Influence of patient education on profiles of physician practices.
BACKGROUND
Few data are available about the effect of patient socioeconomic status on profiles of physician practices.


OBJECTIVE
To determine the ways in which adjustment for patients' level of education (as a measure of socioeconomic status) changes profiles of physician practices.


METHODS
Cross-sectional survey of patients in physician practices.


METHODS
Managed care organization in western New York State.


METHODS
A random sample of 100 primary care physicians and 50 consecutive patients seen by each physician.


METHODS
Ranks of physicians for patient physical and mental health (Short Form 12-Item Health Survey) and satisfaction (Patient Satisfaction Questionnaire), adjusted for patient age, sex, morbidity, and education.


RESULTS
Physicians whose patients had a lower mean level of education had significantly better ranks for patient physical and mental health status after adjustment for patients' level of education level than they did before adjustment (P < 0.001); this result was not seen for patient satisfaction. After adjustment for patients' level of education, each 1-year decrease in mean educational level was associated with a rank that improved by 8.1 (95% CI, 6.6 to 9.6) for patient physical health status and by 4.9 (CI, 3.9 to 5.9) for patient mental health status. Adjustment for education had similar effects for practices with more educated patients and those with less educated patients.


CONCLUSIONS
Profiles of physician practices that base ratings of physician performance on patients' physical and mental health status are substantially affected by patients' level of education. However, these results do not suggest that physicians who care for less educated patients provide worse care. Physician profiling should account for differences in patients' level of education.
Fiscella
K
K
University of Rochester School of Medicine and Dentistry, New York, USA.
Franks
P
P
D003430:Cross-Sectional Studies; D003953:Diagnosis-Related Groups; D004522:Educational Status; D005260:Female; D006279:Health Maintenance Organizations; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009518:New York; D017060:Patient Satisfaction; D010361:Patients; D010818:Practice Patterns, Physicians'; D012044:Regression Analysis