Patients' Perspectives of Care and Surgical Outcomes in Michigan

Abstract

Objective To determine the relationship between postoperative morbidity and mortality and patients' perspectives of care. Summary Background Data Priorities in healthcare quality research are shifting to place greater emphasis on patient-centered outcomes. Whether patients' perspectives of care correlate with surgical outcomes remains unclear. Methods Using data from the Michigan Surgical Quality Collaborative clinical registry (2008–2012), we identified 41,833 patients undergoing major elective general or vascular surgery. Our exposure variables were the HCAHPS Total and Base Scores derived from the Hospital Value-Based Purchasing (VBP) Patient Experience of Care Domain. Using multilevel mixed-effects logistic regression models, we adjusted hospitals' rates of morbidity and mortality for patient comorbidities and case mix. We stratified reporting of outcomes by quintiles of hospitals' Total and Base Scores. Results Risk-adjusted morbidity (13.6% to 28.6%) varied widely across hospitals. There were no significant differences in risk-adjusted morbidity rates between hospitals with the lowest versus highest HCAHPS Total Score (24.5% vs. 20.2%, p=0.312). The HCAHPS Base Score, which quantifies sustained achievement or improvement in patients' perspectives of care, was not associated with a reduction in postoperative morbidity over the study period despite an overall decrease of 2.5% for all centers. We observed a similar relationship between HCAHPS Total and Base Scores and postoperative mortality. Conclusions and Relevance Patients' perspectives of care do not correlate with the incidence of morbidity and mortality following major surgery. Improving patients' perspectives and objective outcomes may require separate initiatives for surgeons in Michigan.

Patient experience and quality of urologic cancer surgery in US hospitals

“…This reinforces the idea that patient experience largely reflects the interpersonal elements of care more so than surgical quality. Although a recent study demonstrated a relationship between HCAHPS scores and recommended process use in surgery, other studies have suggested that the link between patient perspective and surgical outcomes remains elusory . This may stem in part from the use of an instrument not tailored specifically to cancer care or surgery.…”

Understanding the determinants of patient satisfaction with surgical care using the Consumer Assessment of Healthcare Providers and Systems surgical care survey (S-CAHPS)

“…28 In addition, recent studies that examine the relationship of surgical quality metrics to patient satisfaction have used pooled (medical and surgical) HCAHPS data as an outcome variable, a practice which has important limitations. 29,30 Given this information, we plan to examine S-CAHPS results in response to more traditional outcomes measures, such as NSQIP-defined complication rates. The broad application of S-CAHPS to clinical practice if successful will allow much more meaningful outcome data for these and other studies.…”

Is There a Relationship Between Patient Satisfaction and Favorable Surgical Outcomes?

“…Tsai et al 11 also found an association between low risk-adjusted mortality in surgical patients and high satisfaction scores on HCAHPS. However, Sheetz et al 13 in an evaluation of the Michigan Surgical Quality Collaborative registry did not find a significant difference in risk-adjusted mortality between hospitals with high versus low HCAHPS total performance scores (4% mortality in the lowest quintile vs. 3.3% mortality in the highest quintile). Elliott and colleagues, 14 similarly showed no correlation between patient satisfaction and one year mortality.…”

“…Similarly Sheetz et al 13 showed no correlation between risk adjusted complication rates and satisfaction on the HCAHPS survey (25% morbidity in lowest quintile vs 25% morbidity in highest quintile). Gurland and colleagues also found that patients with postoperative complications had no diminution in the overall patient satisfaction ranking domains 18 .…”