Measuring patients' experiences with individual primary care physicians. Results of a statewide demonstration project.
BACKGROUND
Measuring and reporting patients' experiences with health plans has been routine for several years. There is now substantial interest in measuring patients' experiences with individual physicians, but numerous concerns remain.


OBJECTIVE
The Massachusetts Ambulatory Care Experiences Survey Project was a statewide demonstration project designed to test the feasibility and value of measuring patients' experiences with individual primary care physicians and their practices.


METHODS
Cross-sectional survey administered to a statewide sample by mail and telephone (May-August 2002).


METHODS
Adult patients from 5 commerical health plans and Medicaid sampled from the panels of 215 generalist physicians at 67 practice sites (n=9,625).


METHODS
Ambulatory Care Experiences Survey produces 11 summary measures of patients' experiences across 2 domains: quality of physician-patient interactions and organizational features of care. Physician-level reliability was computed for all measures, and variance components analysis was used to determine the influence of each level of the system (physician, site, network organization, plan) on each measure. Risk of misclassifying individual physicians was evaluated under varying reporting frameworks.


RESULTS
All measures except 2 achieved physician-level reliability of at least 0.70 with samples of 45 patients per physician, and several exceeded 0.80. Physicians and sites accounted for the majority of system-related variance on all measures, with physicians accounting for the majority on all "interaction quality" measures (range: 61.7% to 83.9%) and sites accounting for the largest share on "organizational" measures (range: 44.8% to 81.1%). Health plans accounted for neglible variance (<3%) on all measures. Reporting frameworks and principles for assuring misclassification risk < or =2.5% were identified.


CONCLUSIONS
With considerable national attention on the importance of patient-centered care, this project demonstrates the feasibility of obtaining highly reliable measures of patients' experiences with individual physicians and practices. The analytic findings underscore the validity and importance of looking beyond health plans to individual physicians and sites as we seek to improve health care quality.
Safran
Dana Gelb
DG
The Health Institute, Institute for Clinical Research and Health Policy Studies, Tufts-New England Medical Center, Boston, Mass, USA.
Karp
Melinda
M
Coltin
Kathryn
K
Chang
Hong
H
Li
Angela
A
Ogren
John
J
Rogers
William H
WH
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D019538:Health Care Surveys; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D007348:Insurance, Health; D007407:Interviews as Topic; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D015203:Reproducibility of Results; D018401:Sample Size