.12; sensitivity = 0.94, 0.95 ± 0.11, 0.11; specificity = 0.35, 0.37 ± 0.20, 0.18; AUC = 0.80, 0.74 ± 0.07, 0.11; respectfully). Including select patient-reported subjective measures increased the top random forest performance slightly (accuracy = 0.80 ± 0.10, sensitivity = 0.91 ± 0.14, specificity = 0.62 ± 0.23, AUC = 0.86 ± 0.09). The current work has demonstrated that prediction models developed from preoperative sensor-derived functional metrics can reliably predict expected functional recovery following surgery and this can be used by clinicians to help set realistic patient expectations.
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Affiliation(s)
- Riley A Bloomfield
- Department of Electrical & Computer Engineering, Western University, London, CA, USA.
| | - Jordan S Broberg
- Department of Medical Biophysics, Western University, London, CA, USA
| | | | - Brent A Lanting
- Schulich School of Medicine, Western University, London, CA, USA
| | - Kenneth A McIsaac
- Department of Electrical & Computer Engineering, Western University, London, CA, USA
| | - Matthew G Teeter
- Department of Medical Biophysics, Western University, London, CA, USA; Schulich School of Medicine, Western University, London, CA, USA
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Lei K, Liu LM, Xiang Y, Chen X, Fan HQ, Peng Y, Luo JM, Guo L. Clinical value of CT-based patient-specific 3D preoperative design combined with conventional instruments in primary total knee arthroplasty: a propensity score-matched analysis. J Orthop Surg Res 2020; 15:591. [PMID: 33298106 PMCID: PMC7724895 DOI: 10.1186/s13018-020-02123-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 11/25/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate the operation and early clinical effect in primary total knee arthroplasty (TKA) about the novel combination of CT-based patient-specific three-dimensional (3D) preoperative design and conventional osteotomy instruments, compared with the conventional method. Methods After a 1:1 propensity score-matching (PSM), patients were matched to the novel technique group and the conventional group, 109 cases in each group. The conventional group adopted a preoperative design based on a full-length radiograph (FLX) and received TKA with conventional osteotomy instruments. The novel technique group used a CT-based patient-specific 3D preoperative design combined with conventional osteotomy instruments; during the surgery, the femoral entry point, femoral valgus osteotomy angle, the fix point of tibial plateau extramedullary guide pin, and the position of tibial extramedullary positioning rod were accurately selected according to the preoperative 3D design to ensure accurate intraoperative implementation. The lower limb alignment, component position, operation time, tourniquet time, hospital stay, blood loss volume, incidence of postoperative complications, visual analog scale (Vas) score, and New Knee Society Score System (NEW-KSS) at 1 day before operation and 1, 6, and 12 months after operation were recorded and compared. Results The novel technique group was significantly better than the conventional group in controlling lateral tibial component angle (LTC) (P < 0.001), and the novel technique group had lower percentages of hip-knee-ankle angle (HKA) outliers (P < 0.001) and overcorrection (P = 0.003). The operation time, tourniquet time, and hospital stay of the novel technique group was shorter (P < 0.05). In 1 month after the operation, the novel technique group achieved a significantly better VAS score (P < 0.05), but a similar NEW-KSS score (P > 0.05) when compared with the conventional group. But in 6 and 12 months after surgery, no statistical differences were seen in the above two scores (P > 0.05). Conclusion The novel technique of CT-based patient-specific 3D preoperative design combined with conventional instruments can improve the accuracy of osteotomy in primary total knee arthroplasty, with benefits of significantly reducing pain and rapid recovery during the early postoperative period, but having no obvious effect on outcome after a 1-year follow-up.
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Affiliation(s)
- Kai Lei
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Li Ming Liu
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Yi Xiang
- Department of Orthopaedics, Logistic Support Forces of the Chinese PLA 985 Hospital, No. 30 Qiaodong Street, Taiyuan, 030001, Shanxi, China
| | - Xin Chen
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Hua Quan Fan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Yang Peng
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Jiang Ming Luo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University, No. 30 Gaotanyan Street, Shapingba District, Chongqing, 400036, China.
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Diwan W, Nakonezny PA, Wells J. The Effect of Length of Hospital Stay and Patient Factors on Patient Satisfaction in an Academic Hospital. Orthopedics 2020; 43:373-379. [PMID: 32956469 DOI: 10.3928/01477447-20200910-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 02/03/2023]
Abstract
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a metric for patient satisfaction consisting of 19 questions divided into 10 domains. Scores affect hospital reimbursements and accreditation and may play a role in patient outcomes. It is unclear how length of stay and other factors affect each of the 10 domains. This retrospective review gathered data of 600 patients between December 2008 and January 2017 who completed the HCAHPS survey. The odds of complete satisfaction in each of the 10 domains was evaluated. The results suggest increased length of stay is associated with lower odds of patient satisfaction and decreased likelihood of recommending the hospital. The odds of being completely satisfied regarding communication with physicians, discharge information, and responsiveness of the hospital staff, as well as the odds of recommending the hospital to others, were lower if the care provider was younger than the patient. Obese patients were also more likely to be satisfied with responsiveness and care transition. Male patients were more satisfied with communication about medications (odds ratio [OR], 1.694), care transition (OR, 1.489), and cleanliness (OR, 2.120). Medicare and fewer consults were related to increased odds of patient satisfaction with care transition (OR, 1.748 and 0.573, respectively). Males, older patients, and White patients were more likely to recommend the hospital (OR, 1.476, 1.025, and 1.690, respectively). Length of stay affects patient satisfaction and likelihood of recommending the hospital to others. Other factors such as a younger provider age than the patient, lower body mass index, female sex, non-Medicare insurance, and higher number of consults are also associated with lower satisfaction in various domains. Hospital systems can bolster patient satisfaction by strategizing day-of-surgery and weekend staffing to reduce length of stay. [Orthopedics. 2020;43(6):373-379.].
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Abstract
Inpatient satisfaction evaluation is essential for orthopedics serves. So the aim of this study was to develop a survey to evaluate the inpatients satisfaction in the orthopedics and traumatology service. The study was conducted with 102 patients (22 females and 80 males), who were hospitalized in an orthopedics and traumatology service. Data collection was performed with face to face interview. The survey development process was carried out in 4 steps: defining the problem and determining the subdimensions (1), composition an item pool (2), counselling expert (3), and reformation and implementation the survey (4). The final version of the survey have had 6 subdimensions: physiotherapist (1-3 items), inpatient administration (4,5 items), technical equipment and hygiene (6-8), doctor (9-11 items), nurse (12-14 items), and general satisfaction (15,16 items). In survey development process, internal consistency and item analysis were used for the reliability analysis. Cronbach alpha coefficient was calculated. The mean age of the participants was 41.43 ± 17.85 years, 85 of the patients underwent surgery on the knee, 13 on the hip, 3 on the leg, and 1 on the thigh. Six items were excluded from 22-itemed basic form of the survey as a result of the item analysis. The internal consistency of the final version of the survey was found good reliable (Cronbach alpha: 0.880). So health providers will be able to use it reliably on orthopedic inpatients speaking Turkish. Also it could be translate to other language to widely use.
