Differences Between Family Practices in the Associations of Patient Characteristics With Health Care Experiences

Abstract

When comparing health care providers, patient experience data are usually adjusted for case-mix associations to ensure fair comparisons. Previous studies in the United States showed that case-mix associations sometimes vary across health care providers. Such variation could indicate differential provider behavior for patient subgroups, in which case current adjustment techniques might be inappropriate. To see whether this variation is also apparent in a health care system different from the U.S. system, the authors analyzed Dutch patients' experiences with family practice care. Using multilevel random slope models, the associations between age, general health status, mental health status, education, sex, and ethnicity on one hand and reported experiences on the other hand were assessed across family practices. The authors found only five significant variances between case-mix coefficients, all for outcomes related to health care professionals' conduct. These findings correspond to previous U.S. findings, suggesting that the case-mix variations reported here and previously constitute a rather robust phenomenon.

Do effects of common case-mix adjusters on patient experiences vary across patient groups?

“…However, it is also possible that demographic subgroups really receive a different quality of care, or have a different set of preferences [ 17 ]. On the one hand it may still be argued that adjustment is desirable when differences between demographic subgroups in the quality of care they receive is consistent across providers [ 18 ], which is often the case [ 19 ]. On the other hand, such an approach might reduce the incentive for providers to further tailor their care to meet the demands and preferences of different demographic subgroups.…”

“…Similarly, evidence suggests that the effect of some demographic characteristics on various experiences of enrollees with a health plan vary by region [ 8 ]. Further, the impact of demographic characteristics on patient experiences appears somewhat inconsistent across hospitals [ 11 ] and general practices [ 12 ] and largely consistent across health plans [ 13 ]. Taken together, these studies provide evidence for some inconsistencies in the effect of demographic characteristics as case-mix adjusters for comparisons of patient experiences.…”

Assessing the outcomes and experiences of care from the perspective of people living with chronic conditions, to support countries in developing people-centred policies and practices: study protocol of the International Survey of People Living with Chronic Conditions (PaRIS survey)

“…Potential case-mix variables for analysis of the Field Trial data will be selected based on theoretical notions and empirical evidence. [35][36][37][38][39][40] Depending on the data analysis of the Field Trial, the case-mix adjustment in the analyses of the Main Survey data may be modified.…”

“…Case-mix variables are variables that may hamper a fair comparison of patient-reported indicators between countries or regions. Potential case-mix variables for analysis of the Field Trial data will be selected based on theoretical notions and empirical evidence 35–40. Depending on the data analysis of the Field Trial, the case-mix adjustment in the analyses of the Main Survey data may be modified.…”

Multilevel Modelling for Public Health and Health Services Research

“…The interpretation of random slopes will vary according to the substantive nature of the research but always depends on the nature of the covariance. Damman et al (2011) give a series of examples of random slope models examining the relationship between healthcare experiences and patient characteristics in a sample of patients drawn from 32 family practices in the Netherlands. They showed a negative covariance between the practice-level intercept and the residual for the patient's age, indicating less variability between practices for older patients; similarly variation decreased with increasing patient health status.…”