American College of Surgeons, Chicago, IL.
Department of Surgery, University of Chicago Medicine, Chicago, IL.
Ann Surg. 2020 Mar;271(3):475-483. doi: 10.1097/SLA.0000000000003034.
The aim of the study was to determine the association of patient-reported experiences (PREs) and risk-adjusted surgical outcomes among group practices.
The Centers for Medicare and Medicaid Services required large group practices to submit PREs data for successful participation in the Physician Quality Reporting System (PQRS) using the Consumer Assessment of Healthcare Providers and Systems for PQRS survey. Whether these PREs data correlate with perioperative outcomes remains ill defined.
Operations between January 1, 2014 and December 31, 2016 in the American College of Surgeons' National Surgical Quality Improvement Program registry were merged with 2015 Consumer Assessment of Healthcare Providers and Systems for PQRS survey data. Hierarchical logistic models were constructed to estimate associations between 7 subscales and 1 composite score of PREs and 30-day morbidity, unplanned readmission, and unplanned reoperation, separately, while adjusting for patient- and procedure mix.
Among 328 group practices identified, patients reported their experiences with clinician communication the highest (mean ± standard deviation, 82.66 ± 3.10), and with attention to medication cost the lowest (25.96 ± 5.14). The mean composite score was 61.08 (±6.66). On multivariable analyses, better PREs scores regarding medication cost, between-visit communication, and the composite score of experience were each associated with 4% decreased odds of morbidity [odds ratio (OR) 0.96, 95% confidence interval (CI) 0.92-0.99], readmission (OR 0.96, 95% CI 0.93-0.99), and reoperation (OR 0.96, 95% CI 0.93-0.99), respectively. In sensitivity analyses, better between-visit communication remained significantly associated with fewer readmissions.
In these data, patients' report of better between-visit communication was associated with fewer readmissions. More sensitive, surgery-specific PRE assessments may reveal additional unique insights for improving the quality of surgical care.
本研究旨在确定患者报告的体验（PREs）与群体实践中的风险调整手术结果之间的关联。
医疗保险和医疗补助服务中心要求大型群体实践机构在成功参与医师质量报告系统（PQRS）时，使用医疗保健提供者和系统消费者评估调查（Consumer Assessment of Healthcare Providers and Systems for PQRS survey）提交 PREs 数据。这些 PREs 数据是否与围手术期结果相关仍未得到明确界定。
2014 年 1 月 1 日至 2016 年 12 月 31 日期间，美国外科医师学院国家手术质量改进计划登记处的手术与 2015 年医疗保健提供者和系统消费者评估调查（Consumer Assessment of Healthcare Providers and Systems for PQRS survey）数据合并。构建分层逻辑模型，以分别估计 7 个子量表和 1 个 PREs 综合评分与 30 天发病率、非计划再入院和非计划再次手术之间的关联，同时调整患者和手术组合。
在确定的 328 个群体实践中，患者报告的与临床医生沟通的体验最高（平均±标准差，82.66±3.10），而对药物费用的关注最低（25.96±5.14）。平均综合评分为 61.08（±6.66）。多变量分析显示，药物成本、就诊间沟通和体验综合评分方面 PREs 评分更好与发病率降低 4%[比值比（OR）0.96，95%置信区间（CI）0.92-0.99]、再入院（OR 0.96，95%CI 0.93-0.99）和再次手术（OR 0.96，95%CI 0.93-0.99）相关。在敏感性分析中，就诊间沟通更好与再入院减少仍显著相关。
在这些数据中，患者报告的就诊间沟通改善与再入院减少相关。更敏感、针对手术的 PRE 评估可能会为改善手术护理质量提供更多独特的见解。