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Affiliation(s)
- Arzu Erden
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Karadeniz Technical University, Trabzon, Turkey
| | - Murat Emirzeoğlu
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Karadeniz Technical University, Trabzon, Turkey
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Chen Y, Fang X, Huang Z, Li W, Zhang W. Factors affecting the clinical outcomes including patient satisfaction after Oxford unicompartmental knee arthroplasty: a retrospective study. ARTHROPLASTY 2020; 2:19. [PMID: 35236452 PMCID: PMC8796461 DOI: 10.1186/s42836-020-00038-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oxford unicompartmental knee arthroplasty (UKA) is widely used for treating patients with unicompartmental knee diseases. However, the factors affecting the outcomes of and patients' satisfaction with Oxford UKA remain controversial. The aims of this study were to evaluate the clinical and radiological outcomes, including patient satisfaction, after Oxford UKA and identify the influencing factors related to patients' satisfaction. METHODS We retrospectively analyzed the data of patients who underwent UKA in our medical institution from 2013 to 2018. Demographic information, clinical scores, patient satisfaction and imaging findings were recorded. The patients were followed up for at least 1 year. Multivariate Logistic regression analysis was performed to identify influencing factors related to clinical outcomes including patient satisfaction. RESULTS A total of 80 patients (involving 87 knees) were included. The Numerical Rating Scale (NRS) scores and Knee Society Scores (KSS) were significantly improved after operation as compared to preoperative scores (6.0 vs. 1.0, P < 0.001; 113.0 ± 27.2 vs. 167.2 ± 23.9, P < 0.001), and the varus deformity was corrected (181.0 vs. 176.0, P < 0.05). Six patients (7.5%) developed postoperative complications, and no case suffered from prosthesis loosening. The time since operation (TSO) and angle E were found to be predictors of KSS improvement (P = 0.009; P = 0.024). The postoperative KSS and angle E were found to be predictors of patient satisfaction (P = 0.001; P = 0.032). CONCLUSION Oxford UKA can improve the NRS score and KSS and correct varus deformities. A shorter TSO and smaller angle E are indicators of a greater KSS improvement. A higher KSS and smaller angle E are indicative of higher patient satisfaction.
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Affiliation(s)
- Yang Chen
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Xinyu Fang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Zida Huang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Wenbo Li
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China
| | - Wenming Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, 350004, China.
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Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To assess nonresponder biases for the HCAHPS survey following spine surgery. SUMMARY OF BACKGROUND DATA The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publicly reported patient satisfaction survey. In addition to having the potential of impacting a hospital's reputation, it is directly linked to government reimbursement. However, it is known that a minority of patients return this survey, and it is expected that there are nonresponder biases. METHODS All adult inpatient spine surgery patients at a single institution between January 2013 and August 2017 at a single institution were selected for retrospective analysis. Patient demographics and perioperative outcomes were assessed as potential predictors of not returning HCAHPS surveys. Univariate and multivariate analyses were performed. RESULTS Of 5517 spine surgeries analyzed, 1505 (27.3%) patients returned the HCAHPS survey. Response rate was variable based on patient characteristics (with statistically significant differences based on age, functional status, race, and American Society of Anesthesiologists score) but not variable based on anatomic region of the spine surgery. Multivariate analysis revealed that patients who did not return the HCAHPS survey were more likely to be black/African American (OR = 2.8, P < 0.001), have a higher American Society of Anesthesiologists score (OR 1.76, P < 0.001), and have had a major adverse event (OR = 1.66; P = 0.001), minor adverse event (OR = 2.50; P < 0.001), discharged to a destination other than home (OR = 2.16, P < 0.001), hospital readmission (OR = 2.58; P < 0.001), and a long hospital length of stay (OR = 1.28, P = 0.001). CONCLUSION For spine surgery patients, patient characteristics and perioperative outcomes were found to be significantly associated with the nonresponder bias for HCAHPS surveys. Although the potential resultant bias in HCAHPS scores cannot be directly determined, this must be considered in interpreting the results of such satisfaction surveys given that less than one-third of patients actually completed this survey in the study population. LEVEL OF EVIDENCE 3.
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Proper Disposal of Prescription Opioids in Southwest Virginia: Assessment of Patient, Physician, and Medical Student Beliefs and Practices. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26:259-269. [PMID: 32235208 DOI: 10.1097/phh.0000000000001153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
CONTEXT Southwestern Virginia demonstrates the highest regional mortality rate from prescription opioid overdoses. Nationally, 65% of patients misusing opioid medications received them from friends and family, underscoring the need for effective disposal of unused narcotics. OBJECTIVES (1) To understand patient, provider, and medical student beliefs and misconceptions regarding proper methods of opioid disposal; (2) to characterize discrepancies that exist between patient self-reported habits and medical student/provider perceptions of opioid usage, disposal, and diversion. DESIGN Descriptive, cross-sectional, observational study. SETTING Large, nonprofit health care organization and allopathic medical school in Southwestern Virginia. PARTICIPANTS All ambulatory patients 18 years or older presenting for elective consultation at health system orthopedics department; all institutionally employed physicians with active system e-mail addresses; and all current students at the associated medical school. MAIN OUTCOMES/MEASURES Patients: The number who had received information regarding proper methods of opioid disposal, intended disposal method, methods of disposal considered appropriate, comfort level with opioid disposal, and demographic data. Physicians and Medical Students: The number who had received instruction regarding proper methods of opioid disposal, acceptable means of opioid disposal, most appropriate disposal method, disposal method most likely to be employed by patients, practice profile/prescribing data, and medical school year. RESULTS In total, 64% of patients (n = 255/750) had never received instruction from a physician regarding opioid disposal; 56% of physicians (n = 212/732) and 78% (n = 80/171) of medical students indicated that they never received formal instruction regarding methods of disposal. The majority of physicians believed that their patients are most likely to use in-home methods of disposal or store prescription medications for future use; 61% of patients indicated a preference for accessible disposal facilities. CONCLUSIONS The discrepancy between patient and physician responses highlights a lack of communication regarding disposal of unused opioid medications and is a target for future intervention.
