RAND Study Finds Patients' Ratings of Their Medical Care Do Not Reflect the Technical Quality of Their Care

Patients' ratings of their medical care do not substitute for evaluations of the technical quality of that care, according to a study issued today by researchers from the RAND Corporation, UCLA and the U.S. Department of Veterans Affairs Healthcare System.

The study is the first to compare patients' own reports about the quality of their medical care with a comprehensive evaluation of their medical records.

Researchers studying vulnerable older patients found that while patients on average rated the quality of their medical care a 9 on a 10-point scale, comprehensive reviews of their medical records found they received recommended care just 55 percent of the time.

“Patients' ratings of health care are easy to obtain and report, but our findings suggest they do not accurately measure the technical quality of medical care,” said Dr. John T. Chang, a UCLA physician and lead author of the study. “If we want to understand the technical quality of health care, then we need to look at medical records.”

The findings provide additional insights into developing measurements of quality care at the health plan level. The study found that patients' views about the quality of their medical care was closely related to the quality of communications provided by their health providers, which is one dimension of the quality medical care.

The study was led by researchers from RAND Health, the David Geffen School of Medicine at UCLA and the Greater Los Angeles Veterans Affairs Healthcare System and is published in the May 2 edition of the Annals of Internal Medicine.

Patients' ratings of the quality of their health care are being used to help both consumers and those who pay for health insurance decide which health providers to use.

Some health providers use patient assessments to report information about care because such surveys are relatively inexpensive to compile and patients generally report being satisfied with their personal health providers, according to researchers.

“This study shows that we cannot let patient ratings alone drive the debate over whether we need to improve the quality of care,” said Dr. Neil Wenger, UCLA Professor of Medicine and a RAND researcher who is senior author of the study. “We need to measure the technical quality of care in order to have an informed discussion.”

“The findings about patient ratings of their healthcare are critical given the overall move toward patient-directed health care in this country,” said Dr. Robin Hertz, senior director of outcomes research population studies at Pfizer Inc, who is managing the collaboration with RAND. “Consumers are being asked to evaluate healthcare providers, systems and plans based in part on data that reflect consumer satisfaction. Unfortunately, this study shows that patient ratings reflect some important things, but not whether they are receiving recommended care.”

The findings are from a project called Assessing the Care of Vulnerable Elders (ACOVE), an effort to examine the quality of health care provided to vulnerable older Americans who live independently. The project is a partnership between RAND Health and Pfizer.

The study examined the medical care given over a 13-month period to 236 patients age 65 or older who were at risk of declining health and were enrolled in two managed-care health plans. After the 13-month period patients were asked to grade their medical care using standard questionnaires.

Researchers compared patients' rankings with an examination of their medical records using 207 measures of health care quality received by the older patients for 22 common medical conditions, including pneumonia, heart disease, malnutrition and urinary incontinence.

Other authors of the study are Carol P. Roth, Caren J. Kamberg and John Adams, all of RAND; Paul G. Shekelle and Catherine H. MacLean of RAND and the Greater Los Angeles Veterans Affairs Healthcare System; and Ron D. Hays, David H. Solomon, David B. Reuben and Roy T. Young of UCLA.

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 health care quality, costs and delivery, among other topics.

Pfizer Inc discovers, develops, manufactures and markets leading prescription medicines, for humans and animals, and many of the world's best-known consumer products.