Assessing treatment outcomes using a single question: the net promoter score

Area of Science:

• Orthopedic Surgery
• Health Services Research
• Patient Experience

Background:

• Patient satisfaction is crucial for healthcare quality assessment.
• The Net Promoter Score (NPS), or 'friends and family test,' is increasingly used in healthcare to gauge patient recommendation likelihood.
• Understanding factors influencing patient recommendation is vital for improving healthcare services.

Purpose of the Study:

• To determine the Net Promoter Score (NPS) for primary lower limb joint replacement surgery.
• To identify key factors influencing patient recommendations for joint replacement services.
• To compare NPS with traditional satisfaction metrics and assess its utility in healthcare.

Main Methods:

• Prospective assessment of 6186 individuals undergoing primary lower limb joint replacement.
• Analysis of factors contributing to patient recommendation responses using logistic regression.
• Calculation of NPS for total hip replacement (THR) and total knee replacement (TKR).

Main Results:

• Pain relief, met pre-operative expectations, and hospital experience were significant predictors of patient recommendation (ORs ranging from 2.13 to 2.57).
• The type of surgery also influenced recommendation (OR 2.31).
• A predictive model incorporating these factors explained 95% of the variation in recommendation responses. NPS differed significantly between THR (71) and TKR (49), highlighting the need for case-mix adjustment.

Conclusions:

• The Net Promoter Score (NPS) is a valuable metric for assessing patient experience in joint replacement surgery, distinct from traditional satisfaction measures.
• Pain relief, expectation management, and hospital experience are critical drivers of patient recommendations.
• Adjusting for case mix is essential when using NPS as an overarching departmental score due to variations between different procedures like THR and TKR.