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  • Does Objective Quality of Physicians Correlate with Patient Satisfaction Measured by Hospital Compare Metrics in New York State?

    Final Number:

    Kimon Bekelis MD; Symeon Missios MD; Todd MacKenzie Ph.D.

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2017 Annual Meeting

    Introduction: It is unclear whether publicly reported benchmarks correlate with the quality of physicians and institutions. We investigated the association of patient satisfaction measures from a public reporting platform with the performance of neurosurgeons in New York State.

    Methods: We performed a cohort study involving patients undergoing neurosurgical operations from 2009-2013, who were registered in the Statewide Planning and Research Cooperative System (SPARCS) database. This cohort was merged with publicly available data from the CMS Hospital Compare website. A propensity adjusted regression analysis was used to investigate the association of patient satisfaction metrics with neurosurgeon quality, as measured by their individual rate of mortality and average length-of-stay (LOS).

    Results: Overall, 166,365 patients underwent neurosurgical procedures during the study. Using a propensity adjusted multivariable regression analysis we demonstrated that undergoing neurosurgical operations in hospitals with a greater percentage of patient-assigned “high” score were associated with higher chance of being treated by a physician with superior performance in terms of mortality (OR 1.90; 95% CI, 1.86 to 1.95), and a higher chance of being treated by a physician with superior performance in terms of length-of-stay (LOS) (OR 1.24; 95% CI, 1.21 to 1.27). Similar associations were identified for hospitals with a higher percentage of patients, who claimed they would recommend these institutions to others.

    Conclusions: Merging a comprehensive all-payer cohort of neurosurgery patients in New York State with data from the CMS Hospital Compare website, we observed an association of superior hospital-level patient satisfaction measures with the objective performance of individual neurosurgeons in the corresponding hospitals.

    Patient Care: The present analysis demonstrated an association of superior physician performance with subjective patient satisfaction Hospital Compare metrics. It is unlikely that there is a direct correlation between the two variables. However, this association likely reflects a general “culture of excellence” in institutions with a focus on patient satisfaction. Such facilities are likely to also attract the highest performing physicians. In this regard, patient satisfaction must be viewed as an essential but not sole indicator of surgical quality. Furthermore, the association between subjective and objective surgical outcomes may vary significantly between disease states, patient populations and specific procedures.

    Learning Objectives: By the conclusion of this session, participants should be able to: Identify whether publicly reported benchmarks correlate with the quality of physicians and institutions for neurosurgery patients

    References: 1. Austin JM, Jha AK, Romano PS, Singer SJ, Vogus TJ, Wachter RM, et al: National hospital ratings systems share few common scores and may generate confusion instead of clarity. Health Aff (Millwood) 34:423-430, 2015 2. Bekelis K, Goodney RP, Dzebisashvili N, Goodman DC, Bronner KK: Variation in the Care of Surgical Conditions: Cerebral Aneurysms, in Practice TDIfHPaC (ed): A Dartmouth Atlas of Health Care Series. Lebanon, NH, 2014 3. Bekelis K, Missios S, Coy S, Rahmani R, MacKenzie T, Asher AL: Correlation of subjective Hospital Compare metrics with objective outcomes of cranial neurosurgical procedures in New York State. Neurosurgery in press, 2017 4. Birkmeyer NJ, Birkmeyer JD: Strategies for improving surgical quality--should payers reward excellence or effort? N Engl J Med 354:864-870, 2006 5. Cassel CK, Conway PH, Delbanco SF, Jha AK, Saunders RS, Lee TH: Getting more performance from performance measurement. N Engl J Med 371:2145-2147, 2014 6. Centers for Medicare and Medicaid Services: Hospital Compare, in, 2015, Vol 2015 7. Centers for Medicare and Medicaid Services: Physician Compare, in, 2015, Vol 2015 8. Fung CH, Lim YW, \Mattke S, Damberg C, Shekelle PG: Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Int Med 148:111-123, 2008 9. Goff SL, Lagu T, Pekow PS, Hannon NS, Hinchey KL, Jackowitz TA, et al: A qualitative analysis of hospital leaders' opinions about publicly reported measures of health care quality. Jt Comm J Qual Patient Saf 41:169-177, 2015 10. Harder B, Comarow A: Hospital quality reporting by US News & World Report: why, how, and what's ahead. JAMA 313:1903-1904, 2015

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