L. H. Nicholas1,2, L. H. Nicholas1,2 1Johns Hopkins School Of Public Health,Health Policy & Management,Baltimore, MD, USA 2Johns Hopkins University School Of Medicine,Surgery,Baltimore, MD, USA
Introduction: Public and private payers increasingly rely on measures of process compliance and patient satisfaction to determine hospital payments and to steer patients to hospitals where they will have better outcomes. However, these measures do not correlate with risk-adjusted mortality, raising questions about their usefulness for patients and payers. Given the low mortality rates associated with most elective surgical procedures, however, it is important to understand whether quality metrics correlate with changes in patient health and functional status.
Methods: Medicare claims from 6,761 surgical admissions between July 2005 and December 2010 were linked to pre-and post admission survey measures of self-rated health and functional status collected as part of the nationally representative Health and Retirement Study. Hospitals were classified by their terciles of performance on a composite process score reflecting compliance with Surgical Care Improvement Program (SCIP) measures and the proportion of patients who would recommend their hospital from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) during the period of each admission. Multivariate regression was used to assess the relationship between risk-adjusted measures of patient self-rated health and counts of activities of daily living (ADL) limitations with the hospital's HCAHPS and SCIP scores.
Results: Compliance with SCIP measures averaged 76.5% in low-performing hospitals, 88.6% in medium-performing, and 94.1% in high-performing hospitals. 57.8% of patients recommended hospitals in the lowest HCAHPS tertile, 68.9% in the middle, and 78.2% in the highest. Compared to patients treated in hospitals with the lowest SCIP and HCAHPS rankings, patients in higher-scoring hospitals had better self-rated health, fewer depressive symptoms, and fewer ADL limitations. However, these differences largely reflect healther patients selecting hospitals with higher SCIP compliance and patient satisfaction. After we controlled for patient health prior to hospitalization, there was no relationship between either SCIP compliance or HCAHPS score and patient health or functional status after admission.
Conclusion: Hospitals with higher levels of SCIP compliance and higher patient satisfaction scores attract patients who are healthier than those choosing low-performing hospitals. However, neither SCIP compliance nor HCAHPS rankings consistently correlate with changes in patient self-rated health and functional status with inpatient surgery. Additional outcomes data collection may be needed to distinguish between high and low-quality hospitals.
