Factors Driving Patient Perception of Quality Care After Primary Total Hip and Total Knee Arthroplasty

Abstract

Introduction: Differences in female and male patient perception of care and satisfaction following primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) were assessed via Hospital Consumer Assessment of Healthcare Providers and Systems survey, demographic, and clinical data.

Methods: After institutional review board approval, a retrospective review of the Hospital Consumer Assessment of Healthcare Providers and Systems survey responses at a private, academic, level-I trauma center was performed from January 2011 to December 2013. Inclusion criteria were primary THA and TKA patients who were 18 years or older and returned the survey.

Results: Overall, 1,166 THA and 1,411 TKA were included, with 55.0% of female THA patients and 64.5% of male THA patients highly satisfied (P = 0.002). The mean overall hospital rating was 7.2 for female THA and 7.8 for male THA (P = 0.003) patients. No significant differences was found in the TKA cohort. For all cohorts, the Nurse Communication with Nurses domain reported the greatest correlation with overall hospital rating (range, ρ = 0.418 to ρ = 0.502; P < 0.0001).

Discussion: This series indicated that initiatives to improve patient care and patient perception of care should focus on nurse-patient communication, hospital staff responsiveness, the care transition process, and hospital environment. Patient sex was a significant factor in the overall satisfaction for THA, with female patients reporting significantly lower ratings than male patients.

Figure 1

Percentage of female and male respondents from the TKA and THA populations who were highly satisfied (overall hospital score of 9 or 10) (A) and average patient-reported overall hospital rating of female and male patients in THA and TKA populations (B). There were significant differences between the percentage of highly satisfied female patients in the THA population (*P = 0.002) an between the overall hospital rating of female and male patients in the THA population (**P = 0.003). THA = total hip arthroplasty, TKA = total knee arthroplasty

Figure 2

Mean percent top-box domain scores for each male/female patient and THA (A), TKA (B), and all female and male patients for both THA and TKA populations (C). THA = total hip arthroplasty, TKA = total knee arthroplasty