519163
research-article2014
AJMXXX10.1177/1062860613519163American Journal of Medical QualitySrinivas et al
Article
Association Between Patient Satisfaction and Outcomes in Kidney Transplant
American Journal of Medical Quality 2015, Vol. 30(2) 180–185 © 2014 by the American College of Medical Quality Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1062860613519163 ajmq.sagepub.com
Rajagopal Srinivas,1 Kenneth D. Chavin, MD, PhD,1 Prabhakar K. Baliga, MD,1 Titte Srinivas, MD,1 and David J. Taber, PharmD, BCPS1
Abstract This was a cross-sectional cohort study analyzing aggregate publicly reported data integrated from 2 primary sources and included all US accredited kidney transplant programs that report data within the Scientific Registry of Transplant Recipients and Hospital Compare; 188 kidney transplant programs, representing 15 710 transplants were included in this study. In general, the scores for patient satisfaction questions were higher for higher-performing transplant programs; 5 questions reached statistically significant associations (P < .05). A composite of these 5 questions demonstrated a strong association with a center’s performance indices for both 1-month and 1-year graft and patient outcomes (69% vs 40%, P < .001, and 60% vs 44%, P = .035, respectively), which remained significant after controlling for baseline demographics. The results demonstrate that there is a positive and statistically significant correlation between a patient’s perceived quality of care, as measured by HCAHPS data, and quantified clinical outcomes for graft loss and patient death in kidney transplant recipients. Keywords kidney transplant, patient satisfaction, HCAHPS, graft survival, patient survival In recent years, the Centers for Medicare and Medicaid Services (CMS) has emphasized the importance of quantifying the measures of a health system’s quality of care. This is evidenced by the CMS Payment Advisory Commission’s recommendation to Congress to link a hospital’s reimbursement rates to quality-of-care metrics.1 In transplantation, these quality metrics, measured by the ratio of observed-to-expected graft and patient event rates and reported for each transplant center by the Scientific Registry of Transplant Recipients (SRTR), have been viewed both positively and negatively within the transplant community.2 Although it is crucial to have an intricate understanding of quality outcomes for each transplant program, one study demonstrated that after kidney transplant programs were found to have significantly higher-than-expected event rates (low performance), transplant volume significantly decreased in the following year.3 However, studies also demonstrate that the reported observed-to-expected event rates are strong and accurate forecasters of future transplant program performance.4 Along with an emphasis on outcomes, CMS also has placed increased importance on patient satisfaction as a measure of quality of care. This is demonstrated by the widespread utilization and reporting of the Hospital
Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey within the Hospital Compare database.5 These data represent patient perceptions of the quality and comprehensiveness of care they receive from a given health care system. There is evidence from medical disciplines outside of transplantation that HCAHPS data are significantly associated with hospital quality metrics. One study conducted in cardiac medicine demonstrated that patient satisfaction was positively correlated with 13 of 14 performance measures for acute myocardial infarction. In a follow-up study, movement to higher quartiles of patient satisfaction scores led to lower 30-day readmission rates for heart failure, acute myocardial infarction, and pneumonia.6,7 A third study demonstrated that hospitals with consistently low performance on cardiac scoring guidelines also had consistently low patient satisfaction scores.8
1
Medical University of South Carolina, Charleston, SC
Corresponding Author: David J. Taber, PharmD, BCPS, Division of Transplant Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 409, Charleston, SC 29425. Email: [email protected]
Downloaded from ajm.sagepub.com at OAKLAND UNIV on June 12, 2015
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Srinivas et al Although a link between patient satisfaction and outcomes metrics has been established within certain medical disciplines, these relationships have not been analyzed and published within transplantation. Establishing that patient satisfaction is associated with a transplant center’s overall quality performance will allow improved understanding of the driving forces behind the provision of quality care within transplantation. Therefore, the aim of this study was to assess the association between a health system’s reported HCAHPS results and the SRTRreported 1-month and 1-year observed-to-expected event rates for graft and patient survival.
