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Hospital-Acquired Conditions After Orthopedic Surgery Do Not Affect Patient Satisfaction Scores

Day, Michael S.; Hutzler, Lorraine H.; Karia, Raj; Vangsness, Kella; Setia, Nina; Bosco, Joseph A. III

The Journal for Healthcare Quality (JHQ): November-December 2014 - Volume 36 - Issue 6 - p 33–40
doi: 10.1111/jhq.12031
Original Articles

Introduction: The purpose of this study was to determine whether development of a hospital-acquired condition (HAC) affected responses to Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey questions. HCAHPS is a national, standardized satisfaction survey. Patient responses form, in part, the basis for Medicare reimbursement to hospitals via the value-based purchasing system established by the Patient Protection and Affordable Care Act of 2010. We hypothesized that patients who developed an HAC would be less satisfied with their care.

Methods: We randomly distributed the HCAHPS survey, a validated, standardized measure of patient satisfaction, to 6,056 patients discharged from our institution for any orthopedic admission over a 2-year period. All patients who develop HACs are logged by our hospital quality assurance monitoring system. We reviewed the HCAHPS database, identified completed surveys associated with patients who had developed an HAC, and compared satisfaction scores between patients with HACs and patients without HACs. Survey scores were normalized to a 100-point scale. Univariate analysis was performed for two global ratings, and six specific satisfaction categories. Subgroup analysis was performed for surgical site infections (SSIs) and venous thromboembolic disease (VTE).

Results: A total of 2,876 controls and 159 HAC cases were identified from completed surveys. The cases and controls were similar in terms of race, however, the HAC group contained significantly more women (p < .001). Patients in the HAC group also were, on average, significantly older, with a mean age of 66.84 versus 58.65 (p < .001). There was no difference in satisfaction scores in patients’ mean rating of communication by nurses (p = .81), communication by doctors (p = .31), communication about medications (p = .69), pain control (p = .66), the cleanliness of the hospital environment (p = .54), and the quietness of the hospital (p = .589). The mean normalized score for overall satisfaction was 93.99 (out of 100) for controls and 94.84 for HAC cases (p = .61). The mean normalized score for overall willingness to recommend the hospital to others was 90.22 for controls and 90.65 for HAC cases (p = .77). There was no statistically significant difference in satisfaction for patients with SSI versus VTE versus all other HACs (p > .05).

Discussion: Performance on HCAHPS is an area that demands hospital attention both to provide patient-centered care and to maximize revenue. Development of an HAC was not associated with decreased satisfaction scores in a population of orthopedic surgery patients at a private, university-affiliated specialty center. The lack of any statistically significant difference in patient satisfaction may be attributable to patient satisfaction with care in response to complications, the decreased sensitivity inherent to using a general satisfaction survey, or a homogeneity among orthopedic surgery patients and their expectations of care.

Published online 23 August 2013.

For more information on this article, contact Lorraine H. Hutzler at

Michael S. Day, MD, MPhil, is an orthopedic surgery resident at NYU Hospital for Joint Diseases.

Lorraine H. Hutzler, BA, is the Quality Project Manager for the Department of Orthopedic Surgery at NYU Hospital for Joint Diseases. She specializes in quality and patient safety.

Raj Karia, MPH, Associate Director Division of Clinical Research and Outcomes Study.

Kella Vangsness, BS, is a Research Assistant for the Department of Orthopedic Surgery.

Nina Setia, MS, is the Chief Patient Experience Officer for NYU Langone Medical Center.

Joseph A. Bosco III, MD, is the Vice Chair of Clinical Affairs at NYU Hospital for Joint Diseases. His research focuses on quality and outcomes in orthopedic surgery.

© 2014 National Association for Healthcare Quality
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