Factors That Influence Inpatient Satisfaction After Shoulder Arthroplasty.
These authors sought to distinguish satisfaction with regards to the outcome of care and satisfaction with the delivery of care.
They investigated inpatient satisfaction according to the Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys after shoulder arthroplasty. The HCAHPS and CG-CAHPS surveys have recently become the gold-standard and preferred form of reporting patient satisfaction for CMS. This trend is relevant for orthopedic surgeons because CAHPS scores are being incorporated into financial reimbursement systems
Eight HCAHPS domains were included in the analysis: (1) communication with doctors; (2) communication with nurses; (3) responsiveness of the staff; (4) pain management; (5) communication about medications; (6) discharge instructions; (7) cleanliness and quietness; and (8) overall rating of the hospital. Five CG-CAHPS domains were included: (1) getting timely appointments, care, and information; (2) how well providers communicate with patients; (3) providers use of information to coordinate patient care; (4) helpful, courteous, and respectful office staff; and (5) patient’s rating of the provider.
They determined factors that influenced them, as well as their correlation with surgical expectations, pain perception, quality of life, surgical setting, and functional outcomes in patients having shoulder arthroplasty.
They found that the The average HCAHPS and CG-CAHPS satisfaction scores for the population were 74.7 ± 20.7 and 82.1 ± 19.4. Overall, 37 (74%) and 34 (68%) patients, respectively, had CG-CAHPS and HCAHPS scores that indicated satisfaction.
Non-smokers had a mean HCAHPS score of 77.7 ± 22.0 and current smokers reported a mean of 59.6 ± 5.2 (p = 0.03).
Patients that were discharged home had a mean HCAHPS score of 77.3 ± 21.9 where those discharged to a skilled-nursing facility (SNF) reported a mean of 59.3 ± 6.6 (p = 0.05).
These same groups also had significantly higher odds of being satisfied with the hospital. They found no significant differences or higher odds seen when comparing overall CG-CAHPS satisfaction between any of the patient-specific factors tested. There was no significant correlation between age, length of stay, pain (PCS), resiliency (RS-11), expectations (SSES), and function (SF-12) for both HCAHPS and CG-CAHPS satisfaction scores. Patients with high preoperative surgical expectations, pain perception, and resiliency are not generally more satisfied with the hospital or clinician. Preoperative diagnosis, location of surgery, and length of stay does not reliably impact satisfaction with the hospital or
36 clinician. HCAHPS and CG-CAHPS inpatient satisfaction does not correlate with legacy functional outcome measures, therefore, may not be predictive of long-term functional outcomes.
No legacy patient reported outcome measures had significant or strong correlations with either HCAHPS or CG-CAHPS satisfaction scores. From this information the authors suggested that CAHPS scores are not effective in predicting long-term functional or perceived outcomes of the arthroplasty.
Comment: We had difficulty understanding the analysis of satisfaction scores with patient reported metrics, such as the Simple Shoulder Test or the ASES score. These data were not presented in the results section or the tables. Thus an apparently unanswered question is "how does satisfaction with the process of care correlate with the functional outcome of the procedure?"