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Mets EJ, Mercier MR, Hilibrand AS, Scott MC, Varthi AG, Grauer JN. Patient-related Factors and Perioperative Outcomes Are Associated with Self-Reported Hospital Rating after Spine Surgery. Clin Orthop Relat Res 2020; 478:643-652. [PMID: 31389897 PMCID: PMC7145058 DOI: 10.1097/corr.0000000000000892] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 06/24/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Since 2013, the Centers for Medicare & Medicaid Services has tied a portion of hospitals' annual reimbursement to patients' responses to the Hospital Consumer Assessment and Healthcare Providers and Systems (HCAHPS) survey, which is given to a random sample of inpatients after discharge. The most general question in the HCAHPS survey asks patients to rate their overall hospital experience on a scale of 0 to 10, with a score of 9 or 10 considered high, or "top-box." Previous work has suggested that HCAHPS responses, which are meant to be an objective measure of the quality of care delivered, may vary based on numerous patient factors. However, few studies to date have identified factors associated with HCAHPS scores among patients undergoing spine surgery, and those that have are largely restricted to surgery of the lumbar spine. Consequently, patient and perioperative factors associated with HCAHPS scores among patients receiving surgery across the spine have not been well elucidated. QUESTIONS/PURPOSES Among patients undergoing spine surgery, we asked if a "top-box" rating on the overall hospital experience question on the HCAHPS survey was associated with (1) patient-related factors present before admission; (2) surgical variables related to the procedure; and/or (3) 30-day perioperative outcomes. METHODS Among 5517 patients undergoing spine surgery at a single academic institution from 2013 to 2017 and who were sent an HCAHPS survey, 27% (1480) returned the survey and answered the question related to overall hospital experience. A retrospective, comparative analysis was performed comparing patients who rated their overall hospital experience as "top-box" with those who did not. Patient demographics, comorbidities, surgical variables, and perioperative outcomes were compared between the groups. A multivariate logistic regression analysis was performed to determine patient demographics, comorbidities, and surgical variables associated with a top-box hospital rating. Additional multivariate logistic regression analyses controlling for these variables were performed to determine the association of any adverse event, major adverse events (such as myocardial infarction, pulmonary embolism), and minor adverse events (such as urinary tract infection, pneumonia); reoperation; readmission; and prolonged hospitalization with a top-box hospital rating. RESULTS After controlling for potential confounding variables (including patient demographics), comorbidities that differed in incidence between patients who rated the hospital top-box and those who did not, and variables related to surgery, the patient factors associated with a top-box hospital rating were older age (compared with age ≤ 40 years; odds ratio 2.2, [95% confidence interval 1.4 to 3.4]; p = 0.001 for 41 to 60 years; OR 2.5 [95% CI 1.6 to 3.9]; p < 0.001 for 61 to 80 years; OR 2.1 [95% CI 1.1 to 4.1]; p = 0.036 for > 80 years), and being a man (OR 1.3 [95% CI 1.0 to 1.7]; p = 0.028). Further, a non-top-box hospital rating was associated with American Society of Anesthesiologists Class II (OR 0.5 [95% CI 0.3 to 0.9]; p = 0.024), Class III (OR 0.5 [95% CI 0.3 to 0.9]; p = 0.020), or Class IV (OR 0.2 [95% CI 0.1 to 0.5]; p = 0.003). The only surgical factor positively associated with a top-box hospital rating was cervical surgery (compared with lumbar surgery; OR 1.4 [95% CI 1.1 to 1.9]; p = 0.016), while nonelective surgery (OR 0.5 [95% CI 0.3 to 0.8]; p = 0.004) was associated with a non-top-box hospital rating. Controlling for the same set of variables, a non-top-box rating was associated with the occurrence of any adverse event (OR 0.5 [95% CI 0.3 to 0.7]; p < 0.001), readmission (OR 0.5 [95% CI 0.3 to 0.9]; p = 0.023), and prolonged hospital stay (OR, 0.6 [95% CI 0.4 to 0.8]; p = 0.004). CONCLUSIONS Identifying patient factors present before surgery that are independently associated with HCAHPS scores underscores the survey's limited utility in accurately measuring the quality of care delivered to patients undergoing spine surgery. HCAHPS responses in the spine surgery population should be interpreted with caution and should consider the factors identified here. Given differing findings in the literature regarding the effect of adverse events on HCAHPS scores, future work should aim to further characterize this relationship. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Elbert J Mets
- E. J. Mets, M. R. Mercier, A. S. Hilibrand, M. C. Scott, A. G. Varthi, J. N. Grauer, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Michael R Mercier
- E. J. Mets, M. R. Mercier, A. S. Hilibrand, M. C. Scott, A. G. Varthi, J. N. Grauer, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Ari S Hilibrand
- E. J. Mets, M. R. Mercier, A. S. Hilibrand, M. C. Scott, A. G. Varthi, J. N. Grauer, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Michelle C Scott
- E. J. Mets, M. R. Mercier, A. S. Hilibrand, M. C. Scott, A. G. Varthi, J. N. Grauer, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
- M. C. Scott, Meharry Medical College, School of Medicine, Nashville, TN, USA
| | - Arya G Varthi
- E. J. Mets, M. R. Mercier, A. S. Hilibrand, M. C. Scott, A. G. Varthi, J. N. Grauer, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Jonathan N Grauer
- E. J. Mets, M. R. Mercier, A. S. Hilibrand, M. C. Scott, A. G. Varthi, J. N. Grauer, Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Eftekhary N, Feng JE, Anoushiravani AA, Schwarzkopf R, Vigdorchik JM, Long WJ. Hospital Consumer Assessment of Healthcare Providers and Systems: Do Patient Demographics Affect Outcomes in Total Hip Arthroplasty? J Arthroplasty 2019; 34:2580-2585. [PMID: 31266690 DOI: 10.1016/j.arth.2019.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 05/08/2019] [Accepted: 06/04/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score is a nationally standardized measure of a patient's hospital experience. This study aims to assess whether HCAHPS scores vary by demographic or surgical factors in patients undergoing primary total hip arthroplasty. METHODS Patients who completed an HCAHPS survey after a primary total hip arthroplasty between October 2011 and November 2016 were included in this study. Patient demographics and surgical factors were evaluated for correlations with individual HCAHPS questions. RESULTS One thousand three hundred eighty-three HCAHPS questionnaires were reviewed for this study. Patients with a submitted HCAHPS response had an average age of 63.83 ± 10.17 years. Gender distribution was biased toward females at 57.27% (792 females) versus 42.73% (591 males). The average body mass index (BMI) was 28.68 ± 5.86 kg/m2. Race distribution was predominantly Caucasian at 81.49% (1127 patients), followed by "unknown" at 8.60% (119 patients) and African-American at 8.46% (117 patients). Home discharge occurred for 93.06% (1287 patients) versus 6.94% for facility discharge (96 patients). Mean length of stay was 2.41 ± 1.17 days. Each 1-year increase in age was positively correlated with a 0.16% increase in top-box response rate (β = 0.0016 ± 0.0008; P < .05). Male gender was correlated with a 4.61% increase in top-box response rate when compared to female gender (β = 0.0461 ± 0.0118; P < .01). BMI was found to be correlated with a 0.20% increase in HCAHPS response rates for each 1 kg/m2 increase (β = 0.0020 ± 0.0010; P < .05). For each day increase in length of stay, HCAHPS top-box response rates decrease by 3.41% (β = -0.0341 ± 0.0051; P < .0001). Race, marital status, smoking status, insurance type, and discharge disposition were not found to be significantly correlated with HCAHPS top-box response rate (P > .05). CONCLUSION The HCAHPS quality measurement metric affects physician reimbursement and may be biased by a number of variables including sex, length of stay, and BMI, rather than a true reflection of the quality of their hospital experience. Further research is warranted to determine whether HCAHPS scores are an appropriate measure of the quality of care received.
