The risk‐outcome‐experience triad: Mortality risk and the hospital consumer assessment of healthcare providers and systems survey

Abstract

BACKGROUND Studies have shown an association between the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) scores and clinical quality. The mortality risk on admission predicts adverse events. It is not known if this risk also portends a suboptimal patient experience. OBJECTIVE To determine if the admission mortality risk identifies an experience of care risk. DESIGN A retrospectively assembled cohort in which individual HCAHPS survey responses were linked to the admission risk of dying. SETTING Five community hospitals of various sizes in Michigan. PATIENTS There were 17,509 HCAHPS medical and surgical respondents; 2513 (14.4%) were at high risk of dying. MEASUREMENTS Odds ratio (OR) (high‐risk patients to low‐risk patients) for providing a top box score for HCAHPS dimensions, controlling for hospital and the standard HCAHPS patient mix adjustment factors. RESULTS High‐risk respondents were less likely to provide the most favorable response (unadjusted) for all HCAHPS domains, although the difference was not significant (P = 0.09) for discharge information. Multivariable analyses indicated that high‐risk patients were less likely to report a top box experience for doctor communication (OR: 0.85; 95% confidence interval [CI]: 0.77‐0.94) and responsiveness of hospital staff (OR: 0.77; 95% CI: 0.69‐0.85), but were more likely to have received adequate discharge information (OR: 1.30, 95% CI: 1.14‐1.48). CONCLUSIONS Patients at high risk of dying who completed surveys were less likely to report favorable physician communication and staff responsiveness. Further understanding of these relationships may help design a care model to improve both outcomes and experience. Journal of Hospital Medicine 2016;11:628–635. © 2016 Society of Hospital Medicine

The Association Between Patient Satisfaction and Patient-Reported Health Outcomes

“…Patients included in the MEPS database were also not tracked longitudinally over time. Additionally, the MEPS database contains limited variables and some variables that might have had an impact on patient satisfaction and outcomes, such as patient comorbidities contributing to mortality risk, were not included (8). Data were also exclusively derived from patients in the United States who were noninstitutionalized.…”

“…Kaye et al noted a possible relationship between high patient satisfaction and improved outcomes in some patient populations (7). In a separate study, Cowen et al suggested a potential interrelationship between patient mortality risk and patient satisfaction and outcomes (8). However, few studies have specifically examined the association of self-reported patient satisfaction scores with a broad range of health outcome metrics.…”

Association Between Patient Satisfaction and Short-Term Outcomes After Major Cancer Surgery

“…Third, we were unable to adjust for some patient characteristics, including illness severity and depression, which are associated with lower patient-satisfaction scores [28, 29]. However, we adjusted for other Elixhauser co-morbidities and the Hospital Compare HCAHPS measure includes an adjustment for self-rated health.…”

It's a matter of respect

“…In this issue of the Journal of Hospital Medicine, Cowen and coauthors shed light on the experience of inpatients on medical and surgical services with a high risk of mortality on admission, as measured by Hospital Consumer Assessment of Healthcare Providers and Systems Surveys (HCAHPS). 1 In their study population, even after adjustment for some confounders, these patients tended to rate responsiveness of hospital staff and communication by doctors lower than patients with a low risk of mortality on admission.…”