Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, MI, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
Ann Surg Oncol. 2017 Nov;24(12):3486-3493. doi: 10.1245/s10434-017-6049-2. Epub 2017 Aug 17.
The aim of this study was to investigate whether patient satisfaction, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, is associated with short-term outcomes after major cancer surgery.
We first used national Medicare claims to identify patients who underwent a major extirpative cancer surgery from 2011 to 2013. Next, we used Hospital Compare data to assign the HCAHPS score to the hospital where the patient underwent surgery. We then performed univariate statistical analyses and fit multilevel logistic regression models to evaluate the relationship between excellent patient satisfaction and short-term cancer surgery outcomes for all surgery types combined and then by each individual surgery type.
We identified 373,692 patients who underwent major cancer surgery for one of nine cancers at 2617 hospitals. In both unadjusted and adjusted analyses, hospitals with higher proportions of patients reporting excellent satisfaction had lower complication rates (p < 0.001), readmissions (p < 0.001), mortality (p < 0.001), and prolonged length of stay (p < 0.001) than hospitals with lower proportions of satisfied patients, but with modest differences. This finding held true broadly across individual cancer types for complications, mortality, and prolonged length of stay, but less so for readmissions.
Hospital-wide excellent patient satisfaction scores are associated with short-term outcomes after major cancer surgery overall, but are modest in magnitude.
本研究旨在探讨患者满意度（通过医院消费者评估医疗保健提供者和系统（HCAHPS）调查进行衡量）是否与重大癌症手术后的短期结局相关。
我们首先使用国家医疗保险索赔数据，确定了 2011 年至 2013 年间接受重大根治性癌症手术的患者。接下来，我们使用医院比较数据将 HCAHPS 评分分配给患者接受手术的医院。然后，我们进行了单变量统计分析，并拟合了多层次逻辑回归模型，以评估所有手术类型和各手术类型的综合患者满意度与短期癌症手术结局之间的关系。
我们确定了 373692 名患者，他们在 2617 家医院接受了九种癌症中的一种的重大癌症手术。在未调整和调整分析中，报告满意度较高的患者比例较高的医院，并发症发生率（p<0.001）、再入院率（p<0.001）、死亡率（p<0.001）和住院时间延长（p<0.001）均较低，而患者满意度较低的医院则较高，但差异较小。这一发现普遍适用于各种癌症类型的并发症、死亡率和住院时间延长，但对再入院率的影响较小。
总体而言，医院范围内的优秀患者满意度评分与重大癌症手术后的短期结局相关，但影响程度较小。
