title: Patients' perspectives of care and surgical outcomes in Michigan: an analysis using the CAHPS hospital survey.
abstract: 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.
  
  
  METHODS
  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
  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.
authors.affiliation: From the Department of Surgery, University of Michigan, Ann Arbor.
authors.forename: Kyle H
authors.initials: KH
authors.lastname: Sheetz
authors.forename: Seth A
authors.initials: SA
authors.lastname: Waits
authors.forename: Micah E
authors.initials: ME
authors.lastname: Girotti
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Englesbe
mesh_terms: D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006302:Health Services Research / Q000379:methods; D017052:Hospital Mortality / Q000639:trends; D006761:Hospitals / Q000592:standards*; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data*; D008297:Male; D008824:Michigan / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D011787:Quality of Health Care; D012042:Registries; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative