Physicians' attitudes toward using patient reports to assess quality of care

Physicians’ Perceptions of Managed Care: A Review of the Literature

In this article, the authors review the health services research literature regarding physician attitudes and opinions relating to managed care and how managed care has affected their clinical practice. This literature suggests that physician perceptions of managed care are largely related to the nature of their ties to managed care plans and to their selection of practice setting. There are substantial limitations in study designs and execution, suggesting that many of the published findings should be viewed with caution; the research basis regarding physicians’ perceptions of managed care is not as strong as the number of articles published on this subject would suggest. The review concludes with suggestions for the conduct of future research on this topic.

Measuring patients' assessments of primary care quality: the use of self-report questionnaires

The views of patients are seen as an increasingly important complement to other measures of quality of care, such as clinical indicators. This review summarizes previous research and current issues relating to the use of patient assessments of primary care quality. Patient assessments can be used to measure a number of different domains of primary care quality. Significant advances have been made in terms of the production of comprehensive, reliable and valid patient assessments, which can be used in both research and quality improvement activities. However, the effectiveness of the use of patient assessments as a technology for quality improvement remains unclear.

Patients' experiences and perceptions of medical student candidates sitting a finals examination

BACKGROUND

The Final Professional Examination for medical students at Leicester Medical School involves the use of real patients, and senior clinicians assess students over a series of consultations with these patients. What the patients themselves think of the students is not known.

AIMS

This qualitative study identifies the perceptions and opinions which patients who have been used in this examination have of the student candidates, and whether these may be used to enhance the training of medical students.

METHOD

Patients who had participated in a number of examination diets were interviewed in either a group interview or individually. The interviews were loosely structured in order to discover the experiences that these patients had and how they interpreted them. Data was analysed inductively using the constant comparative method.

RESULTS

The large majority of views of patients fell into the following categories: observations on student conduct during the examination (both in terms of affective and professional behaviours), demographic characteristics of students and views on student performance.

CONCLUSIONS

Based on the results of this study, educational recommendations are made which might improve student performance in the examination and lead to greater patient satisfaction with the 'end product' of the medical school, namely the graduating student. These include the incorporation of students' observation of infection control measures within the assessment schedule, and more direct preparation of students in handling uncertainty and their anxieties within the consultation.

Patient satisfaction with doctor-patient interaction in a radiotherapy centre during the severe acute respiratory syndrome outbreak

An outpatient radiotherapy department assessed how precautions implemented during the severe acute respiratory syndrome (SARS) outbreak affected patient satisfaction with doctor-patient interaction and explored variables potentially influencing satisfaction. The information obtained would help prepare us for future infectious disease outbreaks. Outpatients seen during the outbreak completed a validated questionnaire assessing satisfaction with doctor-patient interaction. Additional items assessed included patients' perception of SARS measures and patient demographics. Of 149 patients, 97% had heard of SARS, 92% believed SARS precautions necessary, and 54% believed contracting SARS was possible despite the precautions. Patients were satisfied with doctors wearing masks (97%), temperature checks (97%), and patients wearing masks (96%). Despite the high satisfaction levels with SARS precautions, 24% believed it had adversely affected doctor-patient interaction. With regards to doctor-patient interaction, 94% of patients were satisfied. Patients were most satisfied with the 'information exchange' domain (mean score 3.23 out of 4) compared to other domains (P < 0.0001, 100.00% confidence) and were less satisfied with the 'empathy' domain compared to other domains (P < 0.0001, 100.00% confidence). Patients were most satisfied with understanding their treatment plan (100%), doctor being honest (97%) and being understood (96%). Patients were least satisfied with information about caring for their illness (61%), that the visit could be better (59%), and the doctor showing more interest (58%). On multivariate analysis, patients who were less satisfied with SARS measures were significantly less satisfied with doctor-patient interaction (P = 0.0001). Dissatisfaction with SARS measures was associated with significant dissatisfaction for questions in all domains. Older age and non-breast cancer patients were also less satisfied with doctor-patient interaction. Most (94%) of patients were satisfied with doctor-patient interaction, despite implementation of infectious disease prevention measures. However, patients who were dissatisfied with the SARS precautions had poorer satisfaction. In particular, physician empathy appeared to be most adversely affected. The results have relevance to any radiotherapy department preparing contingency plans in the event of infectious disease outbreaks.

Patient satisfaction instruments used at academic medical centers: results of a survey

As physicians and health administrators increasingly incorporate patients' perspectives into health care, patient satisfaction has become a significant health care outcome. However, there is limited knowledge regarding the patient satisfaction instruments being used by leading academic medical centers. The objective of this study was to determine the types of patient satisfaction instruments used by leading academic medical centers. We conducted a telephone survey of 16 leading academic medical centers across the United States to determine the types of patient satisfaction instruments used at each institution for outpatient and inpatient care. Among the institutions surveyed, a significantly higher proportion used internally developed surveys for satisfaction measurement among outpatients than for satisfaction measurement among inpatients. Although much attention has been focused on patient satisfaction in recent years, there is little standardization of the patient satisfaction instruments currently being used at the academic medical centers surveyed, particularly for outpatient care. This lack of standardization limits opportunities for benchmarking of patient satisfaction data among peer institutions and may limit efforts to improve care.

