Perception Meets Reality – Self-Reported Health on HCAHPS and Press Ganey Surveys Is Correlated with Validated Health Scores (ASA, CCI) in Orthopaedic Trauma Patients

Abstract

Introduction The American Society of Anesthesiologists score (ASA) and Charlson Comorbidity Index (CCI) are validated tools to predict post-surgical outcome, cost, and health-related quality of life. Prior studies have had mixed results when comparing self-reported health from various survey instruments with ASA and CCI. Surveys such as the government-mandated Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and optional private surveys (Press Ganey) administered following hospital discharge include self-reported health data. No prior study has examined the relationship between patient self-reported health from HCAHPS and Press Ganey surveys with validated health scores (ASA, CCI). We sought to study this possible relationship in orthopaedic trauma patients. Methods All consecutive adult patients >18y surgically treated for isolated fractures at a Level 1 Trauma Center between January 1, 2014-December 31, 2016 were retrospectively analyzed. Hospital charts, HCAHPS, and Press Ganey data were reviewed; patients without available survey responses were excluded. Patient data also included comorbidities (ASA, CCI), psychiatric history (anxiety, depression, others), substance use, type of injury, and type of surgery. Statistical analysis included Spearman’s Rho for correlations, Wilcoxon Rank-Sum and Kruskal-Wallis for continuous variables, Backwards Stepwise Regression and Ordinal Regression with bootstrapped confidence intervals for odds assessment. Results 152 total patients with mean age 57 and median length of stay 3 days were included. No significant differences existed between injury, comorbidities, psychiatric history, substance use, or surgery. Median ASA was 2 (range 2-3), median CCI was 2 (range 0.5-4), and median CCI 10-year estimated survival was 90% (range 53-97). Median self-reported health rating was 1 (range 1-2, with 0 = excellent and 4 = poor). ASA and CCI both had initial strong correlations with patient self-reported overall health. Upon age and sex adjustment, only ASA remained strongly correlated (OR 3.65, 95% CI 2.03-6.57; p<0.001) with overall health rating. Conclusion Orthopaedic trauma patients appear to have a realistic self-perception of health relative to validated scores. This is the first study to compare HCAHPS and Press Ganey self-reported patient health to ASA and CCI scores. Although further study is needed, the high agreement of self-perception of overall health with ASA scores may show that patient self-reporting is reliable in evaluating these and other outcome measurements.