Patient Experience After Cardiac Surgery

Identifying Areas for Improvement

Meghana R.K. Helder, Hartzell V Schaff, Kristine T. Hanson, Cornelius A. Thiels, Joseph A. Dearani, Richard C. Daly, Simon Maltais, Elizabeth B Habermann

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a publicly reported survey of patient experience with in-hospital care. We reviewed institutional HCAHPS survey data to assess our patients’ experiences after cardiac surgery and to identify targets for practice improvement. Methods: We reviewed data from patients undergoing the most common cardiac operations, with dismissal from October 1, 2012 to September 30, 2015. We used top-box methodology to combine survey results into nine domains, including the global (composite) hospital rating, dichotomized as high versus low. Multivariable logistic regression analysis was used to evaluate the independent associations of variables with low global ratings. Key driver analysis using domain means and Spearman correlation between the global rating and the eight other domains identified targets for quality improvement. Results: Among 1,315 surveyed patients a low global hospital rating was independently associated with low perceived overall health (fair or poor vs excellent; odds ratio [OR], 5.4; p = 0.001), younger age (18 to 59 vs ≥70 years; OR, 1.6; p = 0.048), prolonged length of stay (OR, 1.6; p = 0.02), and robotic mitral valve (MV) repair (robotic vs open repair; OR, 2.4; p = 0.045). Patients undergoing transcatheter aortic valve replacement (TAVR) reported global ratings similar to that of patients with open aortic valve operations (OR, 0.9; p = 0.64). Key drivers of patient experience were care transitions and communication regarding medications. Conclusions: The primary targets of improvement for our institution are care transitions and communications regarding medications. The less-invasive procedures (robotic MV repair, TAVR) were not independently associated with higher patient-experience scores.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StatePublished - Jan 1 2019

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Thoracic Surgery
Odds Ratio
Robotics
Patient Transfer
Mitral Valve
Health Personnel
Communication
Health Fairs
Delivery of Health Care
Quality Improvement
Aortic Valve
Length of Stay
Logistic Models
Regression Analysis
Surveys and Questionnaires

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Patient Experience After Cardiac Surgery : Identifying Areas for Improvement. / Helder, Meghana R.K.; Schaff, Hartzell V; Hanson, Kristine T.; Thiels, Cornelius A.; Dearani, Joseph A.; Daly, Richard C.; Maltais, Simon; Habermann, Elizabeth B.

In: Annals of Thoracic Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Helder, Meghana R.K. ; Schaff, Hartzell V ; Hanson, Kristine T. ; Thiels, Cornelius A. ; Dearani, Joseph A. ; Daly, Richard C. ; Maltais, Simon ; Habermann, Elizabeth B. / Patient Experience After Cardiac Surgery : Identifying Areas for Improvement. In: Annals of Thoracic Surgery. 2019.
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abstract = "Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a publicly reported survey of patient experience with in-hospital care. We reviewed institutional HCAHPS survey data to assess our patients’ experiences after cardiac surgery and to identify targets for practice improvement. Methods: We reviewed data from patients undergoing the most common cardiac operations, with dismissal from October 1, 2012 to September 30, 2015. We used top-box methodology to combine survey results into nine domains, including the global (composite) hospital rating, dichotomized as high versus low. Multivariable logistic regression analysis was used to evaluate the independent associations of variables with low global ratings. Key driver analysis using domain means and Spearman correlation between the global rating and the eight other domains identified targets for quality improvement. Results: Among 1,315 surveyed patients a low global hospital rating was independently associated with low perceived overall health (fair or poor vs excellent; odds ratio [OR], 5.4; p = 0.001), younger age (18 to 59 vs ≥70 years; OR, 1.6; p = 0.048), prolonged length of stay (OR, 1.6; p = 0.02), and robotic mitral valve (MV) repair (robotic vs open repair; OR, 2.4; p = 0.045). Patients undergoing transcatheter aortic valve replacement (TAVR) reported global ratings similar to that of patients with open aortic valve operations (OR, 0.9; p = 0.64). Key drivers of patient experience were care transitions and communication regarding medications. Conclusions: The primary targets of improvement for our institution are care transitions and communications regarding medications. The less-invasive procedures (robotic MV repair, TAVR) were not independently associated with higher patient-experience scores.",
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AU - Thiels, Cornelius A.

AU - Dearani, Joseph A.

AU - Daly, Richard C.

AU - Maltais, Simon

AU - Habermann, Elizabeth B

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