title: Patients' global ratings of their health care are not associated with the technical quality of their care.
abstract: BACKGROUND
  Patient global ratings of care are commonly used to assess health care. However, the extent to which these assessments of care are related to the technical quality of care received is not well understood.
  
  
  OBJECTIVE
  To investigate the relationship between patient-reported global ratings of health care and the quality of providers' communication and technical quality of care.
  
  
  METHODS
  Observational cohort study.
  
  
  METHODS
  2 managed care organizations.
  
  
  METHODS
  Vulnerable older patients identified by brief interviews of a random sample of community-dwelling adults 65 years of age or older who received care in 2 managed care organizations during a 13-month period.
  
  
  METHODS
  Survey questions from the second stage of the Consumer Assessment of Healthcare Providers and Systems program were used to determine patients' global rating of health care and provider communication. A set of 236 quality indicators, defined by the Assessing Care of Vulnerable Elders project, were used to measure technical quality of care given for 22 clinical conditions; 207 quality indicators were evaluated by using data from chart abstraction or patient interview.
  
  
  RESULTS
  Data on the global rating item, communication scale, and technical quality of care score were available for 236 vulnerable older patients. In a multivariate logistic regression model that included patient and clinical factors, better communication was associated with higher global ratings of health care. Technical quality of care was not significantly associated with the global rating of care.
  
  
  CONCLUSIONS
  Findings were limited to vulnerable elders who were enrolled in managed care organizations and may not be generalizable to other age groups or types of insurance coverage.
  
  
  CONCLUSIONS
  Vulnerable elders' global ratings of care should not be used as a marker of technical quality of care. Assessments of quality of care should include both patient evaluations and independent assessments of technical quality.
authors: the David Geffen School of Medicine at UCLA and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California; RAND Health, Santa Monica, California; and RAND Health, Arlington, Virginia.
authors: John T
authors: JT
authors: Chang
authors: Ron D
authors: RD
authors: Hays
authors: Paul G
authors: PG
authors: Shekelle
authors: Catherine H
authors: CH
authors: MacLean
authors: David H
authors: DH
authors: Solomon
authors: David B
authors: DB
authors: Reuben
authors: Carol P
authors: CP
authors: Roth
authors: Caren J
authors: CJ
authors: Kamberg
authors: John
authors: J
authors: Adams
authors: Roy T
authors: RT
authors: Young
authors: Neil S
authors: NS
authors: Wenger