Chakrabarti A K, Sheetz K H, Katariya N N, Singer A L, Hewitt W R, Heilman R L, Khamash H, Reddy K S, Moss A A, Mathur A K
Section of Transplantation Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
Transplant Proc. 2016 Jul-Aug;48(6):1986-92. doi: 10.1016/j.transproceed.2016.03.038.
Currently, transplant patients have limited metrics available to understand transplant center quality. Graft and patient survival do not capture the patient experience, and patients may use more general consumer assessments of hospital care to help select transplant centers. We evaluated whether consumer assessments of hospital quality correlate with short- and long-term kidney transplant center performance.
CMS uses the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to publicly report patients' perspectives on hospital care. We merged 2012 SRTR kidney transplant (n = 200 centers), HCAHPS and American Hospital Association survey data. Center performance was determined by variation in observed-to-expected (O/E) ratios for 1-month and 1-year graft failure. We used multivariate regression to determine whether HCAHPS measures correlate with center performance, after risk-adjusting for structural characteristics and volume.
Center-specific graft failure varied significantly (30 day O/E range: 0-4.1). At 30 days, compared to average centers, cleanliness (OR = 1.26, P = .001), patient recommendation (OR = 1.18, P = .005), and high overall ratings (OR = 1.11, P = .036) predicted high performance. Poor nursing-patient communication (OR = 0.70, P = .030), lower cleanliness (OR = 0.67, P < .001), poor overall ratings (OR = 0.79, P = .038), and no recommendation (OR = 0.68, P = .019) correlated with average/low performance. There was no significant correlation between HCAHPS measures and 1-year outcomes.
The association between hospital consumer assessments of hospital care and center performance after kidney transplantation is limited. More specific metrics oriented to capturing transplant patient perspectives may be valuable in further defining transplant quality.
目前，移植患者用于了解移植中心质量的指标有限。移植物和患者生存率无法体现患者体验，患者可能会利用对医院护理的更一般消费者评估来帮助选择移植中心。我们评估了消费者对医院质量的评估是否与短期和长期肾移植中心的表现相关。
美国医疗保险和医疗补助服务中心（CMS）使用医疗服务提供者和系统消费者评估（HCAHPS）来公开报告患者对医院护理的看法。我们合并了2012年美国器官共享联合网络（SRTR）肾移植数据（n = 200个中心）、HCAHPS数据和美国医院协会调查数据。中心表现通过1个月和1年移植物失败的观察与预期（O/E）比率的差异来确定。在对结构特征和数量进行风险调整后，我们使用多变量回归来确定HCAHPS指标是否与中心表现相关。
各中心的移植物失败情况差异显著（30天O/E范围：0 - 4.1）。在30天时，与平均水平的中心相比，清洁度（比值比[OR]=1.26，P = 0.001）、患者推荐度（OR = 1.18，P = 0.005）和总体高评分（OR = 1.11，P = 0.036）预示着表现良好。护士与患者沟通不良（OR = 0.70，P = 0.030）、清洁度较低（OR = 0.67，P < 0.001）、总体评分较低（OR = 0.79，P = （此处原文有误，应为0.038））以及无推荐（OR = 0.68，P = 0.019）与平均/低表现相关。HCAHPS指标与1年结果之间无显著相关性。
肾移植后医院消费者对医院护理的评估与中心表现之间的关联有限。更针对移植患者观点的具体指标可能对进一步界定移植质量有价值。