Methods Study Design This was an institutional review board–approved retrospective cross-sectional analysis with the primary aim of determining the association between patients’ perceptions of the quality of care they receive and transplant center outcomes. A database was assembled by linking publicly reported data downloaded and integrated from the respective Web sites (http://www.medicare.gov/hospitalcompare and www.srtr.org). Data were manually retrieved from the Hospital Compare Web site by entering the transplant center’s hospital name into the search field and transcribing the reported mean percentages for each HCAHPS question into an MS Excel (Microsoft Corporation, Redmond, WA) database. These data were then integrated with the electronically downloaded transplant outcomes data available from the SRTR Web site for the year 2011. The Hospital Compare data reported on the Web site corresponded to this time period. For the initial analysis, hospitals were dichotomized based on being above or below the median reported score for each HCAHPS question and above or below the reported median SRTR observed-to-expected event rates for 1-month and 1-year adult graft loss and patient death. The rates of centers that were above and below the median SRTR observed-to-expected event rates were compared for each HCAHPS question. Questions that demonstrated an association with SRTR reported outcomes were then aggregated to develop a composite HCAHPS score for each center. The rates of centers above and below the median composite score were compared for SRTR outcomes in both univariable and multivariable fashion.
Transplant Center Selection All transplant centers that performed at least 1 kidney transplant in the United States in 2011 were initially included in the analysis. This included a total of 217 transplant centers, representing 16 583 kidney transplants. Centers excluded from the final analysis were
Veterans Administration hospitals, military hospitals, pediatric hospitals, and those not reporting within Hospital Compare. The final number of centers included in the analysis was 188, representing 15 710 kidney transplants and 95% of the entire US kidney transplant population for 2011.
Statistical Analysis Continuous variables are reported as means ± standard deviation. Categorical variables, such as being above or below the median, are reported as percentages. Continuous variables with normal distribution were compared using the Student t test, with nonparametric comparisons conducted using the Wilcoxon Rank Sum test. Categorical variables were compared using the Pearson χ2 test. Multivariable analysis using binary logistic regression was performed for the dependent variable of being below the median SRTR observed-to-expected event rates for both 1-month and 1-year graft loss and patient death in separate models. Independent covariates included in the model comprised the categorical variable of a center being above or below the median composite HCAHPs score and the continuous variables of donor and recipient demographics and transplant characteristics. A 2-sided P value of
research-article2014
AJMXXX10.1177/1062860613519163American Journal of Medical QualitySrinivas et al
Article
Association Between Patient Satisfaction and Outcomes in Kidney Transplant
American Journal of Medical Quality 2015, Vol. 30(2) 180–185 © 2014 by the American College of Medical Quality Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1062860613519163 ajmq.sagepub.com
Rajagopal Srinivas,1 Kenneth D. Chavin, MD, PhD,1 Prabhakar K. Baliga, MD,1 Titte Srinivas, MD,1 and David J. Taber, PharmD, BCPS1
Abstract This was a cross-sectional cohort study analyzing aggregate publicly reported data integrated from 2 primary sources and included all US accredited kidney transplant programs that report data within the Scientific Registry of Transplant Recipients and Hospital Compare; 188 kidney transplant programs, representing 15 710 transplants were included in this study. In general, the scores for patient satisfaction questions were higher for higher-performing transplant programs; 5 questions reached statistically significant associations (P < .05). A composite of these 5 questions demonstrated a strong association with a center’s performance indices for both 1-month and 1-year graft and patient outcomes (69% vs 40%, P < .001, and 60% vs 44%, P = .035, respectively), which remained significant after controlling for baseline demographics. The results demonstrate that there is a positive and statistically significant correlation between a patient’s perceived quality of care, as measured by HCAHPS data, and quantified clinical outcomes for graft loss and patient death in kidney transplant recipients. Keywords kidney transplant, patient satisfaction, HCAHPS, graft survival, patient survival In recent years, the Centers for Medicare and Medicaid Services (CMS) has emphasized the importance of quantifying the measures of a health system’s quality of care. This is evidenced by the CMS Payment Advisory Commission’s recommendation to Congress to link a hospital’s reimbursement rates to quality-of-care metrics.1 In transplantation, these quality metrics, measured by the ratio of observed-to-expected graft and patient event rates and reported for each transplant center by the Scientific Registry of Transplant Recipients (SRTR), have been viewed both positively and negatively within the transplant community.2 Although it is crucial to have an intricate understanding of quality outcomes for each transplant program, one study demonstrated that after kidney transplant programs were found to have significantly higher-than-expected event rates (low performance), transplant volume significantly decreased in the following year.3 However, studies also demonstrate that the reported observed-to-expected event rates are strong and accurate forecasters of future transplant program performance.4 Along with an emphasis on outcomes, CMS also has placed increased importance on patient satisfaction as a measure of quality of care. This is demonstrated by the widespread utilization and reporting of the Hospital
Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey within the Hospital Compare database.5 These data represent patient perceptions of the quality and comprehensiveness of care they receive from a given health care system. There is evidence from medical disciplines outside of transplantation that HCAHPS data are significantly associated with hospital quality metrics. One study conducted in cardiac medicine demonstrated that patient satisfaction was positively correlated with 13 of 14 performance measures for acute myocardial infarction. In a follow-up study, movement to higher quartiles of patient satisfaction scores led to lower 30-day readmission rates for heart failure, acute myocardial infarction, and pneumonia.6,7 A third study demonstrated that hospitals with consistently low performance on cardiac scoring guidelines also had consistently low patient satisfaction scores.8
1
Medical University of South Carolina, Charleston, SC
Corresponding Author: David J. Taber, PharmD, BCPS, Division of Transplant Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 409, Charleston, SC 29425. Email: [email protected]
Downloaded from ajm.sagepub.com at OAKLAND UNIV on June 12, 2015
181
Srinivas et al Although a link between patient satisfaction and outcomes metrics has been established within certain medical disciplines, these relationships have not been analyzed and published within transplantation. Establishing that patient satisfaction is associated with a transplant center’s overall quality performance will allow improved understanding of the driving forces behind the provision of quality care within transplantation. Therefore, the aim of this study was to assess the association between a health system’s reported HCAHPS results and the SRTRreported 1-month and 1-year observed-to-expected event rates for graft and patient survival.
Methods Study Design This was an institutional review board–approved retrospective cross-sectional analysis with the primary aim of determining the association between patients’ perceptions of the quality of care they receive and transplant center outcomes. A database was assembled by linking publicly reported data downloaded and integrated from the respective Web sites (http://www.medicare.gov/hospitalcompare and www.srtr.org). Data were manually retrieved from the Hospital Compare Web site by entering the transplant center’s hospital name into the search field and transcribing the reported mean percentages for each HCAHPS question into an MS Excel (Microsoft Corporation, Redmond, WA) database. These data were then integrated with the electronically downloaded transplant outcomes data available from the SRTR Web site for the year 2011. The Hospital Compare data reported on the Web site corresponded to this time period. For the initial analysis, hospitals were dichotomized based on being above or below the median reported score for each HCAHPS question and above or below the reported median SRTR observed-to-expected event rates for 1-month and 1-year adult graft loss and patient death. The rates of centers that were above and below the median SRTR observed-to-expected event rates were compared for each HCAHPS question. Questions that demonstrated an association with SRTR reported outcomes were then aggregated to develop a composite HCAHPS score for each center. The rates of centers above and below the median composite score were compared for SRTR outcomes in both univariable and multivariable fashion.
Transplant Center Selection All transplant centers that performed at least 1 kidney transplant in the United States in 2011 were initially included in the analysis. This included a total of 217 transplant centers, representing 16 583 kidney transplants. Centers excluded from the final analysis were
Veterans Administration hospitals, military hospitals, pediatric hospitals, and those not reporting within Hospital Compare. The final number of centers included in the analysis was 188, representing 15 710 kidney transplants and 95% of the entire US kidney transplant population for 2011.
Statistical Analysis Continuous variables are reported as means ± standard deviation. Categorical variables, such as being above or below the median, are reported as percentages. Continuous variables with normal distribution were compared using the Student t test, with nonparametric comparisons conducted using the Wilcoxon Rank Sum test. Categorical variables were compared using the Pearson χ2 test. Multivariable analysis using binary logistic regression was performed for the dependent variable of being below the median SRTR observed-to-expected event rates for both 1-month and 1-year graft loss and patient death in separate models. Independent covariates included in the model comprised the categorical variable of a center being above or below the median composite HCAHPs score and the continuous variables of donor and recipient demographics and transplant characteristics. A 2-sided P value of
