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Patient Satisfaction and Quality of Surgical Care in US Hospitals

by Tsai, T.C., Orav, E.J., & Jha, A.K.

Length of stay was shorter in hospitals with the highest levels of patient satisfaction (7.1 days vs 7.7 days, P < 0.001). Adjusting for procedural volume and structural characteristics, institutions in the highest quartile of patient satisfaction had the higher process of care performance (96.5 vs 95.5, P < 0.001), lower readmission rates (12.3% vs 13.6%, P < 0.001), and lower mortality (3.1% vs 3.6%) than those in the lowest quartile. Hospitals with high patient satisfaction also had a higher composite score for quality across all measures (P < 0.001).

Objective

The relationship between patient satisfaction and surgical quality is unclear for US hospitals. Using national data, we examined if hospitals with high patient satisfaction have lower levels of performance on accepted measures of the quality and efficiency of surgical care.

Background

Federal policymakers have made patient satisfaction a core measure for the way hospitals are evaluated and paid through the value-based purchasing program. There is broad concern that performance on patient satisfaction may have little or even a negative correlation with the quality of surgical care, leading to potential trade-offs in efforts to improve patient experience with other surgical quality measures.

Methods

We used the Hospital Consumer Assessment of Healthcare Providers and Systems survey data from 2010 and 2011 to assess performance on patient experience. We used national Medicare data on 6 common surgical procedures to calculate measures of surgical efficiency and quality: risk-adjusted length of stay, process score, risk-adjusted mortality rate, risk-adjusted readmission rate, and a composite z score across all 4 metrics. Multivariate models adjusting for hospital characteristics were used to assess the independent relationships between patient satisfaction and measures of surgical efficiency and quality.

Results

Of the 2953 US hospitals that perform one of these 6 procedures, the median patient satisfaction score was 69.5% (interquartile range, 63% 75.5%). Length of stay was shorter in hospitals with the highest levels of patient satisfaction (7.1 days vs 7.7 days, P < 0.001). Adjusting for procedural volume and structural characteristics, institutions in the highest quartile of patient satisfaction had the higher process of care performance (96.5 vs 95.5, P < 0.001), lower readmission rates (12.3% vs 13.6%, P < 0.001), and lower mortality (3.1% vs 3.6%) than those in the lowest quartile. Hospitals with high patient satisfaction also had a higher composite score for quality across all measures (P < 0.001).

Conclusions

Among US hospitals that perform major surgical procedures, hospitals with high patient satisfaction provided more efficient care and were associated with higher surgical quality. Our findings suggest there need not be a trade-off between good quality of care for surgical patients and ensuring a positive patient experience.

Annals of Surgery, 32(7):1299-1305 - 2015