From the Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
J Am Acad Orthop Surg Glob Res Rev. 2021 Apr 1;5(4):01979360-202104000-00001. doi: 10.5435/JAAOSGlobal-D-21-00052.
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.
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.
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).
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.
医院消费者评估医疗保健提供者和系统（HCAHPS）调查是一项联邦授权调查，用于评估住院后的患者满意度。据指出，只有少数患者会返回该调查。全髋关节置换术（THA）后，实际回复调查的患者和未回复调查的患者之间可能存在潜在偏差（无应答偏倚），这可能会影响调查结果。
本研究回顾性分析了 2013 年 2 月至 2020 年 5 月在一家机构接受择期初次住院 THA 的所有成年患者。出院后，所有患者均邮寄了 HCAHPS 调查，本研究的主要结果是调查回复。评估患者特征和 30 天围手术期结局。进行单变量和多变量分析，以确定上述变量与 HCAHPS 调查回复状况之间的相关性。
在分析的 3310 例 THA 患者中，有 1049 例（31.69%）返回了 HCAHPS 调查。多变量回归分析显示，未回复调查的患者更有可能具有较高的美国麻醉医师协会评分（评分≥3 分，比值比[OR] = 2.27；P <0.001），功能依赖性更高（OR = 2.69；P = 0.005）或为黑人/非裔美国人（OR = 3.40；P <0.001）。同样，未回复调查的患者更有可能发生任何不良事件（OR = 1.80；P = 0.012），重大不良事件（OR = 2.88；P = 0.007），再入院（OR = 2.13；P <0.001），出院至非家庭场所（OR = 1.71；P <0.001）或住院时间超过 3 天（OR = 1.89；P <0.001）。
THA 后，HCAHPS 调查回复率仅为 31.69%，且完成调查与人口统计学和围手术期变量相关。这些发现表明，HCAHPS 调查结果应被视为真实手术患者群体的偏倚样本。在评估医疗保健质量，患者满意度调查结果及其对联邦医院报销率的影响时，无应答偏倚是一个重要因素。
