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commentary

(The Health Care Blog)

December 10, 2014

The Great Patient Experience Survey Myth

Photo by Patrick Heagney/iStock

by Rebecca Anhang Price and Marc N. Elliott

Patient experience measures are increasingly being publicly reported and included in pay-for-performance programs, but critics express concern about the relevance and fairness of using information from patient experience surveys as indicators of health care quality. In a recent article in the Journal of General Internal Medicine, we draw on our experience developing and implementing widely used Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to debunk seven myths.

Myth #1: Patients don't have the expertise to answer questions about the quality of their health care. Surveys, such as CAHPS, ask about patient experience, not technical quality of care. And patients are the best and only source of that information.

Myth #2: Patient experience is too subjective to be actionable. Good patient surveys measure specific care experiences, like whether the health care provider communicated in a way that you understood. Information from such surveys can help to identify aspects of care that could be changed to improve patient experience. Many health care providers choose to act on the results, but unfortunately, not all providers use the information generated by patient surveys to improve care.

Myth #3: Emphasizing patient survey results encourages providers to meet patient expectations for their care, rather than to provide appropriate care. Research suggests that patients value how well their health care providers communicate more than whether he or she offers a specific treatment. Making sure that patients are involved in treatment plans is another way to improve patients' ratings of their care experiences.

Myth #4: There is a tradeoff between good patient experiences and high quality clinical care. It's no surprise that some providers have higher scores for patient experience and lower clinical quality scores, and vice versa. But importantly, we know that it's possible for health care providers to simultaneously offer better patient experiences and better clinical quality. Dozens of studies have found either positive or no association between ratings of patient experience and ratings of clinical quality, suggesting that there is no tradeoff between the two.

Myth #5: It's not fair to compare patient experience scores across health care providers or health plans because some factors beyond their control can affect their scores. It's true that factors like how poor or sick patients are can affect patient experience scores. But such differences can be accounted for by a statistical technique called case-mix adjustment, which makes it possible to estimate how health care providers would score if they all served the same patients. Case-mix adjustment levels the playing field, and reduces the likelihood that providers will avoid taking patients who they think will give them poor ratings of patient experience because of factors outside providers' control.

Myth #6: Only patients who have very good or very bad experiences take the surveys, so the results are biased. Although the possibility of bias is important to remember, studies have not found evidence that response rates bias comparisons of case-mix adjusted CAHPS scores.

Myth #7: There are faster, cheaper, and more customized ways to gather information about patient experiences. Patients may find approaches such as online reviews less burdensome, and providers might see customized surveys as more immediately relevant for quality improvement than standardized surveys such as CAHPS. But making fair comparisons between providers or plans requires standardized and consistent measurement such as that provided by the CAHPS surveys in the United States or the General Practice Patient Survey in England.

Patient experience with care is an essential element in any assessment of health care quality. Patient experience surveys give patients a voice, and — when conducted and analyzed according to rigorous standards — provide fair and relevant indicators that complement other metrics of health care quality to inform patients' choices and providers' decisions about how to improve care.


Rebecca Anhang Price is a policy researcher and Marc N. Elliott is a senior statistician at the nonprofit, nonpartisan RAND Corporation.

This commentary originally appeared on The Health Care Blog on December 10, 2014.