Quality Monitoring of Physicians: Linking Patients’ Experiences of Care to Clinical Quality and Outcomes

Abstract

BACKGROUND: Physicians are increasingly asked to improve the delivery of clinical services and patient experiences of care. OBJECTIVE:We evaluated the association between clinical performance and patient experiences in a statewide sample of physician practice sites and a sample of physicians within a large physician group. DESIGN, SETTING, PARTICIPANTS:We separately identified 373 practice sites and 119 individual primary care physicians in Massachusetts. MEASUREMENTS: Using Health Plan Employer Dataand Information Set data, we produced two composites addressing processes of care (prevention, disease management) and one composite addressing outcomes. Using Ambulatory Care Experiences Survey data, we produced seven composite measures summarizing the quality of clinical interactions and organizational features of care. For each sample (practice site and individual physician), we calculated adjusted Spearman correlation coefficients to assess the relationship between the composites summarizing patient experiences of care and those summarizing clinical performance.RESULTS: Among 42 possible correlations (21 correlations involving practice sites and 21 involving individual physicians), the majority were positive in site level (71%) and physician level (67%) analyses. For the 28 possible correlations involving patient experiences and clinical process composites, 8 (29%) were significant and positive, and only 2 (7%) were significant and negative. The magnitude of the significant positive correlations ranged from 0.13 to 0.19 at the site level and from 0.28 to 0.51 at the physician level. There were no significant correlations between patient experiences and the clinical outcome composite. CONCLUSIONS:The modest correlations suggest that clinical quality and patient experience are distinct, but related domains that may require separate measurement and improvement initiatives.KEY WORDS: quality of care; patient centered care; primary care; quality measurement; quality improvement.

analysis & commentary Measuring Patient Experience As A Strategy For Improving Primary Care

“…[13][14][15][16][17] For example, patients hospitalized for acute myocardial infarction (AMI) who reported more problems with care had poorer outcomes both one month and twelve months after discharge, although these effects were mediated for patients with subsequently positive outpatient care experiences. 18 Furthermore, patient experience has a strong relationship to patients' adherence to medication and other care regimens.…”

“…37,13 Patients' reports of interactions with the health care system can reveal system problems that affect quality and efficiency along with patient experience.…”

Patient-Reported Racial/Ethnic Healthcare Provider Discrimination and Medication Intensification in the Diabetes Study of Northern California (DISTANCE)

“…This is consistent with previous evidence that patient ratings of interpersonal care may not corre- spond to the technical quality of care. [37][38][39][40] Patient reports of discrimination could still be an indicator for other problems during the medical encounter not examined, such as decreased patient trust, which can influence health outcomes through separate pathways and has been shown to be especially important for patients with diabetes. 41 Patients with diabetes and other chronic conditions are typically much more dependent on their healthcare than other patients, and thus the quality of the patient-provider relationship is of great importance.…”

Does Patient Assessment of the Quality of the Primary Care They Receive Predict Subsequent Outcomes? An Oklahoma Physicians Resource/Research Network (OKPRN) Study

“…The authors concluded that "clinical quality and patient experience are distinct but related domains that require separate measures and improvement initiatives." 19 Kerse and colleagues studied adults being cared for in primary care practices in New Zealand. Patients completed a waiting room survey about attributes of their relationship with their PCP before a visit.…”