ORIGINAL ARTICLE – THORACIC
Interactive CardioVascular and Thoracic Surgery 20 (2015) 236–241 doi:10.1093/icvts/ivu371 Advance Access publication 5 November 2014
Patient satisfaction with health-care professionals and structure is not affected by longer hospital stay and complications after lung resection: a case-matched analysis† Cecilia Pompilia, Michela Tiberib, Michele Salatib, Majed Refaib, Francesco Xiuméb and Alessandro Brunellia,* a b
St James’s University Hospital, Leeds, West Yorkshire, UK Ospedali Riuniti Ancona, Ancona, Italy
* Corresponding author. Department of Thoracic Surgery, St James’s University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK. Tel: +44-113-2068776; fax: +44-113-2068824; e-mail: [email protected] (A. Brunelli). Received 3 July 2014; received in revised form 30 September 2014; accepted 5 October 2014
Abstract OBJECTIVES: The objective of this investigation was to assess satisfaction with care of patients with long hospital stay (LHS) or complications after pulmonary resection in comparison with case-matched counterparts with a regular postoperative course. METHODS: This is a prospective observational analysis on 171 consecutive patients submitted to pulmonary resections (78 wedges, 8 segmentectomies, 83 lobectomies, 3 pneumonectomies) for benign (35), primary (93) or secondary malignant (43) diseases. A hospital stay >7 days was defined as long (LHS). Major cardiopulmonary complications were defined according to the ESTS database. Patient satisfaction was assessed by the administration of the EORTC IN-PATSAT32 module at discharge. The questionnaire is a 32-item self-administered survey including different scales, reflecting the perceived level of satisfaction about the care provided by doctors, nurses and other personnel. To minimize selection bias, propensity score case-matching technique was applied to generate two sets of matched patients: patients with LHS with counterparts without it; patients with complications with counterparts without it. RESULTS: Median length of postoperative stay was 4 days (range 2–43). Forty-one patients (24%) had a hospital stay>7 days and 21 developed cardiopulmonary complications (12%). Propensity score yielded two well-matched groups of 41 patients with and without LHS. There were no significant differences in any patient satisfaction scale between the two groups. The comparison of the results of the patient satisfaction questionnaire between the two matched groups of 21 patients with and without complications did not show significant differences in any scale. CONCLUSIONS: Patients experiencing poor outcomes such as long hospital stay or complications have similar perception of quality of care compared with those with regular outcomes. Patient-reported outcome measures are becoming increasingly important in the evaluation of the quality of care and may complement more traditional objective indicators such as morbidity or length of stay. Keywords: Lung resection • Patient satisfaction • Quality of care • Complications • Hospital stay
INTRODUCTION Patient-reported outcome measures (PROMs) are increasingly important in the evaluation of the quality of care. Although physician-driven indicators (i.e. morbidity and length of stay) remain the most commonly used quality metrics, many Health Organizations have started taking into consideration outcomes perceived by patients (i.e. quality of life, patient satisfaction with care) as a measure of quality of care. The UK Government, for instance, has included perceived patient experience with care as one of the domains set out in the NHS Outcomes Framework, designed to safeguard the quality of NHS services (http://www.dh.gov.uk/health).
† Presented at the 22nd European Conference on General Thoracic Surgery, Copenhagen, Denmark, 15–18 June 2014.
In USA, the Strategic Framework Board of the National Quality Forum developed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (www.hcahpsonline.org/home. aspx) with the intent of enhancing public accountability and transparency of providers. In fact, HCAHPS in the form of patient satisfaction ratings has been included in the annual quality metrics to be reported by hospitals in order to receive financial incentives from the Government. Nevertheless, to date, the link between physician-driven and patient-reported measures of quality remains elusive. There is in fact a paucity of evidence investigating the possible association between these two domains, which complicates their process of integration and combined use. In this context, one aspect that we thought worthy of investigation was to verify whether the satisfaction with health-care structure and professionals perceived by those patients classified as having been provided with suboptimal care according to physician-driven
© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
C. Pompili et al. / Interactive CardioVascular and Thoracic Surgery
indicators (prolonged stay or complicated), differed from the one perceived by patients with a regular postoperative course.
