Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors.
OBJECTIVE
To determine the extent to which practice level scores mask variation in individual performance between doctors within a practice.


METHODS
Analysis of postal survey of patients' experience of face-to-face consultations with individual general practitioners in a stratified quota sample of primary care practices.


METHODS
Twenty five English general practices, selected to include a range of practice scores on doctor-patient communication items in the English national GP Patient Survey.


METHODS
7721 of 15,172 patients (response rate 50.9%) who consulted with 105 general practitioners in 25 practices between October 2011 and June 2013.


METHODS
Score on doctor-patient communication items from post-consultation surveys of patients for each participating general practitioner. The amount of variance in each of six outcomes that was attributable to the practices, to the doctors, and to the patients and other residual sources of variation was calculated using hierarchical linear models.


RESULTS
After control for differences in patients' age, sex, ethnicity, and health status, the proportion of variance in communication scores that was due to differences between doctors (6.4%) was considerably more than that due to practices (1.8%). The findings also suggest that higher performing practices usually contain only higher performing doctors. However, lower performing practices may contain doctors with a wide range of communication scores.


CONCLUSIONS
Aggregating patients' ratings of doctors' communication skills at practice level can mask considerable variation in the performance of individual doctors, particularly in lower performing practices. Practice level surveys may be better used to "screen" for concerns about performance that require an individual level survey. Higher scoring practices are unlikely to include lower scoring doctors. However, lower scoring practices require further investigation at the level of the individual doctor to distinguish higher and lower scoring general practitioners.
University of Exeter Medical School, St Lukes Campus, Exeter EX1 2LU, UK.
Martin J
MJ
Roberts
University of Exeter Medical School, St Lukes Campus, Exeter EX1 2LU, UK john.campbell@exeter.ac.uk.
John L
JL
Campbell
Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK.
Gary A
GA
Abel
University of Exeter Medical School, St Lukes Campus, Exeter EX1 2LU, UK.
Antoinette F
AF
Davey
Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK.
Natasha L
NL
Elmore
University of Exeter Medical School, St Lukes Campus, Exeter EX1 2LU, UK.
Inocencio
I
Maramba
University of Exeter Medical School, St Lukes Campus, Exeter EX1 2LU, UK.
Mary
M
Carter
RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA.
Marc N
MN
Elliott
Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK.
Martin O
MO
Roland
Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK.
Jenni A
JA
Burt
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D003142:Communication; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult