Share this article on:

Patients' Perspectives of Care and Surgical Outcomes in Michigan: An Analysis Using the CAHPS Hospital Survey

Sheetz, Kyle H. MS; Waits, Seth A. MD; Girotti, Micah E. MD; Campbell, Darrell A. Jr MD; Englesbe, Michael J. MD

doi: 10.1097/SLA.0000000000000626

Objective: To determine the relationship between postoperative morbidity and mortality and patients' perspectives of care.

Background: Priorities in health care quality research are shifting to place greater emphasis on patient-centered outcomes. Whether patients' perspectives of care correlate with surgical outcomes remains unclear.

Design: Retrospective cohort study.

Methods: Using data from the Michigan Surgical Quality Collaborative clinical registry (2008–2012), we identified 41,833 patients undergoing major elective general or vascular surgery. Our exposure variables were the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Total and Base Scores derived from the Hospital Value-Based Purchasing Patient Experience of Care Domain. Using multilevel, mixed-effects logistic regression models, we adjusted hospitals' rates of morbidity and mortality for patient comorbidities and case mix. We stratified reporting of outcomes by quintiles of hospitals' Total and Base Scores.

Results: Risk-adjusted morbidity (13.6%–28.6%) varied widely across hospitals. There were no significant differences in risk-adjusted morbidity rates between hospitals with the lowest and highest HCAHPS Total Scores (24.5% vs 20.2%, P = 0.312). The HCAHPS Base Score, which quantifies sustained achievement or improvement in patients' perspectives of care, was not associated with a reduction in postoperative morbidity over the study period despite an overall decrease of 2.5% for all centers. We observed a similar relationship between HCAHPS Total and Base Scores and postoperative mortality.

Conclusions and Relevance: Patients' perspectives of care do not correlate with the incidence of morbidity and mortality after major surgery. Improving patients' perspectives and objective outcomes may require separate initiatives for surgeons in Michigan.

Patient-centered outcomes are of growing importance. We stratified Michigan hospitals using the HCAHPS survey of patients'perspectives of care and assessed the incidence of postoperative morbidity/mortality. Patients'perspectives do not correlate with objective surgical outcomes, calling to question their ability to incentivize surgical quality improvement.

From the Department of Surgery, University of Michigan, Ann Arbor.

Reprints: Michael J. Englesbe, MD, Department of Surgery, University of Michigan Medical School, 2926A Taubman Center, 1500 East Medical Center Dr, Ann Arbor, MI 48109. E-mail:

Disclosure: M.J.E is supported by NIH-NIDDK (K08 DK0827508) and the Blue Cross Blue Shield of Michigan Foundation. The authors declare no conflicts of interest.

© 2014 by Lippincott Williams & Wilkins.