title: What Factors Drive Inpatient Satisfaction After Knee Arthroplasty?
abstract: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, developed by the Centers for Medicare & Medicaid Services, is directly tied to hospital reimbursement. The purpose of this study is to analyze survey responses from patients who underwent primary knee arthroplasty in order to identify factors that drive patient dissatisfaction in the inpatient setting.
  
  
  
  HCAHPS responses received from patients undergoing elective total and unicompartmental knee arthroplasty at our institution between January 1, 2013 and January 1, 2016 were obtained and expressed as a percentage of overall satisfaction. Satisfaction scores were correlated to patient demographics.
  
  
  
  Overall, responses from 580 patients were obtained (554 total knee arthroplasties, 26 unicompartmental knee arthroplasties). There was a statistically significant difference in overall satisfaction when comparing sex (P = .034), race (P = .030), and socioeconomic status (P = .001). Men reported a higher average satisfaction score than women (77.8% vs 74.2%). Patients in the 1st quartile of socioeconomic status reported a higher average satisfaction than those in the 4th quartile (81.3% vs 71.3%). African American patients reported a higher satisfaction than Caucasian and other races (81.6% vs 75.3% vs 66.3%, respectively). There was an inverse relationship between increased length of stay and reported satisfaction (r = -0.113, P = .006).
  
  
  
  Our data indicate that patients who are likely to report higher levels of inpatient satisfaction after knee arthroplasty are male, African American, of lower socioeconomic status, and with shorter length of stay. To our knowledge, this is the first reported analysis of the HCAHPS survey in relation to total joint arthroplasty.
authors.affiliation: Duke University School of Medicine, Durham, North Carolina.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Peres-da-Silva
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Lindsay T
authors.initials: LT
authors.lastname: Kleeman
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Samuel S
authors.initials: SS
authors.lastname: Wellman
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, North Carolina.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Green
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: David E
authors.initials: DE
authors.lastname: Attarian
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Bolognesi
authors.affiliation: Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina.
authors.forename: Thorsten M
authors.initials: TM
authors.lastname: Seyler
mesh_terms: D001741:Black or African American; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000523:psychology*; D014487:Centers for Medicare and Medicaid Services, U.S.; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010549:Personal Satisfaction; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States; D044465:White People
keywords: HCAHPS; hospital reimbursement; knee arthroplasty; patient demographics; patient satisfaction