Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY.
Department of Orthopedic Surgery, Albany Medical Center, Albany Medical College, Albany, NY.
J Arthroplasty. 2019 Jul;34(7S):S84-S90. doi: 10.1016/j.arth.2018.11.019. Epub 2018 Nov 20.
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.
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.
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.
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.
医院患者评估医疗保健提供者和系统（HCAHPS）评分是衡量患者住院体验的一项全国标准化指标。本研究旨在评估初次全关节置换术（TJA）和翻修 TJA 患者的 HCAHPS 评分是否存在差异。
本研究纳入了在我院接受初次或翻修全髋关节或全膝关节置换术（THA 或 TKA）并完成 HCAHPS 调查的患者。HCAHPS 评分由我院质量和患者安全中心收集，并与我院电子数据仓库交叉引用。查询患者人口统计学、手术因素和质量结果。使用 MatLab 2017a 进行适当的统计分析，P 值小于.05 被认为具有统计学意义。
在 2011 年 10 月至 2016 年 11 月期间，共有 523 例初次 THA 接受者和 59 例翻修 THA 接受者在我院完成了 HCAHPS 调查。在此期间，507 例初次 TKA 接受者和 40 例翻修 TKA 接受者完成了 HCAHPS 调查。与翻修 THA 相比，初次 THA 患者对整体医院评分的“最佳选择”比例明显更高（58.46% vs 41.38%），他们认为护士仔细倾听他们的意见（84.3% vs 72.88%），并且清楚地了解每种药物的作用（69.48% vs 56.90%）。此外，尽管大多数 HCAHPS 问题没有达到统计学意义，但在 20 个 HCAHPS 问题中有 18 个问题的回答有利于初次 THA。接受翻修 TKA 的患者在更安静的病房方面选择“最佳选择”的比例明显更高，在另外 12 个 HCAHPS 问题中，翻修 TKA 患者的 HCAHPS 评分也呈上升趋势。
初次 THA 患者的 HCAHPS 评分高于翻修 THA 患者，而与初次 TKA 患者相比，翻修 TKA 患者的 HCAHPS 评分普遍呈上升趋势。这一公开报告的质量衡量指标会影响医生的报酬，但可能会受到患者健康状况、手术复杂性和住院时间长短的影响，而不是真正反映他们的医院体验质量。