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Affiliation(s)
- Nima Eftekhary
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - James E Feng
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Insall Scott Kelly Institute, New York, NY
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Press Ganey Administration of Hospital Consumer Assessment of Healthcare Providers and Systems Survey Result in a Biased Responder Sample for Hip and Knee Arthroplasties. J Arthroplasty 2019; 34:2538-2543. [PMID: 31331703 DOI: 10.1016/j.arth.2019.06.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Press Ganey administration of Hospital Consumer Assessment of Healthcare Providers and Systems Survey after discharge is sometimes used to monitor hospital performance and adjust reimbursements. HYPOTHESIS significant differences exist between responders and nonresponders. We assessed baseline characteristic differences between responders and nonresponders; sampling bias; responding predictability in total joint arthroplasty patients; and differences in sampling and response rates among different hospitals. METHODS A prospective database of arthroplasty patients from January 1, 2016 to September 30, 2016 was used to compare responders' and nonresponders' baseline characteristics at 4 hospitals. A univariate analysis between groups was performed. A multiple logistic regression model was used to assess whether Press Ganey sampling was predictable. We identified receiving and responding predictors. RESULTS We captured 96.6% (3255 of 3369) of hip and knee arthroplasties. Hospital Consumer Assessment of Healthcare Providers and Systems Survey sampling rate was 60% and response rate was 36% (1157). Responders were more likely Caucasians, nonsmokers, discharged home, have shorter hospital stays, have higher baseline joint pain and physical composite scores, and have better mental health composite scores. Concordance indices suggest reasonable-to-very-strong model predictability for those sampled (range 0.56-0.91) and those responding (range 0.61-0.78). Completion predictors were Caucasian race (P < .0001), younger ages (P < .0001), discharged home (P < .0001), negative smoking status (P = .02), quit smoking (P = .0026), higher baseline mental health composite scores (P = .0096), and diagnoses of femoroacetabular impingement (P = .0056), osteoarthritis (P = .0111), or prosthesis failure (P = .0036). CONCLUSION Responders/nonresponders were significantly different in several characteristics. It can be predicted who will likely be sampled and who will complete. Responders were not representative of arthroplasty population. Research is needed for more representative sampling methods. LEVEL OF EVIDENCE Level III.
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Smith GA, Chirieleison S, Levin J, Atli K, Winkelman R, Tanenbaum JE, Mroz T, Steinmetz M. Impact of length of stay on HCAHPS scores following lumbar spine surgery. J Neurosurg Spine 2019; 31:366-371. [PMID: 31151093 DOI: 10.3171/2019.3.spine181180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, completed by patients following an inpatient stay, are utilized to assess patient satisfaction and quality of the patient experience. HCAHPS results directly impact hospital and provider reimbursements. While recent work has demonstrated that pre- and postoperative factors can affect HCAHPS results following lumbar spine surgery, little is known about how these results are influenced by hospital length of stay (LOS). Here, the authors examined HCAHPS results in patients with LOSs greater or less than expected following lumbar spine surgery to determine whether LOS influences survey scores after these procedures. METHODS The authors conducted a retrospective review of HCAHPS surveys, patient demographics, and outcomes following lumbar spine surgery at a single institution. A total of 391 patients who had undergone lumbar spine surgery and had completed an HCAHPS survey in the period between 2013 and 2015 were included in this analysis. Patients were divided into those with a hospital LOS equal to or less than the expected (LTE-LOS) and those with a hospital LOS longer than expected (GTE-LOS). Expected LOS was based on the University HealthSystem Consortium benchmarks. Nineteen questions from the HCAHPS survey were examined in relation to patient LOS. The primary outcome measure was a comparison of "top-box" ("9-10" or "always or usually") versus "low-box" ("1-8" and "somewhat or never") scores on the HCAHPS questions. Secondary outcomes of interest were whether the comorbid conditions of cancer, chronic renal failure, diabetes, coronary artery disease, hypertension, stroke, or depression occurred differently with respect to LOS. Statistical analysis was performed using Fisher's exact test for the 2 × 2 contingency tables and the chi-square test for categorical variables. RESULTS Two hundred fifty-seven patients had an LTE-LOS, whereas 134 patients had a GTE-LOS. The only statistically significant difference in preoperative characteristics between the patient groups was hypertension, which correlated to a shorter LOS. A GTE-LOS was associated with a decreased likelihood of a top-box score for the HCAHPS survey items on doctor listening and pain control. CONCLUSIONS Here, the authors report a decreased likelihood of top-box responses for some HCAHPS questions following lumbar spine surgery if LOS is prolonged. This study highlights the need to further examine the factors impacting LOS, identify patients at risk for long hospital stays, and improve mechanisms to increase the quality and efficiency of care delivered to this patient population.
