Person-centred care compared with standardized care for patients undergoing total hip arthroplasty—a quasi-experimental study

Journal of Orthopaedic Surgery and Research

Elisabeth Hansson²  Johan Kärrholm²  Urban Berg¹  Jón Karlsson²  Lars-Eric Olsson² 

[1] Department of Surgery and Orthopaedics, Kungälv Hospital, Kungälv, Sweden;Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden

关键词: ASA classification;    Tampa scale of Kinesiophobia;    General self-efficacy;    Person-centered care;    Person-centred care;   

Others  :  1151784
DOI  :  10.1186/s13018-014-0095-2

 received in 2014-06-10, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

Background

A common approach to decrease length of stay has been to standardize patient care, for example, by implementing clinical care pathways or creating fast-track organizations. In a recent national report, it was found that Sweden¿s healthcare system often fails to anticipate and respond to patients as individuals with particular needs, values and preferences. We compared a standardized care approach to one of person-centred care for patients undergoing total hip replacement surgery.

Methods

A control group (n =138) was consecutively recruited between 20th September 2010 and 1st March 2011 and an intervention group (n =128) between 12th December 2011 and 12th November 2012, both scheduled for total hip replacement. The primary outcome measures were length of stay and physical function at both discharge and 3 months later.

Results

The mean length of stay in the control group was 7 days (SD 5.0) compared to 5.3 days in the intervention group (SD 2.2). Physical functional performance, as assessed using activities of daily living, was similar at baseline for both groups. At discharge, 84% in the control group had regained activities of daily living level A vs. 72% in the intervention group. At 3 months after surgery, 88% in the control group had regained their independence vs. 92.5% in the person-centred care group.

Conclusions

Focusing attention on patients as people and including them as partners in healthcare decision-making can result in shorter length of stay. The present study shows that the patients should be the focus and they should be involved as partners.

【 授权许可】

   
2014 Olsson et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Garellic G, Kärrholm K, Rogmark C, Herberts P, Rolfsson O, Malchau H, Lindahl H: Annual Report from the Swedish Hip Arthroplasty Registry. 2011.
• [2]Kehlet H, Wilmore DW: Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg 2008, 248:189-198.
• [3][http://www.vardanalys.se/Support/In-English/Reports1/] webcite Coulter A, Docteur E: Patient-centeredness in Sweden¿s health system - An assessment and six steps for progress.Nat Agency Health Anal 2012, URL: accessed November 2013
• [4]Baumann C, Rat AC, Osnowycz G, Mainard D, Cuny C, Guillemin F: Satisfaction with care after total hip or knee replacement predicts self-perceived health status after surgery. BMC Musculoskelet Disord 2009, 10:150. BioMed Central Full Text
• [5]Ethgen O, Bruyere O, Richy F, Dardennes C, Reginster JY: Health-related quality of life in total hip and total knee arthroplasty. A qualitative and systematic review of the literature. J Bone Joint Surg Am Vol 2004, 86-A:963-974.
• [6]Williams A, Dunning T, Manias E: Continuity of care and general wellbeing of patients with comorbidities requiring joint replacement. J Adv Nurs 2007, 57:244-256.
• [7]Corrigan JMDKLT, Donaldson MS, Maguire SK, Pike KC: A new Health System for the 21st Century. Crossing the Quality Chasm. Institute of Medicine. National Academy of Sciences, National Academies Press, Washington, DC; 2001.
• [8]Ekman I, Wolf A, Olsson LE, Taft C, Dudas K, Schaufelberger M, Swedberg K: Effects of person-centred care in patients with chronic heart failure: the PCC-HF study. Eur Heart J 2012, 33:1112-1119.
• [9]Ekman I, Swedberg K, Taft C, Lindseth A, Norberg A, Brink E, Carlsson J, Dahlin-Ivanoff S, Johansson IL, Kjellgren K, Lidén E, Öhlén J, Olsson LE, Rosen H, Rydmark M, Stibrant SK: Person-centered care¿ready for prime time. Eur J Cardiovasc Nurs 2011, 10:248-251.
• [10]Olsson LE, Karlsson J, Ekman I: The integrated care pathway reduced the number of hospital days by half: a prospective comparative study of patients with acute hip fracture. J Orthop Surg Res 2006, 1:3. BioMed Central Full Text
• [11]Burstrom K, Johannesson M, Diderichsen F: Swedish population health-related quality of life results using the EQ-5D. Qual Life Res 2001, 10:621-635.
• [12]Zuckerman JD, Koval KJ, Aharonoff GB, Skovron ML: A functional recovery score for elderly hip fracture patients: II. Validity and reliability. J Orthop Trauma 2000, 14:26-30.
• [13]Katz SFA, Moskowitz R, Jackson B, Jaffe M: Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. J Am Med Assoc ?, 185:914-9. 1963, Sep 21,
• [14]Olsson L, Karlsson J, Ekman I: Effects of nursing interventions within an integrated care pathway for patients with hip fracture. J Adv Nurs 2007, 58:116-125.
• [15]Ceder L, Thorngren KG, Wallden B: Prognostic indicators and early home rehabilitation in elderly patients with hip fractures. Clin Orthop Relat Res 1980, 152:173-184.
• [16]Wang T, Ackland T, Hall S, Gilbey H, Parsons R: Functional recovery and timing of hospital discharge after primary total hip arthroplasty. Aust N Z J Surg 1998, 68:580-583.
• [17]Wasielewski RC, Weed H, Prezioso C, Nicholson C, Puri RD: Patient comorbidity: relationship to outcomes of total knee arthroplasty. Clin Orthop Relat Res 1998, 356:85-92.
• [18]Hayes JH, Cleary R, Gillespie WJ, Pinder IM, Sher JL: Are clinical and patient assessed outcomes affected by reducing length of hospital stay for total hip arthroplasty? J Arthroplast 2000, 15:448-452.
• [19]Husted H, Holm G, Jacobsen S: Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients. Acta orthopaedica 2008, 79(2):168-173.
• [20]Husted H: Fast-track hip and knee arthroplasty: clinical and organizational aspects. Acta Orthop Suppl 2012, 83:1-39.
• [21]Caesar U, Karlsson J, Olsson L-E, Samuelsson K, Hansson-Olofsson E: Incidence and root causes of cancellations for elective orthopaedic procedures: a single center experience of 17,625 consecutive cases. Patient Safety Surg 2014, 8:24. BioMed Central Full Text
• [22]Carlström E, Olsson L-E: The association between subcultures and resistance to change ¿ in a Swedish hospital clinic. J Health Organ Manag 2014, 28(4):458-476.