237
Table 1: European Organization for Research and Treatment of Cancer (EORTC) IN-PATSAT32 scales
This is a prospective observational analysis on 171 consecutive patients submitted to pulmonary resections (78 wedges, 8 segmentectomies, 83 lobectomies, 3 pneumonectomies) for either benign (35), primary (93) or secondary malignant (43) diseases during an 18-month period in a single centre. There were few dropouts: 1 patient died after the operation, 5 others refused to complete the questionnaire. As a rule, the operations were performed through a musclesparing nerve-sparing, anterolateral thoracotomy or video-assisted thoracic surgery by board-certified qualified thoracic surgeons. Patients were deemed functionally inoperable in case of both predicted postoperative forced expiratory volume in 1 s (FEV1) and predicted postoperative carbon monoxide lung diffusion capacity (DLCO)
Interactive CardioVascular and Thoracic Surgery 20 (2015) 236–241 doi:10.1093/icvts/ivu371 Advance Access publication 5 November 2014
Patient satisfaction with health-care professionals and structure is not affected by longer hospital stay and complications after lung resection: a case-matched analysis† Cecilia Pompilia, Michela Tiberib, Michele Salatib, Majed Refaib, Francesco Xiuméb and Alessandro Brunellia,* a b
St James’s University Hospital, Leeds, West Yorkshire, UK Ospedali Riuniti Ancona, Ancona, Italy
* Corresponding author. Department of Thoracic Surgery, St James’s University Hospital, Beckett Street, Leeds, West Yorkshire LS9 7TF, UK. Tel: +44-113-2068776; fax: +44-113-2068824; e-mail: [email protected] (A. Brunelli). Received 3 July 2014; received in revised form 30 September 2014; accepted 5 October 2014
Abstract OBJECTIVES: The objective of this investigation was to assess satisfaction with care of patients with long hospital stay (LHS) or complications after pulmonary resection in comparison with case-matched counterparts with a regular postoperative course. METHODS: This is a prospective observational analysis on 171 consecutive patients submitted to pulmonary resections (78 wedges, 8 segmentectomies, 83 lobectomies, 3 pneumonectomies) for benign (35), primary (93) or secondary malignant (43) diseases. A hospital stay >7 days was defined as long (LHS). Major cardiopulmonary complications were defined according to the ESTS database. Patient satisfaction was assessed by the administration of the EORTC IN-PATSAT32 module at discharge. The questionnaire is a 32-item self-administered survey including different scales, reflecting the perceived level of satisfaction about the care provided by doctors, nurses and other personnel. To minimize selection bias, propensity score case-matching technique was applied to generate two sets of matched patients: patients with LHS with counterparts without it; patients with complications with counterparts without it. RESULTS: Median length of postoperative stay was 4 days (range 2–43). Forty-one patients (24%) had a hospital stay>7 days and 21 developed cardiopulmonary complications (12%). Propensity score yielded two well-matched groups of 41 patients with and without LHS. There were no significant differences in any patient satisfaction scale between the two groups. The comparison of the results of the patient satisfaction questionnaire between the two matched groups of 21 patients with and without complications did not show significant differences in any scale. CONCLUSIONS: Patients experiencing poor outcomes such as long hospital stay or complications have similar perception of quality of care compared with those with regular outcomes. Patient-reported outcome measures are becoming increasingly important in the evaluation of the quality of care and may complement more traditional objective indicators such as morbidity or length of stay. Keywords: Lung resection • Patient satisfaction • Quality of care • Complications • Hospital stay
INTRODUCTION Patient-reported outcome measures (PROMs) are increasingly important in the evaluation of the quality of care. Although physician-driven indicators (i.e. morbidity and length of stay) remain the most commonly used quality metrics, many Health Organizations have started taking into consideration outcomes perceived by patients (i.e. quality of life, patient satisfaction with care) as a measure of quality of care. The UK Government, for instance, has included perceived patient experience with care as one of the domains set out in the NHS Outcomes Framework, designed to safeguard the quality of NHS services (http://www.dh.gov.uk/health).
† Presented at the 22nd European Conference on General Thoracic Surgery, Copenhagen, Denmark, 15–18 June 2014.
In USA, the Strategic Framework Board of the National Quality Forum developed the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) (www.hcahpsonline.org/home. aspx) with the intent of enhancing public accountability and transparency of providers. In fact, HCAHPS in the form of patient satisfaction ratings has been included in the annual quality metrics to be reported by hospitals in order to receive financial incentives from the Government. Nevertheless, to date, the link between physician-driven and patient-reported measures of quality remains elusive. There is in fact a paucity of evidence investigating the possible association between these two domains, which complicates their process of integration and combined use. In this context, one aspect that we thought worthy of investigation was to verify whether the satisfaction with health-care structure and professionals perceived by those patients classified as having been provided with suboptimal care according to physician-driven
© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
C. Pompili et al. / Interactive CardioVascular and Thoracic Surgery
indicators (prolonged stay or complicated), differed from the one perceived by patients with a regular postoperative course.
237
Table 1: European Organization for Research and Treatment of Cancer (EORTC) IN-PATSAT32 scales
This is a prospective observational analysis on 171 consecutive patients submitted to pulmonary resections (78 wedges, 8 segmentectomies, 83 lobectomies, 3 pneumonectomies) for either benign (35), primary (93) or secondary malignant (43) diseases during an 18-month period in a single centre. There were few dropouts: 1 patient died after the operation, 5 others refused to complete the questionnaire. As a rule, the operations were performed through a musclesparing nerve-sparing, anterolateral thoracotomy or video-assisted thoracic surgery by board-certified qualified thoracic surgeons. Patients were deemed functionally inoperable in case of both predicted postoperative forced expiratory volume in 1 s (FEV1) and predicted postoperative carbon monoxide lung diffusion capacity (DLCO)
