Satisfaction with care is important to both patients
and to those who pay for it. The Net Promoter Score (NPS), widely
used in the service industries, has been introduced into the NHS
as the ‘friends and family test’; an overarching measure of patient
satisfaction. It assesses the likelihood of the patient recommending
the healthcare received to another, and is seen as a discriminator
of healthcare performance. We prospectively assessed 6186 individuals
undergoing primary lower limb joint replacement at a single university
hospital to determine the Net Promoter Score for joint replacements
and to evaluate which factors contributed to the response. Achieving pain relief (odds ratio (OR) 2.13, confidence interval
(CI) 1.83 to 2.49), the meeting of pre-operative expectation (OR
2.57, CI 2.24 to 2.97), and the hospital experience (OR 2.33, CI
2.03 to 2.68) are the domains that explain whether a patient would
recommend joint replacement services. These three factors, combined
with the type of surgery undertaken (OR 2.31, CI 1.68 to 3.17),
drove a predictive model that was able to explain 95% of the variation
in the patient’s recommendation response. Though intuitively similar,
this ‘recommendation’ metric was found to be materially different
to satisfaction responses. The difference between THR (NPS 71) and
TKR (NPS 49) suggests that no overarching score for a department
should be used without an adjustment for case mix. However, the
Net Promoter Score does measure a further important dimension to
our existing metrics: the patient experience of healthcare delivery. Cite this article:
This study aimed to evaluate the effect of using ICPs (Integrated Care Pathways) on the outcome of TKA. Prospective data was collected from 429 patients (130 from 2 sites that use 1CPs and 299 from 4 sites that did not). Pre-operatively and at 12 months an independent researcher performed a clinical knee examination and patients completed WOMAC and SF-36 questionnaires. At 12 months patients answered additional questions on satisfaction with outcome. The follow-up rate was 86%. The median length of stay (LOS) in the ICP group was 9 days compared with 12 in the non-ICP group (p <
0. 001). After adjusting for other significant variables, ICP site was shown to be the most significant factor in shorter LOS (p <
0. 001). Following discharge, 78% of the ICP group and 47% of the non-ICP group received outpatient physiotherapy (p <
0. 001). Logistic regression analysis showed that the ICP group were 4 times more likely to receive outpatient physiotherapy (odds ratio = 4. 35, p <
0. 001). After adjusting for other significant variables and baseline values, at 12 months the ICP group had significantly less pain (p = 0. 041) and significantly better function (p <
0. 00 1) than the non-ICP group. There was no difference in the number of postoperative orthopaedic complications (p = 0. 64). At 12 months, 83% of the ICP group were very satisfied with their surgery compared to 70% of the non-ICP group (p = 0. 009). Logistic regression showed that the ICP group were over twice as likely to be very satisfied with their outcome at 12 months (odds ratio = 2. 27, p = 0. 029). These results indicate that ICPs can result in shorter LOS without compromising outcome although use of outpatient physiotherapy was increased. In addition ICPs appear to result in greater patient satisfaction.