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Affiliation(s)
| | | | - Jay Levin
- 2Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Karam Atli
- 2Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Robert Winkelman
- 2Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Thomas Mroz
- 1Center for Spine Health, Cleveland Clinic Foundation; and
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Eftekhary N, Feng JE, Anoushiravani AA, Schwarzkopf R, Vigdorchik JM, Long WJ. Hospital Consumer Assessment of Healthcare Providers and Systems: Do Patient Demographics Affect Outcomes in Total Knee Arthroplasty? J Arthroplasty 2019; 34:1570-1574. [PMID: 31053469 DOI: 10.1016/j.arth.2019.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/03/2019] [Accepted: 04/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a nationally standardized tool to assess patient experience between hospitals. The HCAHPS survey can affect hospital reimbursement. This study aims to determine if HCAHPS scores vary by a number of demographic variables in patients undergoing primary total knee arthroplasty (TKA). METHODS Patients who underwent primary TKA and returned a completed HCAHPS survey were included in this study. HCAHPS surveys were collected from our institution's Center for Quality and Patient Safety department, which was cross-referenced with our hospital's electronic data warehouse. Patient demographics, surgical factors, and quality outcomes were queried, and multivariable linear regression was performed. RESULTS In total, 1028 HCAHPS questionnaires after primary TKA were evaluated. The average age of patients was 65.9 ± 9.0 years and 67.9% (698 patients) were female. Average body mass index was 32.5 ± 6.9 kg/m2. Sixty-nine percent of the patients (1287 patients) were discharged home versus 10.3% (106 patients) to another facility. Mean length of stay was 2.9 ± 1.4 days. Age was correlated with a 0.3% decrease in top-box response rate (P < .01) for each 1-year increase in age. Compared to Caucasian race, African American race was correlated with a 5.6% increased rate for top-box response (P < .01), while Asian race (P = .42) and unknown race (P = 1.00) demonstrated no significant difference. Marital status demonstrated that divorced/separated status resulted in a significant 5.4% decrease in top-box response rates (P < .05). Similarly, single (P = .12) and widowed (P = .09) statuses also demonstrated a trend toward lower top-box response rates when compared to married or partnered patients. For each day increase in length of stay, HCAHPS top-box response rates decrease by 1.6% (P < .01). Gender, body mass index, smoking status, insurance type, and discharge disposition were not found to be significantly correlated with HCHAPS top-box response rate (P > .05). CONCLUSION HCAHPS scores in patients undergoing primary TKA are influenced not just by hospital and surgeon factors such as length of stay but by demographic variables such as age, race, and marital status. As surgeons become more involved with the burden of improving patient experience, they should be aware that static demographic variables can have a significant effect on HCAHPS scores.
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Affiliation(s)
- Nima Eftekhary
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - James E Feng
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopaedic Surgery, Albany Medical Center, Albany, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY; Insall Scott Kelly Institute for Orthopaedics and Sports Medicines, New York, NY
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Wijaya MI, Mohamad AR, Hafizurrachman M. Improving patient satisfaction: the virtual breakthrough series collaborative. Int J Health Care Qual Assur 2019; 32:296-306. [PMID: 30859877 DOI: 10.1108/ijhcqa-01-2018-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to improve the Siloam Hospitals' (SHs) patient satisfaction index (PSI) and overcome Indonesia's geographical barriers. DESIGN/METHODOLOGY/APPROACH The topic was selected for reasons guided by the Institute of Healthcare Improvement virtual breakthrough series collaborative (VBSC). Subject matter experts came from existing global quality development in collaboration with sales and marketing, and talent management agencies/departments. Patient satisfaction (PS) was measured using the SH Customer Feedback Form. Data were analysed using Friedman's test. FINDINGS The in-patient (IP) department PSI repeated measures comparison during VBSC, performed using Friedman's test, showed a statistically significant increase in the PSI, χ2 = 44.00, p<0.001. Post hoc analysis with Wilcoxon signed-rank test was conducted with a Bonferroni correction applied, which resulted in a significant increase between the baseline and action phases ( Z=3.317, p=0.003) between the baseline and continuous improvement phases ( Z=6.633, p<0.001), and between the action and continuous improvement phases ( Z=3.317, p=0.003), suggesting that IP PSI was continuously increasing during all VBSC phases. Like IP PSI, the out-patient department PSI was also continuously increasing during all VBSC phases. RESEARCH LIMITATIONS/IMPLICATIONS The VBSC was not implemented using a control group. Factors other than the VBSC may have contributed to increased PS. PRACTICAL IMPLICATIONS The VBSC was conducted using virtual telecommunication. Although conventional breakthrough series might result in better cohesiveness and commitment, Indonesian geographical barriers forced an alternative strategy, which is much more cost-effective. ORIGINALITY/VALUE The VBSC, designed to improve PS, has never been implemented in any Indonesian private hospital group. Other hospital groups might also appreciate knowing about the VBSC to improve their PSI.
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Affiliation(s)
- Made Indra Wijaya
- Faculty of Medicine, Cyberjaya University College of Medical Sciences (CUCMS) , Cyberjaya, Malaysia
| | - Abd Rahim Mohamad
- Faculty of Medicine, Cyberjaya University College of Medical Sciences (CUCMS) , Cyberjaya, Malaysia
| | - Muhammad Hafizurrachman
- Department of Public Health, Sekolah Tinggi Ilmu Kesehatan Indonesia Maju, Jakarta, Indonesia
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Eftekhary N, Feng JE, Anoushiravani AA, Schwarzkopf R, Vigdorchik JM, Long WJ. Revision Versus Primary Hospital Consumer Assessment of Healthcare Providers and Systems Scores in Total Joint Arthroplasty. J Arthroplasty 2019; 34:S84-S90. [PMID: 30545652 DOI: 10.1016/j.arth.2018.11.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 10/23/2018] [Accepted: 11/10/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) score is a nationally standardized measure of a patient's inpatient experience. This study aims to assess whether HCAHPS scores differ between patients undergoing primary total joint arthroplasty (TJA) and patients undergoing revision TJA. METHODS Patients who underwent primary or revision total hip or total knee arthroplasty (THA or TKA) and returned a completed HCAHPS survey were included in this study. HCAHPS scores were collected from our institution's Center for Quality and Patient Safety department, which was cross-referenced with our hospital's electronic data warehouse. Patient demographics, surgical factors, and quality outcomes were queried. Appropriate statistical analyses were performed using MatLab 2017a and P-values less than .05 were deemed significant. RESULTS In total, 523 primary and 59 revision THA recipients completed HCAHPS surveys at our institution between October 2011 and November 2016. During this same period, 507 primary TKA recipients and 40 revision TKA recipients completed HCAHPS surveys. Compared to revision THA, primary THA patients had a significantly higher top box for overall hospital ratings (58.46% vs 41.38%), felt that nurses listened to them carefully (84.3% vs 72.88%), and felt that they clearly understood the role of each medication (69.48% vs 56.90%). Moreover, 18 of 20 HCAHPS question responses favored primary THA despite not reaching significance for the majority of HCAHPS questions. Patients with revision TKA demonstrated a significantly higher incidence of "top box" choices for quieter rooms and a trend favoring better HCAHPS scores in revision TKA in a further 12 of 20 HCAHPS responses. CONCLUSION Patients undergoing primary THA report higher HCAHPS scores than those undergoing revision THA, while revision TKA demonstrated a general trend toward higher scores when compared to primary TKA patients. This publicly reported quality measurement metric which factors into physician reimbursement may be biased by the patient's health status, the complexity of the surgical procedure, and length of stay in hospital rather than a true reflection of the quality of their hospital experience.
