Patient Satisfaction and Quality Measures in Hemodialysis Access
Ina Soh, MD, MS1, Ellen C. Meltzer, MD, MS1, Stephen J. Tarsa, PhD2, Victor J. Davila, MD1, Wlliam M. Stone, MD1, Samuel R. Money, MD1, Andrew J. Meltzer, MD1.
1Mayo Clinic AZ, Phoenix, AZ, USA, 2Harvard University, Cambridge, MA, USA.
OBJECTIVES: Patient experience is gaining attention as a quality measure. It is not clear if favorable patient experience, as measured by In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) scores, correlates with objective quality measures in the end-stage-renal-disease quality incentive program (ESRD-QIP). This study evaluates the relationship between patient satisfaction and access-related quality benchmarks at U.S. dialysis centers.
METHODS: 2016-2017 Medicare Dialysis Facility Compare data was linked to publicly available ICH-CAHPS survey data for all U.S. dialysis centers. Quality metrics pertaining to dialysis access included percentage of patients with functioning arteriovenous fistulae (AVF) and percentage with vascular catheter for >90 days. Outcomes were correlated with ICH-CAHPS survey responses. Multivariable regression using scaled data demonstrated the adjusted association between objective quality metrics and patient experience. RESULTS: Across 6149 dialysis centers, median AVF use was 67% (mean 67%, stdev 11%) and median catheter use >90 days was 10% (mean 11%, stdev 6.9%). Achievement of AVF and catheter quality measures was significantly associated with ICH-CAHPS domains pertaining to communication, staff professionalism, and provision of information to patients (p<0.0001). Multivariable regression showed AVF prevalence (but not catheter avoidance) was associated with high composite ICH-CAHPS scores (p<0.0004). Other factors independently associated with patient satisfaction included non-profit status and dialysis facility size. There was no association between patient satisfaction and other objective quality measures, including rates of infection, mortality, hospitalization, or transfusion. CONCLUSIONS: Patient satisfaction and achievement of hemodialysis access-related quality measures are not mutually exclusive. At the center level, AVF prevalence is positively associated with patient satisfaction, in contrast to other objective quality benchmarks. For vascular surgeons involved in access creation and maintenance, these findings underscore the importance of communication and patient education.
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