Introduction: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey has made patient experience a key driver of quality and reimbursement for hospital systems and spine surgeons nationwide.
The purpose of this study was to determine if there are differences in patient experience scores between patients undergoing decompression and fusion of the lumbar spine.
Methods: A retrospective cohort analysis was performed using HCAHPS survey data from 449 patients who underwent lumbar decompression or fusion surgery at our institution from 1/1/2013-12/31/2015.
Patients were divided by surgery type into either the decompression (n=257) or fusion (n=192) surgery group. The number of "top-box" responses for each HCAHPS survey question was compared between the two groups using Pearson's chi-squared test. The data for both groups were adjusted for patient-mix according to CMS methodology and then analyzed using Pearson's chi-squared test.
Results: The fusion surgery group was found to have a significantly less "top-box" responses for four questions of the HCAHPS survey when compared to the decompression group. These four survey questions were the patient assessments of doctors listening carefully (78.0% vs. 86.4%, p=0.021), the hospital staff doing “everything they could” for the patient’s pain (75.9% vs. 84.6%, p=0.027), the hospital staff explaining the reasons for giving new medications (74.2% vs. 84.9%, p=0.019), and the responsiveness of help after a call button was pressed (60.8% vs. 70.9%, p=0.037). Notably, the same four questions were again found to be lower in the fusion group after adjusting the data for the patient-mix.
Conclusions: Our results suggest that patients undergoing fusion surgery of the lumbar spine may be more likely to report lower HCAHPS scores than patients undergoing decompression surgery. Our findings also suggest that the patient-mix adjustments used by CMS may not account for the differences in scores between these two groups of lumbar surgery patients.
Patient Care: This research will help the field of spine surgery to understand factors that may influence patient satisfaction. By identifying these factors, hospital systems and providers can better address the needs of patients affected by these factors.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the metrics evaluated in HCAHPS Survey and 2) recognize differences in HCAHPS scores observed in our sample of lumbar decompression and fusion patients