Parents’ expectations regarding their children’s eye care: interview results

PURPOSE

To determine a relevant set of concerns that parents express as expectations regarding their children's eye care.

DESIGN

Qualitative, cross-sectional, pilot study.

METHODS

A total of 48 interviews were conducted with parents of pediatric ophthalmology patients at Duke University Eye Center and the McGovern Davidson Children's Health Center at Duke University to elicit parents' expectations regarding their children's eye care. Interviews were audiotaped, transcribed, and coded for parent expectations.

RESULTS

Content analysis of transcripts from the 48 interviews yielded 35 different expectation areas for eye care, which were further classified into six groups: (1) Communication, (2) Interpersonal Manner, (3) Doctor's Skill, (4) Examination and Testing, (5) Logistics, and (6) Other. The six expectation areas most frequently identified by parents as the single "most important" expectation were the following: (1) Clinical Competence, (2) Interaction with Child, (3) Education/Training, (4) Explanation in Clear Language, (5) Information about Diagnosis, and (6) Personal Connection.

CONCLUSIONS

Parents of pediatric ophthalmology patients expressed expectation areas in the Communication group more frequently than any other group. However, when asked to identify their single most important expectation area, more than half of parents identified Clinical Competence.

Performance profiles: the influence of patient satisfaction data on physicians' practice

OBJECTIVE

Health maintenance organizations and other payers increasingly use patient satisfaction data to profile physician performance. Little is known about physicians' use of patient satisfaction information or how profiles affect individual physician behaviors. The objective of this study was to examine primary care physicians' perceptions of performance profiles based on patient satisfaction data, whether physicians use profiles to change practice behaviors, and which profile components physicians think are important for assessing quality of care.

METHODS

A written survey was conducted in 1998 in Massachusetts with 810 primary care physicians (304 pediatricians, 201 family practitioners, 305 internists) who had at least 100 patients in a large managed care plan and had received 1 or more profiles based on patient satisfaction data. Physicians in training were excluded. Physicians' perceptions of profiles and their reported use to change practice behaviors were measured.

RESULTS

The response rate was 68%. Twenty-three percent reported that profiles were very or extremely useful for improving care. Only 7% reported using profiles often or always to change care. Although specific profile components related to interpersonal aspects of care were rated more useful, <11% reported using profiles often or always to make changes on any individual component. A majority, 67% to 89%, reported making no or minor changes on profile components. Responses did not vary by specialty, demographics, or practice characteristics. Physicians rated interpersonal factors (eg, ability to communicate with patients, ability to show caring and empathy) as the most important indicators of quality of care; they report having the most control over these factors. Office factors (eg, staying on schedule, ease of scheduling appointments) were ranked as least important for assessing quality of care.

CONCLUSION

Although health maintenance organizations and other payers increasingly use patient satisfaction reports to profile individual physicians and guide physician compensation and health plan participation, <25% of primary care physicians find profiles useful for improving patient care and even fewer report using profiles to change practice. Profiles likely have limited influence on behavior changes. Payers who invest in profiles may find it advantageous to focus on health plans and practice facilities rather than on individual physicians.

Development and testing of a visit-specific patient satisfaction questionnaire: the Princess Margaret Hospital Satisfaction With Doctor Questionnaire

PURPOSE

To develop a psychometrically sound patient-satisfaction-with-physician questionnaire that can be used in an outpatient oncology setting.

PATIENTS AND METHODS

The questionnaire was developed by a four-step process involving a total of 277 cancer patients. The item-generation process utilized input from 95 oncology outpatients, three medical researchers, and the relevant literature. Items were tested by 70 of the above patients. Initial item reduction was achieved by input from another eight patients. Factor analysis and validity testing used data derived from a different group of 174 oncology outpatients. Convergent validity was tested by correlating the Princess Margaret Hospital Patient Satisfaction with Doctor Questionnaire (PMH/PSQ-MD) with Rubin et al's Physician subscale of the Patient's Viewpoint Questionnaire (PS-PVQ) and Smith et al's Patient-Doctor Interaction Scale (PDIS). Divergent validity was tested by comparing these questionnaires with Spitzer's quality of life (QOL) questionnaire.

RESULTS

The final PMH/PSQ-MD is a 29-item self-administered questionnaire with four response categories and a "does not apply" category. Four domains were confirmed by factor analysis: (1) information exchange, (2) interpersonal skills, (3) empathy, and (4) quality of time. The questionnaire has an overall Cronbach's alpha of 0.97; the values for each domain are, respectively, 0.92, 0.90, 0. 88, and 0.88. The PMH/PSQ-MD correlated well with both the PDIS and the PS-PVQ (P <.001 for both). Divergent validity was confirmed with Spitzer's QOL questionnaire.

CONCLUSION

The PMH/PSQ-MD is an outpatient satisfaction questionnaire specific to the patient-physician interaction that has shown excellent internal consistency, is feasible, and has strong support for validity in this oncology population.