Patient perspectives of care and process and outcome quality measures for heart failure admissions in US hospitals: how are they related in the era of public reporting?
OBJECTIVE
Process quality measure performance has improved significantly with public reporting, requiring reevaluation of process-outcome relationships and the emerging role of patient perspectives on care.


OBJECTIVE
To evaluate associations between heart failure patient perspectives of care and publicly reported processes and outcomes.


METHODS
Cross-sectional study, July 2008-June 2011.


METHODS
US hospitals in the Press Ganey database.


METHODS
Heart failure inpatients.


METHODS
Outcomes were Hospital Compare hospital-level risk-adjusted 30-day heart failure mortality and readmissions. Predictors included Hospital Compare heart failure processes of care, a weighted process composite and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) domains for heart failure. Hospital characteristics included volume of heart failure patients and race, health status and education.


RESULTS
Among 895 included hospitals, performance on process measures was high (median by hospital for composite, 95.6%); the median HCAHPS overall rating was 86.9. Median mortality was 11.3% and readmissions was 24.8%. No process measures were statistically significantly associated with lower mortality or readmissions in adjusted analyses. Higher ratings on HCAHPS patient perspectives of care were significantly correlated with lower readmissions in adjusted analyses, particularly those publicly reported domains conceptually related to readmissions. The magnitude was small (1.8 points higher on a 100-point scale between the highest and lowest quartiles of hospital readmissions).


CONCLUSIONS
Publicly reported process quality measures were no longer associated with outcomes, but higher patient perspectives of care were associated with lower heart failure readmissions. These associations support continued reevaluation of these measures and increased emphasis on patient experience and outcomes, as planned for Value-Based Purchasing.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
Sydney Morss
SM
Dy
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
Kitty S
KS
Chan
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
Hsien-Yen
HY
Chang
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
Allen
A
Zhang
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD 21205, USA.
Junya
J
Zhu
Press Ganey, 404 Columbia Place, South Bend, IN 46601, USA.
Deirdre
D
Mylod
D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure; D006761:Hospitals / Q000592:standards; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D010343:Patient Admission; D017060:Patient Satisfaction; D019984:Quality Indicators, Health Care; D014481:United States
heart failure; hospital quality; patient satisfaction; public reporting; quality measurement