title: How well do subjective Hospital Compare metrics reflect objective outcomes in spine surgery?
abstract: OBJECTIVE The accuracy of public reporting in health care is an issue of debate. The authors investigated the association of patient satisfaction measures from a public reporting platform with objective outcomes for patients undergoing spine surgery. METHODS The authors performed a cohort study involving patients undergoing elective spine surgery from 2009 to 2013 who were registered in the New York Statewide Planning and Research Cooperative System database. This cohort was merged with publicly available data from the Centers for Medicare and Medicaid Services (CMS) Hospital Compare website. A mixed-effects regression analysis, controlling for clustering at the hospital level, was used to investigate the association of patient satisfaction metrics with outcomes. RESULTS During the study period, 160,235 patients underwent spine surgery. Using a mixed-effects multivariable regression analysis, the authors demonstrated that undergoing elective spine surgery in hospitals with a higher percentage of patient-assigned high satisfaction scores was not associated with a decreased rate of discharge to rehabilitation (OR 0.77, 95% CI 0.57-1.06), mortality (OR 0.96, 95% CI 0.90-1.01), or hospitalization charges (β 0.04, 95% CI -0.16 to 0.23). However, it was associated with decreased length of stay (LOS; β -0.19, 95% CI -0.33 to -0.05). 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 spine surgery patients in New York state with data from the CMS Hospital Compare website, the authors were not able to demonstrate an association of improved performance in patient satisfaction measures with decreased mortality, rate of discharge to rehabilitation, and hospitalization charges. Increased patient satisfaction was associated with decreased LOS.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana; and.
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D016208:Databases, Factual; D017586:Diskectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D017722:Hospital Charges; D017052:Hospital Mortality; D006801:Humans; D007796:Laminectomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D007902:Length of Stay; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D009518:New York / Q000453:epidemiology; D017060:Patient Satisfaction; D013123:Spinal Fusion / Q000009:adverse effects / Q000706:statistics & numerical data*; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States
keywords: CAD = coronary artery disease; CHF = congestive heart failure; CMS = Centers for Medicare and Medicaid Services; CRF = chronic renal failure; DM = diabetes mellitus; Hospital Compare; ICD-9-CM = International Classification of Disease, Ninth Revision, Clinical Modification; IQR = interquartile range; LOS = length of stay; N2QOD = National Neurosurgical Quality and Outcomes Database; PVD = peripheral vascular disease; SPARCS = Statewide Planning and Research Cooperative System; Statewide Planning and Research Cooperative System; TIA = transient ischemic attack; outcome; patient satisfaction; spine surgery