S. J. Masoud1, O. K. Jawitz2, H. R. Phillips3, P. J. Mosca2 1Duke University Medical Center,School Of Medicine,Durham, NC, USA 2Duke University Medical Center,Department Of Surgery,Durham, NC, USA 3Duke University Medical Center,Department Of Medicine, Division Of Cardiology,Durham, NC, USA
Introduction: There is mounting evidence that safety culture and quality of communication within hospitals is linked to patient outcomes. Of outcomes publicly reported by Medicare through its Hospital Compare website, only 30-day mortality following coronary artery bypass graft (CABG) is attached to a specific surgical procedure. Communication quality is in part measured by the 25-item Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, which Medicare uses in adjusting reimbursement to over 3,000 hospitals nationwide. We aimed to assess the relationship between HCAHPS patient ratings of doctor or nurse communication and CABG mortality.
Methods: HCAHPS and complications data were extracted from Medicare Hospital Compare (July 2018 update). Hospitals without CABG mortality data were excluded from the analysis. Pearson and multivariate partial correlation with multiple regression modeling measured the association of HCAHPS ratings, or the percent of surveys reporting providers “always” (rather than usually, sometimes, or never) communicated well, and case volume on log-transformed 30-day CABG mortality rates. Archived data (2014-2018) were used to explore the reciprocal effect of CABG mortality on HCAHPS ratings over time in repeated measures ANOVA with post-hoc main effects tests.
Results: Among 4,973 hospitals, 1,017 had available CABG data and were included in the study. Ratings of nurse and doctor communication each correlated inversely with CABG mortality (Pearson’s r = -.132, p < .001 and r = -.066, p < .035). When controlling for CABG case volume, only ratings for nurses correlated significantly (r = -.092, p < .01), with multiple regression predicting a 0.7% decrease in CABG mortality for each 1% increase in HCAHPS ratings (R2 = .074, p < .001). Repeated measures ANOVA (figure) showed that improvement of HCAHPS ratings was dependent upon whether a hospital ranked in the top or bottom half of included hospitals by CABG mortality (p = .004, ηp2 = .005). While both groups had comparable nurse communication ratings in 2014 (p = .849), low mortality hospitals had significantly higher ratings relative to high mortality hospitals by 2018 (p = .025).
Conclusions: HCAHPS patient ratings of nurse communication, but not doctor communication, had a small albeit significant inverse relationship with 30-day CABG mortality, even when controlling for CABG case volume. Moreover, low mortality hospitals demonstrated greater improvement in nurse communication ratings over time. Though not establishing causal relationships, our study suggests that a better understanding of how frontline staff communicate with patients may also inform efforts to improve surgical outcomes.
