Closing the Loop in a Private Hip Registry – The Importance of Questionnaire Simplification

Richard N Villar MBBS, MA, MS, FRCS
Ali S Bajwa MBBS, MRCSEd, MSc Orth, MPhil (Cantab), DSEM (UK & I), MFSEM (UK), FRCS Tr & Orth (Ed)
Mihir R Paikray

Villar Bajwa Practice, Spire Cambridge Lea Hospital, Cambridge, UK.

A good response rate to follow-up questionnaires is an important objective for any registry. The purpose of this study was to investigate if changing the design and simplifying a follow-up questionnaire could improve the response rate of patients after hip arthroplasty.

Method

We examined the response rate of 1126 consecutive patients followed up by postal questionnaire after either Total Hip Replacement (THR) or Hip Resurfacing Arthroplasty (HRA) over an eight-month period. These follow-ups captured both the modified Harris Hip Score (mHHS) and a Visual Analogue Scale (VAS) for satisfaction. Patients were divided into two groups: Group 1 (550 patients) who received our standard follow-up questionnaire between May 2012 – Aug 2012 and Group 2 (576 patients) who received our simplified questionnaire between Sep 2012 – Dec 2012. As shown in Figures 1a and 1b, the changes involved:

  • Patient’s episode details printed on a sticky label and tagged to the updated questionnaire compared with being handwritten in the older version.
  • Adding a clear explanatory statement that described the reasons why follow-up information was being sought.
  • Option to opt out from the audit if the patient did not wish to take part.
  • A clear separation between the explanatory note and the questions.
  • Adopting duplex printing, thereby reducing the actual number of pages from two to one.

Fig-1a: Old Questionnaire (click on image for enlarged view)

Fig 1b: New Questionnaire (click on image for enlarged view)

Results

Fig-2: Reply Response Rate Comparison


There was no significant difference between the mean ages of Group 1 and Group 2 patients (66.89 years versus 68.08 years; p=0.145). The male:female ratio for the two groups was also similar (Group 1, 48.91%:51.09%; Group 2, 48.44%:51.56%; p=0.874) as was the ratio of THR to HRA (Group 1, 61.64%:38.36%; Group 2, 65.28%:34.72%; p=0.205). The questionnaire response rate for Group 1 patients was 69.27%, increasing to 81.25% for Group 2.

Fig-3: Surgery Type - Reply Response Rate Comparison

In terms of surgery type, the questionnaire response rate for Group 1 patients was 70.80% for THR and 66.82% for HRA, increasing to 82.18% and 79.50%, respectively, for Group 2. These differences were significant (THR, p<0.001; HRA, p=0.014).

Conclusion


Our results demonstrate that a significant improvement can be made in the patient response rate to registry follow-up questionnaires by simplification and a more structured layout.

Acknowledgement

Richard N Villar MBBS, MA, MS, FRCS

Ali S Bajwa MBBS, MRCSEd, MSc Orth, MPhil (Cantab), DSEM (UK & I), MFSEM (UK), FRCS Tr & Orth (Ed)

Mihir Paikray (Data management & IT Support)

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Authorgeoff shirley
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