Postop pain control linked to satisfaction
Postsurgical pain scores were highly correlated with reports of overall patient satisfaction during healthcare stays in a new finding that was true for some types of surgery more than others. The researchers emphasized the importance of improving patient care in the perioperative setting in alignment with new federal requirements tying performance to pay.
The results were presented in a scientific poster recently at the annual meeting of the American Academy of Pain Medicine. The goal of the research by Dermot Maher, MD, and colleagues from Cedars Sinai Medical Center in Los Angeles was to clarify the relationship between pain control after surgery and the answers provided by patients on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The HCAHPS is the first national, standardized, publicly reported survey of patients’ perspectives on the care they receive in the hospital and is filled out at the time of discharge. The Affordable Care Act of 2010 makes the 27-question HCAHPS a factor in value-based incentive payments.
"This study illustrates the crucial role that pain management in the acute postoperative setting can have, not only on a patient’s perception of pain management, but also on the global perception of their hospitalization," Maher said.
Investigators examined HCAHPS responses by 2,933 surgical patients who were hospitalized at a single trauma center between March 2012 and February 2013. Four questions — two assessing satisfaction with in-hospital pain management and two addressing general satisfaction — showed a statistically robust relationship when retrospectively compared to patient pain scores as assessed via the postanesthesia care unit (PACU) visual analog scale.
One of the most influential factors
Maher said the results are important to providers and patients. Patients consider several factors when evaluating physicians and facilities, he said. "One of the most influential factors is a patient’s perception of pain," he said. "The universal unpleasantness and complicated nature of pain, especially in the postoperative setting, has the potential to negatively impact overall satisfaction if not optimally managed."
Analyses of the data showed patients who had surgery related to spine, non-spine orthopedics, and OB/GYN showed significantly larger correlations of PACU pain scores with HCAHPS responses than did patients who had other types of surgeries. The stronger association between HCAHPS scores and postop pain in certain populations calls into question the appropriateness of universal application of patient satisfaction surveys, or at least the pain component, as a means of reimbursement, Maher said.
In addition to highlighting the need for better postoperative pain control for patients, the study indicates additional value in identifying anesthetic techniques that might improve patient overall satisfaction, such as regional vs. general anesthesia, Maher said. Preadmission, preoperative, and intraoperative interventions, as well as changes in PACU patient care, all could strongly influence HCAHPS scores, he said.
