title: Do Patient Assessments of Hospital Quality Correlate With Kidney Transplantation Surgical Outcomes?
abstract: BACKGROUND
  Currently, transplant patients have limited metrics available to understand transplant center quality. Graft and patient survival do not capture the patient experience, and patients may use more general consumer assessments of hospital care to help select transplant centers. We evaluated whether consumer assessments of hospital quality correlate with short- and long-term kidney transplant center performance.
  
  
  METHODS
  CMS uses the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to publicly report patients' perspectives on hospital care. We merged 2012 SRTR kidney transplant (n = 200 centers), HCAHPS and American Hospital Association survey data. Center performance was determined by variation in observed-to-expected (O/E) ratios for 1-month and 1-year graft failure. We used multivariate regression to determine whether HCAHPS measures correlate with center performance, after risk-adjusting for structural characteristics and volume.
  
  
  RESULTS
  Center-specific graft failure varied significantly (30 day O/E range: 0-4.1). At 30 days, compared to average centers, cleanliness (OR = 1.26, P = .001), patient recommendation (OR = 1.18, P = .005), and high overall ratings (OR = 1.11, P = .036) predicted high performance. Poor nursing-patient communication (OR = 0.70, P = .030), lower cleanliness (OR = 0.67, P < .001), poor overall ratings (OR = 0.79, P = .038), and no recommendation (OR = 0.68, P = .019) correlated with average/low performance. There was no significant correlation between HCAHPS measures and 1-year outcomes.
  
  
  CONCLUSIONS
  The association between hospital consumer assessments of hospital care and center performance after kidney transplantation is limited. More specific metrics oriented to capturing transplant patient perspectives may be valuable in further defining transplant quality.
authors: Section of Transplantation Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors: A K
authors: AK
authors: Chakrabarti
authors: Section of Transplantation Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
authors: K H
authors: KH
authors: Sheetz
authors: Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors: N N
authors: NN
authors: Katariya
authors: Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors: A L
authors: AL
authors: Singer
authors: Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors: W R
authors: WR
authors: Hewitt
authors: Division of Nephrology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors: R L
authors: RL
authors: Heilman
authors: Division of Nephrology, Department of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors: H
authors: H
authors: Khamash
authors: Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors: K S
authors: KS
authors: Reddy
authors: Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA.
authors: A A
authors: AA
authors: Moss
authors: Division of Transplant Surgery, Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Phoenix, Arizona, USA. Electronic address: mathur.amit@mayo.edu.
authors: A K
authors: AK
authors: Mathur
mesh_terms: D003142:Communication; D003430:Cross-Sectional Studies; D006760:Hospitalization; D006801:Humans; D016030:Kidney Transplantation; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction; D015203:Reproducibility of Results; D020379:Risk Adjustment; D014481:United States