OBJECTIVE: Hospital quality is commonly measured using postoperative mortality rates. However, recent data demonstrate that patients may perceive several states of functional disability as worse than death. The objective of this study was to determine how hospitals would rank using traditional compared to patient-preferred outcome measures.
METHODS: The Healthcare Cost and Utilization Project State Inpatient Databases for California, Florida, Iowa, and New York were used to identify patients undergoing open colon resection. Patient-preferred outcomes were based on states of functional disability that patients define as being “as bad as” or “worse than” death. Separate risk-adjustment models were constructed for each outcome using mixed-effects logistic regression models. Expected event rates were derived from final models, with observed over expected ratios calculated for each hospital.
RESULTS: A total of 42,116 patients at 663 hospitals met our inclusion criteria. Overall mortality of the study population was 11.0% at 1 year, while 3.5% of patients had functional disability at 1 year. At the hospital level, unadjusted rates of mortality ranged from 0.0 – 24.1%, while rates of functional disability ranged from 0.0 – 11.8%. Hospitals were ranked based on their performance using traditional and patient-preferred outcomes. There was poor agreement when comparing a hospital’s rank using each approach (ICC=0.22 [0.14 – 0.29], kappa=0.006, p<0.001). A total of 69 (10.4%) hospitals were high performing for both outcomes.
CONCLUSION: Hospital rankings based on traditional outcomes do not align with rankings based on patient-preferred outcomes related to long-term postoperative functional disability.
