title: Surgical adverse outcomes and patients' evaluation of quality of care: inherent risk or reduced quality of care?
abstract: BACKGROUND
  Previous research has shown that sicker patients are less satisfied with their healthcare, but specific effects of adverse health outcomes have not been investigated. The present study aimed to assess whether patients who experience adverse outcomes, in hospital or after discharge, differ in their evaluation of quality of care compared with patients without adverse outcomes.
  
  
  METHODS
  In-hospital adverse outcomes were prospectively recorded by surgeons and surgical residents as part of routine care. Four weeks after discharge, patients were interviewed by telephone about the occurrence of post-discharge adverse outcomes, and their overall evaluation of quality of hospital care and specific suggestions for improvements in the healthcare provided.
  
  
  RESULTS
  Of 2145 surgical patients admitted to the Leiden University Medical Center in 2003, 1876 (88%) agreed to be interviewed. Overall evaluation was less favourable by patients who experienced post-discharge adverse outcomes only (average 19% lower). These patients were also more often dissatisfied (OR 2.02, 95% CI 1.24 to 3.31) than patients without adverse outcomes, and they more often suggested that improvements were needed in medical care (OR 2.07, 1.45 to 2.95) and that patients were discharged too early (OR 3.26, 1.72 to 6.20). The effect of in-hospital adverse outcomes alone was not statistically significant. Patients with both in-hospital and post-discharge adverse outcomes also found the quality of care to be lower (on average 33% lower) than patients without adverse outcomes.
  
  
  CONCLUSIONS
  Post-discharge adverse outcomes negatively influence patients' overall evaluation of quality of care and are perceived as being discharged too early, suggesting that patients need better information at discharge.
authors.affiliation: Department of Medical Decision Making, Leiden University Medical Center, J10-S, PO Box 9600, 2300 RC Leiden, The Netherlands. p.j.marang@lumc.nl
authors.forename: P J
authors.initials: PJ
authors.lastname: Marang-van de Mheen
authors.forename: N
authors.initials: N
authors.lastname: van Duijn-Bakker
authors.forename: J
authors.initials: J
authors.lastname: Kievit
mesh_terms: D003688:Deinstitutionalization / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007430:Intraoperative Care / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000523:psychology*; D011446:Prospective Studies; D011787:Quality of Health Care; D016896:Treatment Outcome