December 20, 2010
Most Massachusetts physician groups are using results from a statewide patient survey to help improve patient experiences, but a significant number are not making use of the information or are making relatively limited efforts, according to a new RAND Corporation study.
Although physician communication skills are thought to be crucial to patient-centered care, the physician groups studied rarely pursued strategies that focused on improving physicians' ability to communicate with patients, according to the study published online by the Journal of General Internal Medicine.
Instead, physician groups most commonly focused on other improvements, such as staff courteousness, scheduling practices and investments in electronic health records.
"It's encouraging that most Massachusetts physician groups are using patient feedback to make improvements. However, we were surprised to find only a small number of groups focusing on the physician's role in improving patient care," said Dr. Mark W. Friedberg, the study's lead author and a natural scientist at RAND, a nonprofit research organization.
An increasing number of government agencies and other groups are compiling public reports of patient-reported experiences with health care providers, both as a tool to help patients choose doctors and other health care providers, and as a way to motivate performance improvement.
Since 2002, the Massachusetts Health Quality Partners has conducted a statewide patient experience survey of more than 200,000 patients enrolled in the state's five largest health plans. The survey assesses the care delivered by more than 4,000 primary care physicians in nearly 500 medical offices operated by 120 medical groups. The results have been available to the public since 2006.
Previous studies have assessed how patients use the publicly available information about physicians, but the RAND study is the first to examine in detail how physician groups make use of such information. Researchers say the findings are particularly important given national calls for physicians to offer more patient-centered health care.
During 2008, researchers conducted interviews with leaders from 72 of the participating Massachusetts medical groups to assess whether they were making use of the patient feedback and the types of improvement steps that had been taken.
About 61 percent of the medical groups reported attempting group-wide improvement efforts based on the patient assessments, 22 percent reported efforts to improve only the performance of low-scoring physicians, and 17 percent reported no improvement efforts.
Physician groups most likely to make wide use of the patient feedback had an integrated medical group model in which physicians are employed by a central entity, while independent practice associations in which physicians affiliate for business purposes were less likely to use the patient assessments. In addition, physician groups were more likely to be engaged in improvement efforts if they received some payments based upon patient experience ratings.
The areas most commonly targeted for improvement involved access issues such as the time it took to get an appointment, front-office staff communications with patients, including how incoming calls were handled, and customer service habits such as courteousness.
The study found physician groups were less likely to focus on the performance of physicians and other clinicians or to focus on educational activities that might enable patients to self-manage their medical conditions.
The researchers hypothesize that physician group leaders were reluctant to focus quality-improvement efforts on medical staff members because of physicians' skepticism about patient experience results, as well as a sensitivity to low morale among primary care physicians.
"If improving physicians' interactions with patients is a high priority, policymakers may need to consider creating incentives to encourage medical groups to engage directly with their providers, rather than focusing on other aspects of the patient experience," Friedberg said.
Funding for the study was provided by the Commonwealth Fund. Other authors of the study are Dr. Eric C. Schneider of RAND, Brigham and Women's Hospital and the Harvard Medical School, Gillian K. SteelFisher of the Harvard School of Public Health, and Melinda Karp of Massachusetts Health Quality Partners.
RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on quality, costs and health services delivery, among other topics.