Bekelis Kimon, Missios Symeon, MacKenzie Todd A, O'Shaughnessy Patrick M
Department of Neurosurgery, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, USA; Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA; Population Health Research Institute of New York at Catholic Health Services of Long Island, Rockville Centre, New York, USA.
Center for Neuro and Spine, Cleveland Clinic-Akron General Hospital, Akron, Ohio, USA.
World Neurosurg. 2017 Jul;103:852-858.e1. doi: 10.1016/j.wneu.2017.04.108. Epub 2017 Apr 26.
It is unclear whether publicly reported benchmarks correlate with quality of physicians and institutions. We investigated the association of patient satisfaction measures from a public reporting platform with performance of neurosurgeons in New York State.
This cohort study comprised patients undergoing neurosurgical operations from 2009 to 2013 who were registered in the Statewide Planning and Research Cooperative System database. The cohort was merged with publicly available data from the Centers for Medicare and Medicaid Services Hospital Compare website. Propensity-adjusted regression analysis was used to investigate the association of patient satisfaction metrics with neurosurgeon quality, as measured by the neurosurgeon's individual rate of mortality and average length of stay.
During the study period, 166,365 patients underwent neurosurgical procedures. Using propensity-adjusted multivariable regression analysis, we demonstrated that undergoing neurosurgical operations in hospitals with a greater percentage of patient-assigned "high" scores was associated with higher chance of being treated by a physician with superior performance in terms of mortality (odds ratio 1.90, 95% confidence interval 1.86-1.95), and a higher chance of being treated by a physician with superior performance in terms of length of stay (odds ratio 1.24, 95% confidence interval 1.21-1.27). Similar associations were identified for hospitals with a higher percentage of patients who claimed they would recommend these institutions to others.
Merging a comprehensive all-payer cohort of neurosurgery patients in New York State with data from the Hospital Compare website, we observed an association of superior hospital-level patient satisfaction measures with objective performance of individual neurosurgeons in the corresponding hospitals.
公开报告的基准与医生及机构的质量之间是否相关尚不清楚。我们调查了一个公共报告平台上的患者满意度指标与纽约州神经外科医生表现之间的关联。
这项队列研究纳入了2009年至2013年在全州规划与研究合作系统数据库中登记的接受神经外科手术的患者。该队列与医疗保险和医疗补助服务中心医院比较网站上的公开数据进行了合并。倾向调整回归分析用于研究患者满意度指标与神经外科医生质量之间的关联,神经外科医生质量通过其个人死亡率和平均住院时间来衡量。
在研究期间,166,365名患者接受了神经外科手术。使用倾向调整多变量回归分析,我们发现,在患者分配的“高”评分比例较高的医院接受神经外科手术,患者接受死亡率表现优异的医生治疗的几率更高(优势比1.90,95%置信区间1.86 - 1.95),接受住院时间表现优异的医生治疗的几率也更高(优势比1.24,95%置信区间1.21 - 1.27)。对于声称会向他人推荐这些机构的患者比例较高的医院,也发现了类似的关联。
将纽约州一个全面的全支付方神经外科患者队列与医院比较网站的数据合并后,我们观察到医院层面较高的患者满意度指标与相应医院中个体神经外科医生的客观表现之间存在关联。