Improving Patient Recall Following Operative Orthopaedic Trauma.

IF 4.4 1区 医学 Q1 ORTHOPEDICS Journal of Bone and Joint Surgery, American Volume Pub Date : 2024-08-27 DOI:10.2106/JBJS.23.01366
Ryan Furdock, Andrew Alejo, Matthew Hoffa, Anna Vergon, Nicholas M Romeo, Heather A Vallier
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Abstract

Background: Orthopaedic trauma patients may experience poor recall regarding their injury and treatment, impairing postoperative outcomes. We sought to evaluate the impact of a standardized postoperative educational protocol on patient recall, adherence to the treatment plan, and satisfaction.

Methods: Two hundred and twenty adult, English-speaking patients with surgically treated lower-extremity fractures were prospectively included. One hundred and ten patients in the educational intervention cohort met with a non-physician study member after surgery but before hospital discharge. They were given a written questionnaire evaluating knowledge of key aspects of their injury and treatment plan. For incorrectly answered questions, the study team member told the patient the correct answer (e.g., "No, you broke your tibia."). Immediately after, the patient was verbally asked the question again (e.g., "Which bone did you break?"), repeating the process until the answer was correct. The 110 patients in the control cohort did not receive this "teach-back" protocol. During their first postoperative appointment, all 220 patients completed a follow-up questionnaire assessing recall, adherence to the treatment plan, and satisfaction.

Results: The control cohort correctly answered 64% of recall-oriented questions versus 89% in the intervention cohort (p < 0.001). Eighty-two percent of control patients versus 89% patients in the intervention cohort adhered to postoperative weight-bearing restrictions (p = 0.09). Eighty-four percent of controls adhered to their deep venous thrombosis prophylaxis regimen versus 99% of the intervention cohort (p < 0.001). On a 5-point Likert scale, controls were less satisfied with their overall orthopaedic care compared with patients in the intervention cohort (mean of 4.38 ± 0.84 versus 4.54 ± 0.63 points; p = 0.02), although this difference was less than the minimal clinically relevant difference of 10% that was defined at study onset. On propensity score-weighted multivariable analysis, receipt of the postoperative educational intervention was the only modifiable factor associated with improvement in patient recall (26% improvement [95% confidence interval, 20% to 31%]; p < 0.001).

Conclusions: Some orthopaedic trauma patients' nonadherence to surgeon recommendations and dissatisfaction with care may be mitigated by postoperative education. This standardized postoperative educational protocol improves orthopaedic trauma patients' recall, adherence to their treatment plan, and satisfaction in a manner requiring minimal time.

Level of evidence: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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提高骨科创伤手术后患者的恢复能力。
背景:骨科创伤患者可能对自己的损伤和治疗回忆不足,从而影响术后效果。我们试图评估标准化术后教育方案对患者回忆、治疗计划的坚持性和满意度的影响:前瞻性地纳入了 220 名接受下肢骨折手术治疗的英语成年患者。教育干预队列中的 110 名患者在手术后出院前会见了一名非医生研究成员。研究人员向他们发放了一份书面问卷,评估他们对伤情和治疗方案的主要方面的了解程度。对于回答错误的问题,研究小组成员会告诉患者正确答案(例如,"不,你的胫骨骨折了")。紧接着,研究小组成员再次口头询问患者该问题(例如,"你摔断了哪块骨头?"),重复这一过程,直到答案正确为止。对照组的 110 名患者没有接受这种 "回授 "方案。在术后第一次就诊时,所有 220 名患者都填写了一份随访问卷,对回忆、治疗计划的依从性和满意度进行评估:结果:对照组患者正确回答以回忆为导向的问题的比例为 64%,而干预组为 89%(P < 0.001)。82%的对照组患者和89%的干预组患者坚持术后负重限制(P = 0.09)。84%的对照组患者坚持深静脉血栓预防方案,而干预组患者的这一比例为 99%(P < 0.001)。在 5 分李克特量表中,对照组患者对骨科护理的总体满意度低于干预组患者(平均值为 4.38 ± 0.84 分,干预组为 4.54 ± 0.63 分;P = 0.02),但这一差异小于研究开始时确定的 10% 的最小临床相关性差异。在倾向评分加权多变量分析中,接受术后教育干预是唯一一个与患者回忆改善相关的可调整因素(改善26% [95%置信区间,20%至31%];P < 0.001):结论:一些骨科创伤患者不遵从外科医生建议和对护理不满意的情况可能会通过术后教育得到缓解。这种标准化的术后教育方案可提高创伤骨科患者的回忆能力、对治疗计划的依从性和满意度,而且只需花费很少的时间:预后二级。有关证据等级的完整描述,请参阅 "作者须知"。
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来源期刊
CiteScore
8.90
自引率
7.50%
发文量
660
审稿时长
1 months
期刊介绍: The Journal of Bone & Joint Surgery (JBJS) has been the most valued source of information for orthopaedic surgeons and researchers for over 125 years and is the gold standard in peer-reviewed scientific information in the field. A core journal and essential reading for general as well as specialist orthopaedic surgeons worldwide, The Journal publishes evidence-based research to enhance the quality of care for orthopaedic patients. Standards of excellence and high quality are maintained in everything we do, from the science of the content published to the customer service we provide. JBJS is an independent, non-profit journal.
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