title: Getting satisfaction: drivers of surgical Hospital Consumer Assessment of Health care Providers and Systems survey scores.
abstract: BACKGROUND
  Hospital consumer assessment of health care providers and systems (HCAHPS) survey scores formally recognize that patients are central to health care, shifting quality metrics from the physician to patient perspective. This study describes clinical predictors of patient satisfaction in surgical patients.
  
  
  METHODS
  Analysis of a single institution's Surgical Department HCAHPS responses was performed from March 2011-October 2012. The end points were top box satisfaction on two global domains. Multivariable regression was used to determine satisfaction predictors including HCAHPS domains, demographics, and clinical variables such as comorbidities, intensive care unit stay, emergency case, discharge day, floor transfers, complications, and ancillary procedures.
  
  
  RESULTS
  In total, 978 surveys were evaluated representing admissions to Acute care and/or Trauma (n = 177, 18.1%), Thoracic (n = 169, 17.3%), Colorectal (n = 107, 10.9%), Transplant (n = 95, 9.7%), Vascular (n = 92, 9.4%), Oncology (n = 88, 9.0%), Plastic (n = 49, 5.0%), and Cardiac (n = 201, 20.6%) divisions. Overall, 658 patients (67.3%) had high satisfaction and 733 (74.9%) gave definite hospital recommendations. Hospital satisfaction was positively associated with an intensive care unit admission (odds ratio [OR] = 1.64, confidence interval [CI]: 1.20-2.23, P = 0.002) and satisfaction with provider and pain domains. Factors associated with decreased satisfaction were race (non-black minority compared with whites; OR = 0.41, CI: 0.21-0.83, P = 0.012), self-reported poor health (OR = 0.43, CI: 0.27-0.68, P < 0.001), ≥ 2 floor transfers (OR = 0.50, CI: 0.25-0.99, P = 0.046), and postoperative complications (OR = 0.67, CI: 0.55-0.82, P < 0.0001). In addition, weekend discharge (OR = 1.76, CI: 1.02-3.02, P = 0.041) was associated with hospital recommendation.
  
  
  CONCLUSIONS
  Clinical course, particularly complications, impacts patient satisfaction. However, more important than what happens is how it happens, as evidenced by the much greater influence of surgeon and nurse-patient interactions. These results help inform future quality improvement and resource allocation.
authors.affiliation: Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, New York. Electronic address: james_iannuzzi@urmc.rochester.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Iannuzzi
authors.affiliation: Department of Surgery, Vanderbilt University, Nashville, Tennessee.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kahn
authors.affiliation: Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Linlin
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Division of Trauma and Acute Care Surgery, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Mark L
authors.initials: ML
authors.lastname: Gestring
authors.affiliation: Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: Katia
authors.initials: K
authors.lastname: Noyes
authors.affiliation: Surgical Health Outcomes & Research Enterprise, Department of Surgery, University of Rochester Medical Center, Rochester, New York.
authors.forename: John R T
authors.initials: JR
authors.lastname: Monson
mesh_terms: D019538:Health Care Surveys; D006304:Health Status; D006761:Hospitals / Q000592:standards*; D006801:Humans; D015233:Models, Statistical; D015999:Multivariate Analysis; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D019990:Perioperative Care / Q000592:standards; D011183:Postoperative Complications; D011369:Professional-Patient Relations; D058996:Quality Improvement; D012189:Retrospective Studies; D057566:Self Report; D013514:Surgical Procedures, Operative / Q000592:standards*; D014481:United States
keywords: Clinical outcomes; HCAHPS; Outcomes research; Satisfaction; Surgery; Surgical health outcomes research