Do Patient Assessments of Hospital Quality Correlate With Kidney Transplantation Surgical Outcomes?

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. Materials and Methods CMS uses the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) to publicly report patient's 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.