Noticias

Noticias

  • Título: Patient satisfaction and hospitals: The “hotel” matters more than the quality of care!
  • Fecha: 22-08-2014

  • Frank J Criado, MD, FACS, FSVM

    Hospital size and operative volume were significantly associated with satisfaction among general surgery patients in an analysis of 171 hospitals in the United States. Surprisingly, all other safety and effectiveness measures, with the exception of low hospital mortality index, did not reliably reflect patient satisfaction, 'indicating that the system plays perhaps a bigger role than anything else we can do,' Dr. Gregory D. Kennedy said at the annual meeting of the American Surgical Association.

    Moreover, a clean room and well-controlled pain were the best predictors of high patient satisfaction. If it’s 'the quality of the hotel, not the quality of the surgeon that drives patient satisfaction,' and given that this is tied to reimbursement, what should the message be to hospital CEOs? asked discussant Dr. John Ricotta (from MedStar Washington Hospital Center).

    Dr. Kennedy (University of Wisconsin) said the message he takes to administrators and managers is that patient satisfaction cannot be a surrogate marker for safety and effectiveness or the only measure of quality because, in doing the right thing, surgeons often make patients unhappy. As a colorectal surgeon, he said he has unhappy patients every day, and remarked that he sometimes feels like a used car salesman where the only thing that he worries about is whether the patient is having a good experience when they drive off the lot, not whether it’s a safe, reliable car. He suggested that future quality measures may need to make the distinction between satisfied and engaged well-informed patients because a disengaged patient can be highly satisfied, while a highly engaged patient may not.

    For the current study, the investigators examined federal Hospital Consumer Assessment Healthcare Providers and Systems (HCAHPS) survey results from 171 hospitals in the University Health System Consortium database from 2011 to 2012. Patients can check one of four boxes for each question on the 27-item survey, with high satisfaction defined as median responses above the 75th percentile on the top box score. This cutoff was used because the Centers for Medicare & Medicaid Services, which developed the HCAHPS, uses only the top box score, Dr. Kennedy explained.

    The median hospital size was 421 beds (range, 25-1,280 beds), the median operative volume was 6,341 cases (range, 192-24,258 cases), and the mortality index was 0.83 (range, 0-2.61).

    In all, 62% of high-volume hospitals, defined as those with an operative volume above the median, achieved high patient satisfaction, compared with 38% of low-volume hospitals (P less than .001). Similar results were seen for operative volume, he said. Other system measures such as number of ICU cases and Surgical Care Improvement Project (SCIP) compliance were not associated with high HCAHPS scores.

    Among patient safety indicators, only low mortality index was associated with high satisfaction (P less than .001), while complications, early mortality, and overall mortality were not. Interestingly, hospitals with a higher number of Patient Safety Indicator cases – those involving accidental puncture, laceration, and venous thromboembolism – had higher rates of patient satisfaction, 'suggesting that unsafe care is perhaps correlated with high satisfaction,' Dr. Kennedy said. Other discussants criticized the study for failing to tie satisfaction to patient outcomes; for failing to control for factors influencing patient satisfaction such as age, sex, or social status; and for not looking at geographic differences or nursing-to-staff ratios.

    The complete manuscript of this study and its presentation at the American Surgical Association’s 134th Annual Meeting, April 2014, in Boston, is anticipated to be published soon in the Annals of Surgery.



  • Fuente: endovascular.es