Journal of General Internal Medicine

, Volume 26, Issue 5, pp 498–504 | Cite as

Physician Groups’ Use of Data from Patient Experience Surveys

  • Mark W. Friedberg
  • Gillian K. SteelFisher
  • Melinda Karp
  • Eric C. SchneiderEmail author
Original Research



In Massachusetts, physician groups’ performance on validated surveys of patient experience has been publicly reported since 2006. Groups also receive detailed reports of their own performance, but little is known about how physician groups have responded to these reports.


To examine whether and how physician groups are using patient experience data to improve patient care.

Design and Participants

During 2008, we conducted semi-structured interviews with the leaders of 72 participating physician groups (out of 117 groups receiving patient experience reports). Based on leaders’ responses, we identified three levels of engagement with patient experience reporting: no efforts to improve (level 1), efforts to improve only the performance of low-scoring physicians or practice sites (level 2), and efforts to improve group-wide performance (level 3).

Main Measures

Groups’ level of engagement and specific efforts to improve patient care.

Key Results

Forty-four group leaders (61%) reported group-wide improvement efforts (level 3), 16 (22%) reported efforts to improve only the performance of low-scoring physicians or practice sites (level 2), and 12 (17%) reported no performance improvement efforts (level 1). Level 3 groups were more likely than others to have an integrated medical group organizational model (84% vs. 31% at level 2 and 33% at level 1; P < 0.005) and to employ the majority of their physicians (69% vs. 25% and 20%; P < 0.05). Among level 3 groups, the most common targets for improvement were access, communication with patients, and customer service. The most commonly reported improvement initiatives were changing office workflow, providing additional training for nonclinical staff, and adopting or enhancing an electronic health record.


Despite statewide public reporting, physician groups’ use of patient experience data varied widely. Integrated organizational models were associated with greater engagement, and efforts to enhance clinicians’ interpersonal skills were uncommon, with groups predominantly focusing on office workflow and support staff.


patient experience quality of care quality improvement physician groups public reporting 



The authors thank Elizabeth Siteman, BA, for assistance in performing the group leader interviews, and Elizabeth Steiner, MPP, for assistance in coding the interview transcripts. The authors also thank the members of the study national advisory committee for constructive feedback on preliminary study results.


This study was sponsored by the Commonwealth Fund. No funder had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Prior Presentation:

Preliminary results from this study were presented at the Annual Research Meeting of AcademyHealth in Chicago, Illinois on June 29, 2009.

Conflict of Interest:

None disclosed.


