Gwam Chukwuweike, Mistry Jaydev B, Piuzzi Nicolas, Chughtai Morad, Khlopas Anton, Thomas Melbin, Elmallah Randa K, Muschler George, Mont Michael A, Harwin Steven F, Delanois Ronald E
Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
Surg Technol Int. 2017 Jul 25;30:373-378.
Recent healthcare reform has spurred important changes to provider reimbursement. With the implementation of the Value Based Purchasing program, significant weight is placed on patient experience of care. The Press Ganey (PG) survey is currently used by over 10,000 hospitals, as it serves to help optimize patient satisfaction. However, confounding factors, such as clinical depression, are not screened against by PG. Thus, arthroplasty surgeons performing lower extremity total joint arthroplasty (TJA) may have difficulty optimizing patient satisfaction while caring for patients with clinical depression. Therefore, we asked: 1) What Press Ganey elements affect the overall hospital rating in patients who suffer from clinical depression? and 2) Are survey responses different between patients who do and do not have clinical depression?
We queried our institutional PG database for patients who underwent a TJA from November 2009 to January 2015. Our search yielded 1,454 patients, of which 204 suffered from depression and 1,250 did not. Multiple regression analysis was performed to determine the influence (b weight) of selected PG survey domains on overall hospital rating. The weighted mean for domain was also calculated.
Multiple regression analyses showed that overall hospital ratings were significantly influenced by communication with nurses (b-weight = 0.881, p< 0.001) in post-TJA patients with depression. The remaining domains were not statistically significant. There were no significant differences in individual PG elements for patients who did and did not have depression.
Overall patient satisfaction among patients with depression was greatly influenced by communication with nurses. Understanding these challenges may encourage care coordination across disciplines for the management of patients with depression before and after surgery. As a result, this could optimize orthopedic surgery outcomes, but, more importantly, patient health and satisfaction, while reducing costs of care.
近期的医疗改革推动了医疗服务提供者报销政策的重大变革。随着基于价值的采购计划的实施，患者的就医体验被赋予了重要权重。目前，超过10000家医院使用Press Ganey（PG）调查，因为它有助于优化患者满意度。然而，PG调查并未筛查诸如临床抑郁症等混杂因素。因此，进行下肢全关节置换术（TJA）的关节成形外科医生在护理患有临床抑郁症的患者时，可能难以优化患者满意度。所以，我们提出以下问题：1）PG调查中的哪些因素会影响患有临床抑郁症患者对医院的总体评分？2）患有和未患有临床抑郁症的患者在调查回复上是否存在差异？
我们查询了机构PG数据库中2009年11月至2015年1月期间接受TJA的患者。我们的搜索结果为1454名患者，其中204名患有抑郁症，1250名未患抑郁症。进行多元回归分析以确定所选PG调查领域对医院总体评分的影响（b权重）。还计算了各领域的加权平均值。
多元回归分析表明，在患有抑郁症的TJA术后患者中，与护士的沟通对医院总体评分有显著影响（b权重 = 0.881，p < 0.001）。其余领域无统计学意义。患有和未患有抑郁症的患者在PG调查的各个单项上没有显著差异。
抑郁症患者的总体满意度受与护士沟通的极大影响。了解这些挑战可能会促使各学科之间进行护理协调，以管理手术前后的抑郁症患者。因此，这可以优化骨科手术结果，但更重要的是，可以改善患者健康和满意度，同时降低护理成本。