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Affiliation(s)
- Nima Eftekhary
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - James E Feng
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Afshin A Anoushiravani
- Department of Orthopedic Surgery, Albany Medical Center, Albany Medical College, Albany, NY
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - Jonathan M Vigdorchik
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
| | - William J Long
- Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY
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Predicting Inpatient Dissatisfaction Following Total Joint Arthroplasty: An Analysis of 3,593 Hospital Consumer Assessment of Healthcare Providers and Systems Survey Responses. J Arthroplasty 2019; 34:824-833. [PMID: 30777630 DOI: 10.1016/j.arth.2019.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 12/14/2018] [Accepted: 01/05/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, created by the Centers for Medicare and Medicaid, is directly tied to hospital reimbursement. The purpose of this study is to identify factors that are predictive HCAHPS survey responses following primary hip and knee arthroplasty. METHODS Prospectively collected HCAHPS responses from patients undergoing elective hip and knee arthroplasty between January 2013 and October 2017 at our institution were analyzed. Patient age, gender, race, marital status, body mass index, American Society of Anesthesiologists score, preoperative pain score, smoking status, alcohol use, illegal drug use, socioeconomic quartile, insurance type, procedure type, hospital type (academic vs community), distance to medical center, length of stay (LOS), and discharge disposition were obtained and correlated with HCAHPS inpatient satisfaction scores. RESULTS Responses from 3593 patients were obtained: 1546 total hip arthroplasties, 1899 total knee arthroplasties, and 148 unicompartmental knee arthroplasties. Mean overall HCAHPS score was 79.2. Women had lower inpatient satisfaction than men (77.6 vs 81.6, P < .001). Alcohol consumers had lower inpatient satisfaction than abstainers (77.7 vs 81.6, P < .001). Inpatient satisfaction varied by socioeconomic quartile (P < .001) with patients in the highest quartile having lower satisfaction than patients in all other quartiles (P < .001). Patients discharged to a facility had lower inpatient satisfaction than those discharged home (71.2 vs 80.2, P < .001). An inverse correlation between inpatient satisfaction and LOS (r = -0.19, P < .001) and a direct correlation between satisfaction and distance to medical center (r = 0.06, P < .001) were seen. CONCLUSION Patients more likely to report lower levels of inpatient satisfaction after total joint arthroplasty are female, affluent, and alcohol consumers, who are discharged to postacute care facilities. Inpatient satisfaction was inversely correlated with LOS and positively correlated with distance from patient home to medical center. These findings provide targets for improvements in TJA inpatient care.
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Boylan MR, Slover JD, Kelly J, Hutzler LH, Bosco JA. Are HCAHPS Scores Higher for Private vs Double-Occupancy Inpatient Rooms in Total Joint Arthroplasty Patients? J Arthroplasty 2019; 34:408-411. [PMID: 30578151 DOI: 10.1016/j.arth.2018.11.033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/19/2018] [Accepted: 11/22/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Private hospital rooms have a number of potential advantages compared to shared rooms, including reduced noise and increased control over the hospital environment. However, the association of room type with patient experience metrics in total joint arthroplasty (TJA) patients is currently unclear. METHODS For private versus shared rooms, we compared our institutional Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores in patients who underwent primary TJA over a 2-year period. Regression model odds ratios (ORs) were adjusted for surgeon, date of surgery, and length of stay. RESULTS Patients in private rooms were more likely to report a top-box score for overall hospital rating (85.6% vs 79.4%, OR = 1.53, P = .011), hospital recommendation (89.3% vs 83.0%, OR = 1.78, P = .002), call button help (76.0% vs 68.7%, OR = 1.40, P = .028), and quietness (70.4% vs 59.0%, OR = 1.78, P < .001). There were no significant differences on surgeon metrics including listening (P = .225), explanations (P = .066), or treatment with courtesy and respect (P = .396). CONCLUSION For patients undergoing TJA, private hospital rooms were associated with superior performance on patient experience metrics. This association appears specific for global and hospital-related metrics, with little impact on surgeon evaluations. With the utilization of HCAHPS data in value-based initiatives, placement of TJA patients in private rooms may lead to increased reimbursement and higher hospital rankings. LEVEL OF EVIDENCE Level III, retrospective cohort.
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Affiliation(s)
- Matthew R Boylan
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - James D Slover
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Joan Kelly
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Lorraine H Hutzler
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
| | - Joseph A Bosco
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, New York
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Menendez ME, Shaker J, Lawler SM, Ring D, Jawa A. Negative Patient-Experience Comments After Total Shoulder Arthroplasty. J Bone Joint Surg Am 2019; 101:330-337. [PMID: 30801372 DOI: 10.2106/jbjs.18.00695] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND There is growing interest in enhancing the patient experience after discretionary orthopaedic surgery. Patient narratives are a potentially valuable but largely unscrutinized source of information. Using machine learning to understand sentiment within patient-experience comments, we explored the content of negative comments after total shoulder arthroplasty (TSA), their associated factors, and their relationship with traditional measures of patient satisfaction and with perioperative outcomes. METHODS An institutional registry was used to link the records of 186 patients who had undergone elective primary TSA between 2016 and 2017 with vendor-supplied patient satisfaction data, which included patient comments and the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Using a machine-learning-based natural language processing approach, all patient comments were mined for sentiment and classified as positive, negative, mixed, or neutral. Negative comments were further classified into themes. Multivariable logistic regression was employed to determine characteristics associated with providing a negative comment. RESULTS Most patients (71%) provided at least 1 comment; 32% of the comments were negative, 62% were positive, 5% were mixed, and 1% were neutral. The themes of the negative comments were room condition (27%), time management (17%), inefficient communication (13%), lack of compassion (12%), difficult intravenous (IV) insertion (10%), food (10%), medication side effects (6%), discharge instructions (4%), and pain management (2%). Women and sicker patients were more likely to provide negative comments. Patients who made negative comments were more likely to be dissatisfied with overall hospital care and with pain management (2 HCAHPS core items), but there were no differences in any of the studied outcomes (peak pain intensity, opioid intake, operative time, hospital length of stay, discharge disposition, or 1-year American Shoulder and Elbow Surgeons [ASES] score) between those who provided negative comments and those who did not. CONCLUSIONS Patient-narrative analysis can shed light on the aspects of the process of care that are most critiqued by patients. While patient satisfaction may not be a surrogate for effectiveness of care or functional outcomes, efforts to improve the hospital environment, enhance nontechnical skills, and reduce unnecessary delays are important in providing high-quality, patient-centered care after TSA.
