Meun, H. (Henriëtte) (2014) Het meten van zorgzwaarte bij complexe en niet-complexe patiënten na totale heupartroplastiek. thesis, Medicine.
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Abstract
Introduction Coxarthrosis is a growing problem in Western society. It is the most common reason for a total hip arthroplasty. In the Netherlands there is a fixed fee for this operation. A part of the fee depends on the insurer and this can be negotiated between the hospitals and the insurer. If hospitals can give an impression about the amount and intensity of care after total hip arthroplasty, called patient acuity, they are stronger in the negotiation. Patient acuity includes the workload for nurses or carers, which is expressed in time and/or activities. Total hip arthroplasty’s are mainly performed in general hospitals, where non-complex patients are treated. Complex patients, are mainly treated in university medical centers. Because the general hospitals treat the non-complex patients, it is expected that patient acuity is lower compared to university medical centers. In 2013 the development of a measuring instrument in orthopedic patients to measure the amount and the intensity of care was started. The aim of this study is to determine how far this instrument is able to discriminate between non-complex and complex patients. Additionally, it is analyzed if a first impression can be obtained about the possible differences in patient acuity between a university and a general hospital. Material and Methods This was an observational study. By means of the measuring instrument data were collected from patients who had undergone a total hip arthroplasty. The observation took place with the time-and-motion method, the first morning postoperatively at the orthopedic department of UMCG or MCL. In addition, it was examined by using a questionnaire what the perception was of the nursing staff with respect to the care provided. Complexity was operationalized in this study in three ways. Firstly, based on the degree of comorbidity, expressed in ASA-classes. Secondly, on the basis of ADL-dependence after the operation, expressed in Katz-categories. Finally, on the basis of the hospital where patients have been treated (university versus general hospital). Results In both hospitals ten patients were observed. The patient population differed in complexity between the two hospitals, but nevertheless there was no difference measured in time of the total care. The total healthcare that patients received was not dependent on the ASA-class, or the ADL-dependence of the patient. Moreover, it appeared that patient acuity experienced by the nurses was not associated with the duration of the care provided. The nurses indicated that the gravity of care was not affected by time, but thinking about the activity. Discussion and Conclusion By means of measuring instrument no difference in patient acuity between non-complex and complex patients could be measured. It does not discriminate based on comorbidity, ADL dependency or based on the hospital. Therefore no first impression could be given to the possible differences in patient acuity between a university and a general hospital. On the basis of these results it does not seem sensible to further develop the measurement instrument to measure patient acuity.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Stevens, M. and Akker-Scheek, I. van den and Olthof, M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:51 |
| Last Modified: | 25 Jun 2020 10:51 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/1174 |
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