  1. 1.
    Institute of Medicine. Crossing the Quality Chasm: a New Health System for the 21st Century. Washington, D.C.: National Academies Press; 2001.Google Scholar
  2. 2.
    Cleary PD. The increasing importance of patient surveys. Br Med J. 1999;319(7212):720–721.Google Scholar
  3. 3.
    Safran DG, Kosinski M, Tarlov AR, et al. The primary care assessment survey: tests of data quality and measurement performance. Med Care. 1998;36(5):728–739.PubMedCrossRefGoogle Scholar
  4. 4.
    Hays RD, Shaul JA, Williams VSL, et al. Psychometric properties of the CAHPS (TM) 1.0 survey measures. Med Care. 1999;37(3):MS22–MS31.PubMedCrossRefGoogle Scholar
  5. 5.
    Landon BE, Zaslavsky AM, Bernard SL, Cioffi MJ, Cleary PD. Comparison of performance of traditional Medicare vs Medicare managed care. JAMA. 2004;291(14):1744–1752.PubMedCrossRefGoogle Scholar
  6. 6.
    Jha AK, Orav EJ, Zheng J, Epstein AM. Patients’ perception of hospital care in the United States. N Engl J Med. 2008;359(18):1921–1931.PubMedCrossRefGoogle Scholar
  7. 7.
    Safran DG, Karp M, Coltin K, et al. Measuring patients’ experiences with individual primary care physicians: results of a statewide demonstration project. J Gen Intern Med. 2006;21(1):13–21.PubMedCrossRefGoogle Scholar
  8. 8.
    Safran DG. Defining the future of primary care: what can we learn from patients? Ann Intern Med. 2003;138(3):248–255.PubMedGoogle Scholar
  9. 9.
    MHQP website. Accessed November 8, 2010.
  10. 10.
    Hibbard JH, Stockard J, Tusler M. Hospital performance reports: impact on quality, market share, and reputation. Health Aff (Millwood). 2005;24(4):1150–1160.CrossRefGoogle Scholar
  11. 11.
    Hibbard JH. Engaging health care consumers to improve the quality of care. Med Care. 2003;41(1 Suppl):I61–70.PubMedGoogle Scholar
  12. 12.
    Schneider EC, Epstein AM. Use of public performance reports: a survey of patients undergoing cardiac surgery. JAMA. 1998;279(20):1638–1642.PubMedCrossRefGoogle Scholar
  13. 13.
    Faber M, Bosch M, Wollersheim H, Leatherman S, Grol R. Public reporting in health care: how do consumers use quality-of-care information? A systematic review. Med Care. 2009;47(1):1–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Schneider EC, Epstein AM. Influence of cardiac-surgery performance reports on referral practices and access to care - A survey of cardiovascular specialists. N Engl J Med. 1996;335(4):251–256.PubMedCrossRefGoogle Scholar
  15. 15.
    Werner RM, Asch DA. The unintended consequences of publicly reporting quality information. JAMA. 2005;293(10):1239–1244.PubMedCrossRefGoogle Scholar
  16. 16.
    Fung CH, Lim YW, Mattke S, Damberg C, Shekelle PG. Systematic review: the evidence that publishing patient care performance data improves quality of care. Ann Intern Med. 2008;148(2):111–123.PubMedGoogle Scholar
  17. 17.
    American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association. Joint principles of the patient-centered medical home. March 2007; Accessed November 8, 2010.
  18. 18.
    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;22(10):1385–1392.PubMedCrossRefGoogle Scholar
  19. 19.
    Mehrotra A, Pearson SD, Coltin KL, et al. The response of physician groups to P4P incentives. Am J Manag Care. 2007;13(5):249–255.PubMedGoogle Scholar
  20. 20.
    Casalino L, Gillies RR, Shortell SM, et al. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. JAMA. 2003;289(4):434–441.PubMedCrossRefGoogle Scholar
  21. 21.
    Pope C, Ziebland S, Mays N. Analysing qualitative data. In: Pope C, Mays N, eds. Qualitative Research in Health Care. 2nd ed. London: BMJ Books; 2000.Google Scholar
  22. 22.
    Hibbard JH, Peters E, Slovic P, Finucane ML, Tusler M. Making health care quality reports easier to use. Jt Comm J Qual Improv. 2001;27(11):591–604.PubMedGoogle Scholar
  23. 23.
    Robinson JC, Casalino LP, Gillies RR, Rittenhouse DR, Shortell SS, Fernandes-Taylor S. Financial incentives, quality improvement programs, and the adoption of clinical information technology. Med Care. 2009;47(4):411–417.PubMedCrossRefGoogle Scholar
  24. 24.
    Rodriguez HP, Scoggins JF, von Glahn T, Zaslavsky AM, Safran DG. Attributing sources of variation in patients’ experiences of ambulatory care. Med Care. 2009;47(8):835–841.PubMedCrossRefGoogle Scholar
  25. 25.
    Saultz JW, Albedaiwi W. Interpersonal continuity of care and patient satisfaction: a critical review. Ann Fam Med. 2004;2(5):445–451.PubMedCrossRefGoogle Scholar
  26. 26.
    Rodriguez HP, Rogers WH, Marshall RE, Safran DG. Multidisciplinary primary care teams: effects on the quality of clinician-patient interactions and organizational features of care. Med Care. 2007;45(1):19–27.PubMedCrossRefGoogle Scholar
  27. 27.
    Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered care. Health Aff. 2010;29(7):1310–1318.CrossRefGoogle Scholar
  28. 28.
    Rider EA, Perrin JM. Performance profiles: the influence of patient satisfaction data on physicians’ practice. Pediatrics. 2002;109(5):752–757.PubMedCrossRefGoogle Scholar
  29. 29.
    Bodenheimer T. Primary care--will it survive? N Engl J Med. 2006;355(9):861–864.PubMedCrossRefGoogle Scholar
  30. 30.
    Rittenhouse DR, Shortell SM, Gillies RR, et al. Improving chronic illness care: findings from a national study of care management processes in large physician practices. Med Care Res Rev. 2010;67(3):301–320.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  • Mark W. Friedberg
    • 1
  • Gillian K. SteelFisher
    • 2
  • Melinda Karp
    • 3
  • Eric C. Schneider
    • 1
    Email author
  1. 1.Division of General MedicineRAND, Brigham and Women’s Hospital, and Harvard Medical SchoolBostonUSA
  2. 2.Harvard School of Public HealthBostonUSA
  3. 3.Massachusetts Health Quality PartnersWatertownUSA

Personalised recommendations