Getting satisfaction: drivers of surgical Hospital Consumer Assessment of Health care Providers and Systems survey scores

James C Iannuzzi; Steven A Kahn; Linlin Zhang; Mark L Gestring; Katia Noyes; John R T Monson

doi:10.1016/j.jss.2015.03.045

Getting satisfaction: drivers of surgical Hospital Consumer Assessment of Health care Providers and Systems survey scores

J Surg Res. 2015 Jul;197(1):155-61. doi: 10.1016/j.jss.2015.03.045. Epub 2015 Mar 24.

Authors

James C Iannuzzi¹, Steven A Kahn², Linlin Zhang³, Mark L Gestring⁴, Katia Noyes³, John R T Monson³

Affiliations

¹ Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, New York. Electronic address: james_iannuzzi@urmc.rochester.edu.
² Department of Surgery, Vanderbilt University, Nashville, Tennessee.
³ Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
⁴ Division of Trauma and Acute Care Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.

PMID: 25908102
DOI: 10.1016/j.jss.2015.03.045

Abstract

Background: Hospital consumer assessment of health care providers and systems (HCAHPS) survey scores formally recognize that patients are central to health care, shifting quality metrics from the physician to patient perspective. This study describes clinical predictors of patient satisfaction in surgical patients.

Methods: Analysis of a single institution's Surgical Department HCAHPS responses was performed from March 2011-October 2012. The end points were top box satisfaction on two global domains. Multivariable regression was used to determine satisfaction predictors including HCAHPS domains, demographics, and clinical variables such as comorbidities, intensive care unit stay, emergency case, discharge day, floor transfers, complications, and ancillary procedures.

Results: In total, 978 surveys were evaluated representing admissions to Acute care and/or Trauma (n = 177, 18.1%), Thoracic (n = 169, 17.3%), Colorectal (n = 107, 10.9%), Transplant (n = 95, 9.7%), Vascular (n = 92, 9.4%), Oncology (n = 88, 9.0%), Plastic (n = 49, 5.0%), and Cardiac (n = 201, 20.6%) divisions. Overall, 658 patients (67.3%) had high satisfaction and 733 (74.9%) gave definite hospital recommendations. Hospital satisfaction was positively associated with an intensive care unit admission (odds ratio [OR] = 1.64, confidence interval [CI]: 1.20-2.23, P = 0.002) and satisfaction with provider and pain domains. Factors associated with decreased satisfaction were race (non-black minority compared with whites; OR = 0.41, CI: 0.21-0.83, P = 0.012), self-reported poor health (OR = 0.43, CI: 0.27-0.68, P < 0.001), ≥ 2 floor transfers (OR = 0.50, CI: 0.25-0.99, P = 0.046), and postoperative complications (OR = 0.67, CI: 0.55-0.82, P < 0.0001). In addition, weekend discharge (OR = 1.76, CI: 1.02-3.02, P = 0.041) was associated with hospital recommendation.

Conclusions: Clinical course, particularly complications, impacts patient satisfaction. However, more important than what happens is how it happens, as evidenced by the much greater influence of surgeon and nurse-patient interactions. These results help inform future quality improvement and resource allocation.

Keywords: Clinical outcomes; HCAHPS; Outcomes research; Satisfaction; Surgery; Surgical health outcomes research.

MeSH terms

Health Care Surveys
Health Status
Hospitals / standards*
Humans
Models, Statistical
Multivariate Analysis
Patient Satisfaction / statistics & numerical data*
Perioperative Care / standards
Postoperative Complications
Professional-Patient Relations
Quality Improvement
Retrospective Studies
Self Report
Surgical Procedures, Operative / standards*
United States