Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT.
Spine (Phila Pa 1976). 2020 Apr 15;45(8):E448-E456. doi: 10.1097/BRS.0000000000003287.
Retrospective cohort study.
To assess nonresponder biases for the HCAHPS survey following spine surgery.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a publicly reported patient satisfaction survey. In addition to having the potential of impacting a hospital's reputation, it is directly linked to government reimbursement. However, it is known that a minority of patients return this survey, and it is expected that there are nonresponder biases.
All adult inpatient spine surgery patients at a single institution between January 2013 and August 2017 at a single institution were selected for retrospective analysis. Patient demographics and perioperative outcomes were assessed as potential predictors of not returning HCAHPS surveys. Univariate and multivariate analyses were performed.
Of 5517 spine surgeries analyzed, 1505 (27.3%) patients returned the HCAHPS survey. Response rate was variable based on patient characteristics (with statistically significant differences based on age, functional status, race, and American Society of Anesthesiologists score) but not variable based on anatomic region of the spine surgery. Multivariate analysis revealed that patients who did not return the HCAHPS survey were more likely to be black/African American (OR = 2.8, P < 0.001), have a higher American Society of Anesthesiologists score (OR 1.76, P < 0.001), and have had a major adverse event (OR = 1.66; P = 0.001), minor adverse event (OR = 2.50; P < 0.001), discharged to a destination other than home (OR = 2.16, P < 0.001), hospital readmission (OR = 2.58; P < 0.001), and a long hospital length of stay (OR = 1.28, P = 0.001).
For spine surgery patients, patient characteristics and perioperative outcomes were found to be significantly associated with the nonresponder bias for HCAHPS surveys. Although the potential resultant bias in HCAHPS scores cannot be directly determined, this must be considered in interpreting the results of such satisfaction surveys given that less than one-third of patients actually completed this survey in the study population.
回顾性队列研究。
评估脊柱手术后 HCAHPS 调查的无应答者偏倚。
医院消费者评估医疗保健提供者和系统（HCAHPS）调查是一项公开报告的患者满意度调查。除了有可能影响医院的声誉外，它还直接与政府报销挂钩。然而，众所周知，少数患者会退回该调查，并且预计会存在无应答者偏倚。
选择一家机构 2013 年 1 月至 2017 年 8 月期间所有接受单机构成人住院脊柱手术的患者进行回顾性分析。评估患者人口统计学和围手术期结局，作为不返回 HCAHPS 调查的潜在预测因素。进行单变量和多变量分析。
在分析的 5517 例脊柱手术中，有 1505 例（27.3%）患者返回了 HCAHPS 调查。根据患者特征（年龄、功能状态、种族和美国麻醉医师协会评分存在统计学显著差异），但根据脊柱手术的解剖区域无差异，回复率存在差异。多变量分析显示，未回复 HCAHPS 调查的患者更有可能是黑人/非裔美国人（OR=2.8，P<0.001），美国麻醉医师协会评分更高（OR 1.76，P<0.001），发生重大不良事件（OR=1.66；P=0.001）、轻微不良事件（OR=2.50；P<0.001）、出院目的地非家庭（OR=2.16，P<0.001）、医院再入院（OR=2.58；P<0.001）和住院时间延长（OR=1.28，P=0.001）。
对于脊柱手术患者，发现患者特征和围手术期结局与 HCAHPS 调查的无应答者偏倚显著相关。尽管不能直接确定 HCAHPS 评分的潜在结果偏差，但鉴于研究人群中只有不到三分之一的患者实际完成了这项调查，因此在解释此类满意度调查的结果时必须考虑到这一点。
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