Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC.
Department of Biostatistics and Bioinformatics, Duke University, Durham, NC.
J Arthroplasty. 2019 May;34(5):824-833. doi: 10.1016/j.arth.2019.01.008. Epub 2019 Jan 11.
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.
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.
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.
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.
医疗保健提供者和系统的医院消费者评估（HCAHPS）调查由医疗保险和医疗补助服务中心创建，与医院报销直接相关。本研究的目的是确定与原发性髋关节和膝关节置换术后 HCAHPS 调查反应相关的因素。
分析了我院 2013 年 1 月至 2017 年 10 月期间择期髋关节和膝关节置换术患者的前瞻性收集的 HCAHPS 反应。患者年龄、性别、种族、婚姻状况、体重指数、美国麻醉师协会评分、术前疼痛评分、吸烟状况、饮酒、非法药物使用、社会经济四分位、保险类型、手术类型、医院类型（学术与社区）、到医疗中心的距离、住院时间（LOS）和出院处置，并与 HCAHPS 住院满意度评分相关。
共获得 3593 例患者的反应：1546 例全髋关节置换术、1899 例全膝关节置换术和 148 例单髁膝关节置换术。平均总体 HCAHPS 评分为 79.2。女性的住院满意度低于男性（77.6 对 81.6，P<.001）。饮酒者的住院满意度低于不饮酒者（77.7 对 81.6，P<.001）。住院满意度因社会经济四分位而异（P<.001），最高四分位患者的满意度低于所有其他四分位患者（P<.001）。出院到医疗机构的患者的住院满意度低于出院回家的患者（71.2 对 80.2，P<.001）。住院满意度与 LOS（r=-0.19，P<.001）呈负相关，与距医疗中心的距离呈正相关（r=0.06，P<.001）。
全关节置换术后报告住院满意度较低的患者更可能是女性、富裕和饮酒者，他们被送往急性后护理机构。住院满意度与 LOS 呈负相关，与患者家到医疗中心的距离呈正相关。这些发现为改善 TJA 住院护理提供了目标。
