Abstract
Background Improved discharge planning has been implicated in reducing post-operative complications. Readmissions and mortality after coronary artery bypass grafting (CABG) are two procedure-specific complications Medicare publicly reports. While patient assessments of discharge planning within Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys factor into Medicare hospital reimbursement, their association with outcomes after CABG is unknown.
Objectives We evaluated relationships between HCAHPS patient ratings of care transition and discharge information on 30 day CABG readmissions and mortality.
Methods Data were extracted from Medicare Hospital Compare (July 2018). Pearson and partial correlations measured associations between HCAHPS ratings (percent top-box responses) and morbidity-adjusted CABG mortality and readmissions, controlling for procedure volume. Independent t-tests compared complication rates between hospitals scoring in the top and bottom half on discharge planning ratings.
Results Our analysis included 1017 hospitals with available CABG data. Adjusted for procedure volume, discharge information and care transition ratings negatively correlated with 30 day readmissions (r=−0.24, p<0.001 and r=−0.18, p<0.001) and mortality (r=−0.085, p=0.007 and r=−0.087, p=0.006) (table 1). Readmissions (13.4 per 100 discharges SD1.8 vs 14.01.9) and mortality (3.1%0.9% vs 3.3%1.0%) were lower in hospitals with high ratings of discharge information compared to hospitals with lower ratings (p<0.001). Readmissions (13.41.8 vs 14.01.8) and mortality (3.1%0.9% vs 3.3%1.0%) were also lower in hospitals with high care transition ratings (p<0.001) (figure 1).
30-day CABG readmissions and mortality rates by HCAHPS ratings of discharge planning(A) Readmissions and mortality rates (morbidity-adjusted) between hospitals scoring in the top half (n=474 and n=469, respectively) and bottom half (n=551 and n=548) on HCAHPS ratings of discharge information. (B) Readmissions and mortality rates between hospitals scoring in the top half (n=448 and n=446) and bottom half (n=577 and n=571) on HCAHPS ratings of care transition. Bars represent mean ±SEM, ***p<0.001, compared by two-tailed independent t-test
Conclusions HCAHPS discharge information and care transition ratings have significant inverse relationships with 30 day CABG mortality and readmissions, even after adjusting for morbidity and volume. Our analysis suggests health literacy at discharge serves as an important benchmark in improving surgical outcomes.
