From the Department of Surgery, University of Michigan, Ann Arbor.
Ann Surg. 2014 Jul;260(1):5-9. doi: 10.1097/SLA.0000000000000626.
To determine the relationship between postoperative morbidity and mortality and patients' perspectives of care.
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.
Retrospective cohort study.
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.
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.
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.
确定术后发病率和死亡率与患者护理观点之间的关系。
医疗质量研究的重点正在转移，更加注重以患者为中心的结果。患者的护理观点是否与手术结果相关仍不清楚。
回顾性队列研究。
利用密歇根州外科质量协作临床登记处（2008-2012 年）的数据，我们确定了 41833 例接受主要择期普通或血管外科手术的患者。我们的暴露变量是医院消费者评估医疗保健提供者和系统（HCAHPS）总评分和基础评分，这些评分是从医院基于价值的采购患者护理体验领域中得出的。使用多层次混合效应逻辑回归模型，我们根据患者合并症和病例组合调整了医院发病率和死亡率的调整。我们根据医院总评分和基础评分的五分位数分层报告结果。
风险调整发病率（13.6%-28.6%）在医院之间差异很大。HCAHPS 总评分最低和最高的医院之间，风险调整发病率没有显著差异（24.5%与 20.2%，P = 0.312）。HCAHPS 基础评分量化了患者护理观点的持续实现或改善，尽管所有中心的总体下降了 2.5%，但在研究期间与术后发病率的降低无关。我们观察到 HCAHPS 总评分和基础评分与术后死亡率之间存在类似的关系。
患者的护理观点与重大手术后发病率和死亡率的发生率无关。改善患者的观点和客观结果可能需要密歇根州的外科医生采取单独的措施。
