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Back to 2014 Annual Meeting Abstracts
Readmission Decreases Patient Satisfaction in Colorectal Surgery
Leonardo C. Duraes*, James Merlino, Luca Stocchi, Tracy L. Hull, Massarat Zutshi, Daniel Bokar, Brooke Gurland
Colorectal Surgery, Cleveland Clinic Foundation, Cleveland, OH
Purpose: HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is a validated questionnaire designed to measure patients' perception of their in hospital experience with care. HCAHPS is a component of Medicare's value-based purchase initiative. Medicare has also started penalizing hospitals with high readmission rates for certain diagnoses. The aim of this study is to determine if 30-day readmission after colorectal surgery influences HCAHPS scores.
Methods: HCAHPS surveys collected after patients' discharges from 2012 - 2013 following colorectal surgery were linked with a prospectively maintained outcomes database, which included 30-day readmission rates after surgery. HCAHPS domains evaluated were: how well nurses and doctors communicate with patients; how responsive hospital staff are to patients' needs; how well hospital staff help patients manage pain; how well the staff communicates with patients about new medicines; whether key information is provided at discharge; hospital cleanliness and quietness; hospital recommendation; and overall hospital rating. Most favorable survey responses for domains were compared for patients undergoing primary admission versus 30-day readmission.
Results: 1079 HCAHPS surveys were evaluated. 1012 questionnaires (93.8%) corresponded to primary admissions (P), and 67 surveys (6.2%) were from readmissions (R). Patients readmitted to the hospital (R) were statistically more likely to respond unfavorably to "pain management" domains compared to those patients with a primary admission (P) (p=0.004). Patients who were readmitted (R) are also less likely to recommend the hospital (p=0.004). Readmission did not influence the other HCAHPS domains.
Conclusion: Hospital readmission after surgery negatively impacts HCAHPS scores associated with pain and hospital recommendation. Readmissions have the potential to influence hospital reimbursement in two different ways, by itself and by lower HCAHPS score. Comparison of primary admission and readmission "top box" answers in each HCAHPS domain | HCAHPS Domains | Primary Admission | Readmission | p Value | | Communication with Nurses | 689 (68.1%) | 41 (61.2%) | 0.24 | | Communication with Doctors | 711 (70.3%) | 41 (61.2%) | 0.12 | | Responsiveness of Hospital Staff | 196 (43.9%) | 10 (32.3%) | 0.21 | | Pain Management | 544 (58.7%) | 24 (39.3%) | 0.004 | | Communication about Medicine Medicine | 260 (46.3%) | 18 (47.4%) | 0.90 | | Discharge Information | 873 (86.3%) | 55 (82.1%) | 0.34 | | Cleanliness of Hospital Environment | 708 (70.0%) | 47 (70.1%) | 0.97 | | Quietness of Hospital Environment | 457 (45.2%) | 33 (49.3%) | 0.51 | | Overall Hospital Rating | 202 (79.8%) | 48 (72.7%) | 0.17 | | Recommend the Hospital | 867 (85.7%) | 49 (73.1%) | 0.007 |
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