Quality Monitoring of Physicians: Linking Patients’ Experiences of Care to Clinical Quality and Outcomes
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Physicians are increasingly asked to improve the delivery of clinical services and patient experiences of care.
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.
Using Health Plan Employer Data and 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.
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.
The modest correlations suggest that clinical quality and patient experience are distinct, but related domains that may require separate measurement and improvement initiatives.
KEY WORDSquality of care patient centered care primary care quality measurement quality improvement
We would like to thank Massachusetts Health Quality Partners for allowing us use of statewide data for these analyses; Jo-Anne Foley at HVMA for helping to obtain physician-level data; and Angela Li, Angie Rodday, and Hong Chang at Tufts-New England Medical Center for analytic support. This study was funded by the Commonwealth Fund and the William Randolph Hearst Foundation. Dr. Sequist has served as a consultant on the Aetna External Advisory Committee for Racial and Ethnic Equality. Dr. Sequist had full access to all the data in the study and takes responsibility for the integrity and the accuracy of the data analysis.
Conflict of Interest
- 6.Massachusetts Health Quality Partners. Quality Reports. Available at: http://www.mhqp.org/quality/whatisquality.asp?nav = 030000. Accessed August 5, 2008.
- 11.Institute of Medicine. Primary Care: America’s Health in a New Era. Washington, DC: National Academy Press; 1996.Google Scholar
- 16..Friedberg MW, Coltin KL, Pearson SD, et al. Does Affiliation of Physician Groups with One Another Produce Higher Quality Primary Care? J Gen Intern Med. 2007.Google Scholar
- 17.Dillman DA. Mail and Telephone Surveys: The Total Design Method. New York: John Wiley; 1978.Google Scholar
- 23.National Center for Quality Assurance. HEDIS 2005 Volume 1: Narrative - What’s in it and why it matters.; 2004.Google Scholar
- 24.Donabedian A. The definition of quality and approaches to its assessment. Ann Arbor: Health Administration Press; 1980.Google Scholar
- 25.Nunnally JC, Bernstein IH. Psychometric Theory. New York: McGraw Hilll; 1994.Google Scholar