Browsing by Person "MacDonald, Deborah"

Now showing 1 - 3 of 3

Assessing the Viability of the EQ-5D as Part of a Battery of Outcomes in Elderly Total Knee Arthroplasty Patients: A Comparison of Generic, Condition-Specific, and Preference-Based Patient-Reported Outcome Measures
(2011-10-07) Davis, Jessica; Lane, Judith; MacDonald, Deborah; Howie, Colin
Background In the current economic climate it has become increasingly important to evaluate the effectiveness of expensive procedures such as total knee arthroplasties (TKAs). Patient-reported outcome measures, such as generic and condition-specific profile measures, are popular ways of determining outcomes. However, these cannot be used reliably for the purpose of economic evaluations. The EQ-5D, designed for cost-utility analysis, could offer potential advantages to outcome measurement; however, little is known about the viability and performance of this measure in more elderly (_ 75 years) patient cohorts. Aims The aim of this study was to assess the viability of the EQ-5D for use in the evaluation of TKA and to provide justification for its continued inclusion in the clinical audit of patients undergoing arthroplasty in a large general hospital. Methods Seven-hundred and seventy-nine consecutive patients undergoing TKA participated in this study. Self-report audit questionnaire booklets were administered at baseline (during a pre-admission clinic appointment) and six months post-operatively (postally). Booklets comprised of the Oxford Knee Scale (OKS;), 12-dimension Short Form (SF-12;), and the EQ-5D (). Results Two-hundred and forty-six subjects completed both the baseline and follow-up audit surveys. Correlations were strongest between the EQ-5D and OKS instruments (baseline: Tb=-0.58; p0.01; follow-up: Tb=-0.41; p0.01),.. The EQ-5D displayed large effect sizes (d=0.94) and was able to detect clinically important HRQoL improvements (ROC P-value=0.65; CI0.08; p0.001), discriminate those patients who were experiencing poorer pre-operative health (p0.001), and detect those who deteriorated post-operatively (p0.001). Adequate reliability (Cronbach's =0.79) of the EQ-5D instrument was seen post-operatively as well. Conclusions Results from this study reveal that the EQ-5D instrument shows good responsiveness to health changes in elderly TKA patients post-operatively. Its correlations with the OKS, detection of poorer pre-operative health, and detection of deterioration post-operatively also suggest good validity for the EQ-5D in this cohort. Finally, the relatively large reliability statistic post-operatively supports the use of the EQ-5D in audits. Together, these findings support the continued use of the EQ-5D instrument in future arthroplasty audits and provide evidence that it is viable for the use in cost-utility analysis.
Assessing treatment outcomes using a single question: the Net Promoter Score
(British Editorial Society of Bone & Joint Surgery, 2014-05) Hamilton, D. F.; Lane, Judith; Gaston, P.; Patton, J. T.; MacDonald, Deborah; Simpson, Hamish; Howie, Colin
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.
Factors that shape the patient's hospital experience and satisfaction with lower limb arthroplasty: an exploratory thematic analysis
(BMJ Group, 2016-05-23) Lane, Judith; Hamilton, D. F.; MacDonald, Deborah; Ellis, Carla; Howie, C. R.
Objective: It is generally accepted that the patients' hospital experience can influence their overall satisfaction with the outcome of lower limb arthroplasty; however, little is known about the factors that shape the hospital experience. The aim of this study was to develop an understanding of what patients like and do not like about their hospital experience with a view to providing insight into where service improvements could have the potential to improve the patient experience and their satisfaction, and whether they would recommend the procedure. Design: A mixed methods (quan-QUAL) approach. Setting: Large regional teaching hospital. Participants: 216 patients who had completed a postoperative postal questionnaire at 12 months following total knee or total hip arthroplasty. Outcome measures: Overall satisfaction with the outcome of surgery, whether to recommend the procedure to another and the rating of patient hospital experience. Free text comments on the best and worst aspects of their hospital stay were evaluated using qualitative thematic analysis. Results: Overall, 77% of patients were satisfied with their surgery, 79% reported a good-excellent hospital experience and 85% would recommend the surgery to another. Qualitative analysis revealed clear themes relating to communication, pain relief and the process experience. Comments on positive aspects of the hospital experience were related to feeling well informed and consulted about their care. Comments on the worst aspects of care were related to being made to wait without explanation, moved to different wards and when they felt invisible to the healthcare staff caring for them. Conclusions: Positive patient experiences were closely linked to effective patient-health professional interactions and logistics of the hospital processes. Within arthroplasty services, the patient experience of healthcare could be enhanced by further attention to concepts of patient-centred care. Practical examples of this include more focus on developing staff-patient communication and the avoidance of 'boarding' procedures.