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A retrospective analysis of labor analgesia and patient satisfaction about childbirth and pain relief: Is the HCAHPS score a useful tool?
Abstract Number: SAT-23
Abstract Type: Original Research
Background: Patient satisfaction has emerged as a critical factor for value-based incentive payments in the US healthcare system. The Affordable Care Act (ACA) uses the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), a 27-question survey designed to assess multiple domains of the patient experience, and the Centers for Medicare & Medicaid Services uses HCAHPS as a reimbursement modifier. Studies evaluating patient satisfaction and epidural pain relief have varying results; maternal satisfaction has correlated both directly and inversely with epidural analgesia.(1,2) We hypothesize that women who have labor analgesia and a successful vaginal delivery will report higher patient HCAHPS scores compared to women who opt for natural childbirth (NCB), or who require a cesarean delivery after trial of labor, due to enhanced patient satisfaction with labor pain relief and expected labor outcome.
Methods: After IRB approval, we performed a retrospective analysis of patients who completed the HCAHPS survey after their admission for labor and delivery at a single academic medical center between December 2015 and December 2016. Four HCAHPS-derived survey answers about pain relief and satisfaction were extracted. Mode of delivery, use of analgesia, and assisted second stage (forceps or vacuum) were evaluated. Failure to progress in labor with cesarean delivery, and failure of an expressed desire for natural childbirth (NCB) were noted. Fisher’s exact test was performed.
Results: We identified 455 patients admitted for vaginal delivery during the study period who completed the HCAHPS survey upon hospital discharge. We found no association between higher HCAHPS scores and use of neuraxial analgesia for vaginal delivery compared to NCB, failed NCB or unplanned cesarean delivery.
Discussion: We found no clear correlation between labor pain relief or successful vaginal delivery and higher HCAHPS-based satisfaction scores. It is possible that the complex relationship between neuraxial analgesia and patient satisfaction cannot be determined by the HCAHPS-based satisfaction questions alone. A limitation is that HCAHPS response to general satisfaction questions are counted in a “top box” manner, which means that a positive response to a question with a scale from 1-10 is positive only if scored 9 or 10. This scoring mechanism limits the interpretation of results in a more nuanced fashion. Pre-labor expectations and antenatal education are important factors determining satisfaction outcomes that cannot be elicited from the HCAHPS survey. A complex relationship entailing psychological, societal and cultural factors exists between pain, labor analgesia and maternal satisfaction. A more tailored approach than HCAHPS may be necessary to determine the relationship between epidural pain relief and patient satisfaction.
1.Kannan S Reg Anesth Pain Med 2001
2. Camann W Anesth Analg 2017