Patient Factors and Perioperative Outcomes Affect Hospital Consumer Assessment of Healthcare Providers and Systems Survey Response Rates After Primary Total Hip Replacement

Effect of Rehabilitation Nursing under the Guidance of the Health Action Process Approach Model on Perioperative Nursing Effect of Artificial Hip Arthroplasty: Effect on Promoting Quality of Life and Postoperative Rehabilitation

Objective

To explore the influence of rehabilitation nursing under the guidance of Health Action Process Approach (HAPA) model on the perioperative nursing effect of artificial hip replacement and to analyze the effect of this nursing model on the quality of life and postoperative rehabilitation of patients undergoing artificial hip replacement.

Methods

A total of 200 patients with hip arthroplasty treated in our hospital from January 2019 to July 2021 were enrolled. The patients were randomly assigned into the control group and study group. The former received routine nursing, and the latter received rehabilitation nursing under the guidance of the HAPA model. Nursing satisfaction, pain score, Harris hip function score, timed stand-up-walk test, MBI score, and quality of life score were compared.

Results

First of all, we compared the nursing satisfaction. In the study group, 86 cases were very satisfied, 8 cases were satisfied, and 6 cases were general; the satisfaction rate was 100%. In the control group, 48 cases were very satisfied, 22 cases were satisfied, 12 cases were general, and 18 cases were dissatisfied; the satisfaction rate was 82.0%. The nursing satisfaction in the study group was higher compared to that in the control group (P < 0.05). Secondly, we compared the pain scores. Before nursing, there exhibited no significant difference (P > 0.05). After nursing, the pain score of the two groups increased. Moreover, the pain score of the study group at discharge and 1 month, 3 months, and 6 months after operation was lower compared to that of the control group (P < 0.05). Before nursing, there exhibited no significant difference in the Harris hip joint function score (P > 0.05). After nursing, the Harris hip function score increased. Furthermore, the Harris hip function score of the study group at discharge and 1 month, 3 months, and 6 months after operation was higher compared to that of the control group (P < 0.05). In terms of the timed stand-up-walking test, there exhibited no significant difference before nursing (P > 0.05). After nursing, the time of the timed stand-up-walk test in both groups decreased. And the timed stand-up-walk test at discharge and 1 month, 3 months, and 6 months after operation in the study group was lower compared to that in the control group (P < 0.05). Compared with the MBI scores, there exhibited no significant difference before nursing (P > 0.05). After nursing, the MBI scores increased. Of note, the MBI scores of the study group at discharge and 1 month, 3 months, and 6 months after operation were higher compared to those of the control group (P < 0.05). Finally, we compared the scores of life quality. Before nursing, there exhibited no significant difference (P > 0.05). After nursing, the scores of life quality decreased. The scores of physiological function, psychological function, social function, and health self-cognition in the study group were lower compared to those in the control group (P < 0.05).

Conclusion

The perioperative rehabilitation nursing program of artificial hip replacement for the elderly based on the HAPA model is feasible, which can effectively enhance the functional recovery of hip joint, promote the ability of self-care of daily life, relieve pain and anxiety, and help to achieve dynamic balance and gait stability in the early stage. The rehabilitation program is better than routine nursing. As a new social cognitive model, the HAPA model is applied to the rehabilitation nursing environment of hip replacement from the aspect of social cognitive behavior, which can help to enhance the rehabilitation behavior of elderly patients, playing an important role in the rehabilitation effect of perioperative nursing.

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

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.