Patients' perspectives of care and surgical outcomes in Michigan: an analysis using the CAHPS hospital survey

Abstract

Objective: To determine the relationship between postoperative morbidity and mortality and patients' perspectives of care.

Background: Priorities in health care quality research are shifting to place greater emphasis on patient-centered outcomes. Whether patients' perspectives of care correlate with surgical outcomes remains unclear.

Design: Retrospective cohort study.

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 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Total and Base Scores derived from the Hospital Value-Based Purchasing 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%-28.6%) varied widely across hospitals. There were no significant differences in risk-adjusted morbidity rates between hospitals with the lowest and highest HCAHPS Total Scores (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 after major surgery. Improving patients' perspectives and objective outcomes may require separate initiatives for surgeons in Michigan.

Figure 1

Risk-adjusted 30-day morbidity and mortality rates across quintiles of HCAHPS Total Performance Score. Error bars indicate the 95% confidence intervals for the estimate.

Figure 2

Scatterplot of hospitals' rankings for risk-adjusted morbidity (horizontal axis) and HCAHPS Total Score (vertical axis). Each quadrant represents either high or low performance for each measure.