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Affiliation(s)
- Mariano E Menendez
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts
| | - Jonathan Shaker
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts
| | - Sarah M Lawler
- Boston Sports and Shoulder Center, Waltham, Massachusetts
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, Texas
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, Massachusetts.,Boston Sports and Shoulder Center, Waltham, Massachusetts
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Jildeh TR, Taylor KA, Khalil LS, Okoroha KR, Matar RN, Geisenhoff A, Moutzouros V. Risk Factors for Postoperative Opioid Use in Arthroscopic Meniscal Surgery. Arthroscopy 2019; 35:575-580. [PMID: 30612767 DOI: 10.1016/j.arthro.2018.10.122] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 10/22/2018] [Accepted: 10/24/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE (1) To evaluate the influence of preoperative opioid use on postoperative consumption after arthroscopic meniscal surgery and (2) to determine preoperative patient factors associated with increased opioid use after meniscal surgery. METHODS We performed a retrospective review of all patients with a primary diagnosis of a meniscal tear at a single institution between August 2013 and February 2017. Patients were classified as opioid nonusers if they had not received any opioid medications in the 3 months before meniscal surgery, as acute users if they received at least 1 opioid prescription within 1 month preceding meniscal surgery, or as chronic users if they received at least 1 opioid prescription within 3 months preceding meniscal surgery. Clinical records were reviewed for postoperative opioid use within a year after surgery. We also recorded patient demographic characteristics and the degree of knee osteoarthritis at the time of surgery using the Outerbridge classification. RESULTS A total of 735 patients were included. The average age was 46.7 years (range, 12-79 years), and the average body mass index was 30.2 ± 6.2 (range, 13.3-55.4). Patients who were acute or chronic opioid users preoperatively were more likely to continue to use opioids beyond 1 month postoperatively (P < .001). A higher percentage of patients with advanced osteoarthritis (Outerbridge grade 3 or 4) were found to continue to use opioids at all time points beyond the first postoperative month (P < .05). Pair-wise comparisons showed that the number of total opioid prescriptions filled was significantly higher in the group with Outerbridge grade 1 or 2 and the group with Outerbridge grade 3 or 4 than the group with Outerbridge grade 0 (P = .023 and P = .014, respectively). No significant difference in postoperative opioid use was noted when we compared meniscal repair versus resection, primary procedure versus revision, different tear types, or concomitant procedures. CONCLUSIONS In patients undergoing arthroscopic meniscal surgery, the chronicity of preoperative opioid intake and degree of knee osteoarthritis were found to have a significant effect on postoperative opioid use. LEVEL OF STUDY Level III, retrospective comparative study.
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Affiliation(s)
- Toufic R Jildeh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A..
| | - Kevin A Taylor
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Lafi S Khalil
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Kelechi R Okoroha
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Robert N Matar
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan, U.S.A
| | | | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
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Menendez ME, Lawler SM, Ring D, Jawa A. High pain intensity after total shoulder arthroplasty. J Shoulder Elbow Surg 2018; 27:2113-2119. [PMID: 30322752 DOI: 10.1016/j.jse.2018.08.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/26/2018] [Accepted: 08/05/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND As reimbursement becomes increasingly tied to quality and patient experience, there is growing interest in alleviation of postoperative pain combined with optimal opioid stewardship. We characterized predictors of severe inpatient pain after elective total shoulder arthroplasty and evaluated its association with opioid use, operative time, hospital length of stay, discharge disposition, and cost. METHODS We identified 415 patients undergoing elective primary total shoulder arthroplasty between 2016 and 2017 from our registry. Severe postoperative pain was defined as peak pain intensity ≥75th percentile. Multivariable logistic regression modeling was used to determine preoperative characteristics associated with severe pain, including demographics, emotional health, comorbidities, and American Shoulder and Elbow Surgeons score. Opioid consumption was expressed as oral morphine equivalents (OMEs). Costs were calculated using time-driven activity-based costing. RESULTS In decreasing order of magnitude, the predictors of severe postoperative pain were greater number of self-reported allergies, preoperative chronic opioid use, lower American Shoulder and Elbow Surgeons score, and depression. Patients reporting severe pain took more opioids (202 vs. 84 mg OMEs), stayed longer in the hospital (2.9 vs. 2.0 days), used postacute inpatient rehabilitation services more frequently (28% vs. 10%), and were more likely to be high-cost patients (23% vs. 5%; all P < .001), but they did not have longer operations (166 vs. 165 minutes, P = .86). CONCLUSIONS Efforts to address psychological and social determinants of health might do as much or more than technical improvements to alleviate pain, limit opioid use, and contain costs after shoulder arthroplasty. These findings are important in the redesign of care pathways and bundling initiatives.
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Affiliation(s)
- Mariano E Menendez
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA
| | - Sarah M Lawler
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Andrew Jawa
- Department of Orthopaedic Surgery, New England Baptist Hospital, Tufts University School of Medicine, Boston, MA, USA; Boston Sports and Shoulder Center, Waltham, MA, USA.
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Factors Driving Patient Perception of Quality Care After Primary Total Hip and Total Knee Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2018; 2:e061. [PMID: 30656258 PMCID: PMC6324905 DOI: 10.5435/jaaosglobal-d-18-00061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Introduction: Differences in female and male patient perception of care and satisfaction following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) were assessed via Hospital Consumer Assessment of Healthcare Providers and Systems survey, demographic, and clinical data. Methods: After institutional review board approval, a retrospective review of the Hospital Consumer Assessment of Healthcare Providers and Systems survey responses at a private, academic, level-I trauma center was performed from January 2011 to December 2013. Inclusion criteria were primary THA and TKA patients who were 18 years or older and returned the survey. Results: Overall, 1,166 THA and 1,411 TKA were included, with 55.0% of female THA patients and 64.5% of male THA patients highly satisfied (P = 0.002). The mean overall hospital rating was 7.2 for female THA and 7.8 for male THA (P = 0.003) patients. No significant differences was found in the TKA cohort. For all cohorts, the Nurse Communication with Nurses domain reported the greatest correlation with overall hospital rating (range, ρ = 0.418 to ρ = 0.502; P < 0.0001). Discussion: This series indicated that initiatives to improve patient care and patient perception of care should focus on nurse-patient communication, hospital staff responsiveness, the care transition process, and hospital environment. Patient sex was a significant factor in the overall satisfaction for THA, with female patients reporting significantly lower ratings than male patients.
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Inpatient Versus Outpatient Hip and Knee Arthroplasty: Which Has Higher Patient Satisfaction? J Arthroplasty 2018; 33:3402-3406. [PMID: 30143333 DOI: 10.1016/j.arth.2018.07.025] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND More surgeons are offering patients the option of having adult reconstructive procedures performed as an outpatient at an ambulatory surgery center. However, it is unknown if these patients have higher or lower satisfaction with their care than patients having a traditional inpatient stay. The purpose of this study is to compare satisfaction between inpatients and outpatients undergoing hip or knee arthroplasty. METHODS Portions of the Health Consumer Assessment of Healthcare Providers and Systems survey, the Friends and Family Test, and 8 additional questions were administered to 174 consecutive patients. There were 8 non-responders (95.4% response rate) leaving 102 who underwent inpatient and 64 who had outpatient surgery. Responses were stratified using the "boxes" scoring approach as recommended by Health Consumer Assessment of Healthcare Providers and Systems and analyzed with a chi-squared or Fischer's exact test where appropriate. Power analysis determined that 38 patients per group were needed to detect a 1-point difference in overall satisfaction between groups with 80% power and alpha of 0.05 considered significant. RESULTS Outpatients responded with more top responses when asked about the staff's explanation of any medicines received (91.4% vs 77.5%, P = .026), the staff's assistance with their pain management (98.3% vs 88.0%, P = .022), the written health information they were given upon discharge (98.3% vs 90.1%, P = .05), and the courtesy and respect from the nurses (100.0% vs 92.2%, P = .022). Inpatients responded with more bottom responses when asked how prepared they felt for discharge home (8.9% vs 0.0%, P = .014). Top responses in overall satisfaction with the facility (87.1% vs 93.4%, P = .204) and overall experience (89.2% vs 95.2%, P = .177) were similar between inpatients and outpatients, respectively. Not surprisingly, inpatients were older (64.1 vs 59.2 years, P = .001), heavier (body mass index 32.7 vs 30.4, P = .035), and had higher Charlson comorbidity scores (2.6 vs 1.9, P = .002). CONCLUSION Although satisfaction was high in both groups, when differences were present they favored outpatient surgery in the ambulatory surgery center.
