Care Management Institute, Kaiser Permanente, Oakland, CA.
Now with Stanford Health Care, Stanford, CA.
Perm J. 2021 Nov 3;25:21.043. doi: 10.7812/TPP/21.043.
Although patient satisfaction with total joint arthroplasty has been a well-measured outcome, little is known about how preadmission and post-discharge care experiences affect patients' rating of satisfaction.
This work aimed to identify actionable factors associated with better ratings of overall care and surgical results.
A 36-item survey assessing care in the preoperative, perioperative, and post-discharge phases of care and across all phases was mailed to 7,031 patients who underwent primary unilateral elective total hip arthroplasty and total knee arthroplasty in 2018. Exploratory factor analysis identified 7 actionable domains. Stepwise logistic regression models identified domains associated with ratings of overall care and satisfaction with surgical outcome.
Of the 3,026 (43%) patients who returned the survey; 2,814 (93%) rated their overall experience of care as very good or excellent and satisfaction with surgical results as ≥ 7 on a 10-point scale. In exploratory factor analysis, four factors predicted higher ratings of both overall care and surgical outcome: knowing what to do with symptoms and pain during recovery (factor 1), self-reported health (factor 3), knowing what to expect before surgery (factor 4), and shared decision making (factor 6). Coordinated information among providers (factor 2), home health experience (factor 5), and patient-provider relationships (factor 7) also predicted overall care ratings.
Patient-centered quality improvement in total joint replacement care requires thinking of care across the entire episode, including before and after the hospital stay for surgery, in addition to perioperative care. The actionable factors identified from this study can be incorporated into total joint replacement care to improve patients' satisfaction with overall care and surgical results.
尽管患者对全关节置换术的满意度已经得到了很好的衡量，但对于术前和出院后护理体验如何影响患者满意度知之甚少。
本研究旨在确定与更好的整体护理和手术结果评分相关的可操作因素。
2018 年，对 7031 名接受单侧初次择期全髋关节置换术和全膝关节置换术的患者邮寄了一份包含术前、围手术期和出院后护理阶段以及所有阶段的 36 项护理评估调查。探索性因素分析确定了 7 个可操作领域。逐步逻辑回归模型确定了与整体护理评分和对手术结果满意度相关的领域。
在 3026 名（43%）返回调查的患者中，2814 名（93%）对他们的整体护理体验评价为非常好或优秀，对手术结果的满意度为 10 分制的≥7 分。在探索性因素分析中，有四个因素预测了整体护理和手术结果评分更高：了解在康复期间应对症状和疼痛的方法（因素 1）、自我报告的健康状况（因素 3）、了解手术前的预期（因素 4）和共同决策（因素 6）。提供者之间的协调信息（因素 2）、家庭健康体验（因素 5）和医患关系（因素 7）也预测了整体护理评分。
全关节置换护理的以患者为中心的质量改进需要考虑整个手术期间的护理，包括手术前后的护理，以及围手术期护理。从这项研究中确定的可操作因素可以纳入全关节置换护理中，以提高患者对整体护理和手术结果的满意度。
