Increased length of stay affected patient satisfaction after orthopedic surgery
Published results showed lower patient satisfaction and decreased likelihood of recommending the hospital to others were associated with increased length of stay after orthopedic surgery.
“Keys to improving patient satisfaction are as simple as good communication, especially when multiple consulting physicians are requested, and appropriate management of length of hospital stay,” Joel Wells, MD, MPH, told Healio Orthopedics.
Wells and colleagues retrospectively reviewed Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys completed by 646 patients following a hospital stay.
“We aimed to answer if length of hospital stay affected patient satisfaction in addition to whether other patient factors, such as demographics, insurance type and comorbidities, contributed to overall patient satisfaction,” Wells said.
Results showed an association between increased length of stay with lower odds of patient satisfaction, as well as decreased likelihood of recommending the hospital. If the care provider was younger than the patient, researchers found patients had lower odds of being completely satisfied with communication with physicians, discharge information, responsiveness of the hospital staff and recommending the hospital to others. Researchers noted patients who were obese were more likely to be satisfied with responsiveness and care transition, while male patients were more satisfied with communication about medications, care transition and cleanliness. Patient satisfaction with care transition increased among patients with Medicare insurance and patients who received fewer consults, according to results. Researchers found male patients, older patients and white patients had greater odds of recommending the hospital to others.
“The results of our study can help guide physicians, hospital staff [and] management, as well as insurance providers, to understand the factors that influence satisfaction. This is especially important seeing that the results of the [HCAHPS] survey are often used for ratings, promotion and reimbursement,” Wells said. “Although some factors are unable to be modified, certain variables we found can be. Understanding the population being studied and reported may affect the results when comparing one hospital to another.”
Perspective
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In the era of value-based payment, patient satisfaction and outcomes have become increasingly important. HCAHPS survey results have been used as a surrogate for satisfaction since 2012, and, in fiscal year 2016, CMS paid an estimated $1.5 billion in value-based incentives to institutions.
Length of stay is known to correlate with satisfaction. Whether it be the “chicken” or the “egg” — patients with complications, or who have poor outcomes, are less satisfied and also will stay longer, or those hospitalized longer for other reasons become disenchanted and thus less satisfied — remains to be seen and deserves further study. The elimination in 2021 by CMS of most orthopedic inpatient only designations will continue to evolve length of stay as a metric.
Waqaar Diwan, MD, and colleagues’ robust analysis of 646 HCAHPS surveys during an 11-year period confirm the satisfaction-length of stay correlation. While during this time period there were likely changes to patient care pathways and protocols, their results nonetheless show that certain modifiable and non-modifiable factors significantly contribute to outcome metrics. Future research with larger data sets should be directed to more deeply appreciate these relationships. More data can help adjust hospital protocols to optimize outcomes. Moreover, data on non-modifiable factors can inform policymakers to adjust the survey and incentive programs to minimize effects on health disparities.
References:
Bernstein JA, et al. J Arthroplasty. 2020;doi:10.1016/j.arth.2020.04.083.
CY 2021 Medicare hospital outpatient prospective payment system and ambulatory surgical center payment system proposed rule (CMS-1736-P). Available at: www.cms.gov/newsroom/fact-sheets/cy-2021-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center. Accessed Feb. 24, 2021.
Fiscal year (FY) 2016 results for the CMS hospital value-based purchasing program. Available at: https://www.cms.gov/newsroom/fact-sheets/fiscal-year-fy-2016-results-cms-hospital-value-based-purchasing-program. Accessed Feb. 24, 2021.
Grobaty L, et al. JBJS Reviews. 2020;doi:10.2106/JBJS.RVW.20.00073.
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