title: What Influences How Patients Rate Their Hospital After Total Knee Arthroplasty?
abstract: BACKGROUND
  There is increasing pressure from Centers for Medicare and Medicaid Services (CMS) to report quality measures for all hospitalizations. These quality measures are determined based on results from satisfaction surveys, such as Press Ganey® (PG) (Press Ganey® Performance Solutions, Wakefield, Massachusetts). Included in this particular survey element are questions regarding staff, including nurses and doctors, as well as items such as pain control. The results of these surveys will dictate the amount doctors are compensated for their services. Therefore, this study was undertaken to evaluate the effect of treating orthopaedists and nurses, as well as pain control, on PG surveys in patients who underwent total knee arthroplasty (TKA). Specifically, we aimed to ascertain the effect of these factors on how post-TKA patients perceive: 1) their orthopaedist, and 2) their overall surgical experience.
  
  
  METHODS
  We queried the Press Ganey® Database for all patients who underwent a TKA at our institution between November 2009 and January 2015. A weighted mean of question domains was utilized since each had multiple questions. In order to assess if pain management influences orthopaedist perception, a correlation analysis was performed between pain control and perception. In order to assess the influence of pain management on surgical experience, we performed a correlation analysis between pain control and overall hospital rating. A multiple regression analysis was performed using the hospital rating as the dependent variable to determine the most influential factors on surgical experience.
  
  
  RESULTS
  Our analysis demonstrated a significantly positive correlation between patient perception of their pain control and their orthopaedist. There was a significant positive correlation between patient's perception of their pain control and their overall surgical experience. Multiple regression analysis using overall surgical experience as the dependent variable demonstrated a significant positive influence of perception of nurses and orthopaedists. Pain management positively influenced surgical experience; however, this was not significant.
  
  
  CONCLUSIONS
  We found that perception of pain control in post-TKA patients affects perception of the treating orthopaedists, as well as their overall surgical experience. In addition, perception of orthopaedists and nurses both outweigh perception of pain control on overall surgical experience, with nurses being the most important. Orthopaedists should focus on staff education-particularly nurses-and educate them in order to optimize results on PG surveys and, ultimately, improve patient satisfaction. Further studies should correlate current standardized scoring systems and questionnaires for TKA with PG surveys in order to recognize gaps that need to be bridged to improve post-TKA patient satisfaction.
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Morad
authors.initials: M
authors.lastname: Chughtai
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Julio J
authors.initials: JJ
authors.lastname: Jauregui
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Jaydev B
authors.initials: JB
authors.lastname: Mistry
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Randa K
authors.initials: RK
authors.lastname: Elmallah
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Aloise M
authors.initials: AM
authors.lastname: Diedrich
authors.affiliation: Bonutti Clinic, Effingham, Illinois.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Bonutti
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Ronald
authors.initials: R
authors.lastname: Delanois
authors.affiliation: Rubin Institute for Advanced Orthopedics, Center for Joint Preservation and Replacement, Sinai Hospital of Baltimore, Baltimore, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Mont
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology* / Q000706:statistics & numerical data*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000145:classification* / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D059408:Pain Management / Q000523:psychology* / Q000706:statistics & numerical data; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000145:classification; D012189:Retrospective Studies