P76. Spine surgery patient-related factors and outcomes predict HCAHPS self-reported overall hospital rating

Abstract

BACKGROUND CONTEXT Beginning in 2013, the Centers for Medicare & Medicaid Services have tied a portion of hospitals annual reimbursement to patients’ responses on the Hospital Consumer Assessment and Healthcare Providers and Systems (HCAHPS) survey, a survey given to inpatients after discharge. Previous work has suggested that HCAHPS survey results, meant to be an unbiased measure of the quality of care delivered, vary with factors present prior to admission. Specifically, one study found that patients with lower overall health ratings were more likely to rate their overall hospital experience as worse. However, limited work has considered predictors of patients’ hospital ratings on HCAHPS among patients undergoing spine surgery. HCAHPS contains a question asking patients to give a rating to their hospital overall on a scale of 0 to 10, with a score of 9 or 10 considered high, or “top-box.” PURPOSE Among patients undergoing spine surgery, the present study sought to (1) compare patients who rated their overall hospital experience top-box to those who did not, and (2) to identify independent predictors of a top-box overall hospital rating. STUDY DESIGN/SETTING A retrospective study was performed using data from patients undergoing spine surgery at a single institution from 2013 to 2017. PATIENT SAMPLE Patients undergoing spine surgery at a single institution who returned HCAHPS surveys. OUTCOME MEASURES Demographics, comorbidities, surgical factors, and 30-day adverse events predictive of a top-box hospital rating were examined. METHODS Patient demographics, comorbidities, surgical variables, and 30-day perioperative outcomes were compared between patinets who rated their hospital as top-box and those who did not.Multivariate logistic regression was performed to determine independent predictors of a top-box hospital rating. Additionally, controlling for demographics, select comorbidities, and surgical factors, individual multivariate logistic regressions were performed to evaluate the predictive effects for any, major, and minor adverse events, reoperation, readmission, and prolonged hospital length of stay on top-box hospital rating. RESULTS In total,1,480 patients who completed HCHAPS surveys after spine surgery were identified. Patients were 60.55±13.17 years old, and 50.14% were male. Patients who rated the hospital as top-box had higher mean HCAHPS scores than those who did not (62.00±12.81 vs 59.23±14.10, p=0.032). On multivariate logistic regression, compared to age 40 of below, age 41-60 older age (Odds Ratio [OR] 2.16, 95% Confidence Interval [CI] 1.37-3.41, p=0.001), 61-80 (OR 2.47, 95% CI 1.55-3.94), and over 80 years old (OR 2.07, 95% CI 1.05-4.10, p=0.036), cervical surgery (OR 1.41, 95% CI 1.07-1.86, p=0.016; with lumbar surgery as the reference), and male sex (OR 1.32, 95% CI 1.03-1.68, p=0.028) independently predicted a top-box hospital rating. Meanwhile a top-box hospital rating was negatively predicted by ASA class II (OR 0.51, 95% CI 0.28-0.91, p=0.024), III (OR 0.47, 95% CI 0.25-0.89, p=0.020), and IV (OR 0.17, 95% CI 0.05-0.54, p=0.003), and non-elective surgery (OR 0.51, CI 0.33-0.81, p=0.004). When controlling for the occurrence of any adverse event within 30 days, the demographics and surgical factors found to positively or negatively predict a top-box hospital rating remained significant, with essentially unchanged ORs and 95% CIs. Considering 30-day outcomes, controlling for demographics, surgical factors, and select comorbidities, a hospital rating less than top-box was predicted by any adverse event (OR 0.49, 95% CI 0.32-0.77, p=0.002), readmission (OR 0.50, 95% CI 0.28-0.91, p=0.023), and hospital stay longer than the study population's 75th percentile (OR 0.55, 95% CI 0.36-0.83, p=0.004). CONCLUSIONS Among patients undergoing spine surgery, the current study highlights factors that positively and negatively correlate with HCAHPS survey results. It is important to note that, in addition to short-term outcome variables, there are patients factors beyond the surgeon and hospital control that influence these ratings. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.