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Politzer CS, Kildow BJ, Goltz DE, Green CL, Bolognesi MP, Seyler TM. Trends in Opioid Utilization Before and After Total Knee Arthroplasty. J Arthroplasty 2018; 33:S147-S153.e1. [PMID: 29198871 DOI: 10.1016/j.arth.2017.10.060] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/11/2017] [Accepted: 10/11/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Opioids are a mainstay in perioperative pain management among patients undergoing total knee arthroplasty (TKA). However, patterns in opioid use before and after TKA have not been well-studied. The objectives of this study are to characterize prescribing trends preoperatively and postoperatively and identify risk factors for chronic postoperative opioid use. METHODS A review of the prescription-tracking database of a large private payer from 2007 to 2013 was performed using International Classification of Diseases, Ninth Revision and Current Procedural Terminology codes. Chronic opioid use was defined as opioid prescriptions over 6 contiguous months postoperatively. RESULTS We identified 66,950 patients who underwent TKA with minimum 2-year follow-up and medication codes. Of those taking opioids preoperatively (n = 36,668), 34.8% became chronic users postoperatively compared to only 5.0% of the opioid-naïve cohort (n = 30,282). Major risk factors for chronic postoperative opioid use included preoperative opioid use (relative risk [RR] 3.75, 95% confidence interval [CI] 3.59-3.93), female gender (RR 1.23, 95% CI 1.20-1.25), and younger age (≤44 vs ≥60: RR 1.41, 95% CI 1.32-1.49; 45-59 vs ≥60: RR 1.42, 95% CI 1.40-1.46). From 2007 to 2013, there was a significant linear increase in opioid use preoperatively (odds ratio [OR] 1.04, 95% CI 1.03-1.05, P < .001) and postoperatively (OR 1.20, 95% CI 1.18-1.21, P < .001), but chronic postoperative opioid use increased only marginally (OR 1.01, 95% CI 1.00-1.02, P = .021). CONCLUSION The greatest risk factors for chronic postoperative opioid use were preoperative use, younger age, female gender, greater length of stay, and worse health status. Although the use of opioids continues to grow significantly preoperatively and postoperatively, chronic opioid use post-TKA has remained clinically unchanged.
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Affiliation(s)
- Cary S Politzer
- Duke University School of Medicine, Mary Duke Biddle Trent Semans Center for Health Education, Duke University Medical Center Greenspace, Durham, North Carolina
| | - Beau J Kildow
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Daniel E Goltz
- Duke University School of Medicine, Mary Duke Biddle Trent Semans Center for Health Education, Duke University Medical Center Greenspace, Durham, North Carolina
| | - Cynthia L Green
- Department of Biostatistics and Bioinformatics, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Michael P Bolognesi
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thorsten M Seyler
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina
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Evolution and Use of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Surveys and Their Application for Spinal Surgery Patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1097/01.css.0000532432.98702.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Emergency department visits after lumbar spine surgery are associated with lower Hospital Consumer Assessment of Healthcare Providers and Systems scores. Spine J 2018; 18:226-233. [PMID: 28739479 DOI: 10.1016/j.spinee.2017.06.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/12/2017] [Accepted: 06/28/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys are used to assess the quality of the patient experience following an inpatient stay. Hospital Consumer Assessment of Healthcare Providers and Systems scores are used to determine reimbursement for hospital systems and incentivize spine surgeons nationwide. There are conflicting data detailing whether early readmission or other postdischarge complications are associated with patient responses on the HCAHPS survey. Currently, the association between postdischarge emergency department (ED) visits and HCAHPS scores following lumbar spine surgery is unknown. PURPOSE To determine whether ED visits within 30 days of discharge are associated with HCAHPS scores for patients who underwent lumbar spine surgery. STUDY DESIGN Retrospective cohort study. PATIENT SAMPLE A total of 453 patients who underwent lumbar spine surgery who completed the HCAHPS survey between 2013 and 2015 at a single tertiary care center. OUTCOME MEASURES The HCAHPS survey-the Centers for Medicare and Medicaid Services' official measure of patient experience-results for each patient were analyzed as the primary outcome of this study. METHODS All patients undergoing lumbar spine surgery between 2013 and 2015 who completed an HCAHPS survey were studied. Patients were excluded from the study if they had been diagnosed with spinal malignancy or scoliosis. Patients who had an ED visit at our institution within 30 days of discharge were included in the ED visit cohort. The primary outcomes of this study include 21 measures of patient experience on the HCAHPS survey. Statistical analysis included Pearson chi-square for categorical variables, Student t test for normally distributed continuous variables, and Mann-Whitney U test for nonparametric variables. Additionally, log-binomial regression models were used to analyze the association between ED visits within 30 days after discharge and odds of top-box HCAHPS scores. No funds were received in support of this study, and the authors report no conflict of interest-associated biases. RESULTS After adjusting for patient-level covariates using log-binomial regression models, we found postdischarge ED visits were independently associated with lower likelihood of top-box score for several individual questions on HCAHPS. Emergency department visits within 30 days of discharge were negatively associated with perceiving your doctor as "always" treating you with courtesy and respect (risk ratio [RR] 0.26, p<.001), as well as perceiving your doctor as "always" listeningcarefully to you (RR 0.40, p=.003). Also, patients with an ED visit were less likely to feel as if their preferences were taken into account when leaving the hospital (RR 0.61, p=.008), less likely to recommend the hospital to family or friends (RR 0.46, p=.020), and less likely to rate the hospital as a 9 or a 10 out of 10, the top-box score (RR 0.43, p=.005). CONCLUSIONS Our results demonstrate a strong association between postdischarge ED visits and low HCAHPS scores for doctor communication, discharge information, and global measures of hospital satisfaction in a lumbar spine surgery population.
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