Relationship Between Clinical Quality and Patient Experience

Analysis of Data from the English Quality and Outcomes Framework and the National GP Patient Survey

Published in: Annals of Family Medicine, v. 11, no. 5, Sep./Oct. 2013, p. 467-472

Posted on on September 01, 2013

by Nadia R. Llanwarne, Gary A. Abel, Marc N. Elliott, Charlotte Paddison, Georgios Lyratzopoulos, John Campbell, Martin Roland

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Research Question

  1. What is the relationship between clinical quality of care and patient experience in England?

PURPOSE: Clinical quality and patient experience are both widely used to evaluate the quality of health care, but the relationship between these 2 domains remains uncertain. The aim of this study was to examine this relationship using data from 2 established measures of quality in primary care in England. METHODS: Practice-level analyses (N = 7,759 practices in England) were conducted on measures of patient experience from the national General Practice Patient Survey (GPPS), and measures of clinical quality from the national pay-for-performance scheme (Quality and Outcomes Framework). Spearman's rank correlation and multiple linear regression were used on practice-level estimates. RESULTS: Although all the correlations between clinical quality summary scores and patient survey scores are positive, and most are statistically significant, the strength of the associations was weak, with the highest correlation coefficient reaching 0.18, and more than one-half were 0.11 or less. Correlations with clinical quality were highest for patient-reported access scores (telephone access 0.16, availability of urgent appointments 0.15, ability to book ahead 0.18, ability to see preferred doctor 0.17) and overall satisfaction (0.15). CONCLUSION: Although there are associations between clinical quality and measures of patient experience, the 2 domains of care quality remain predominantly distinct. The strongest correlations are observed between practice clinical quality and practice access, with very low correlations between clinical quality and interpersonal aspects of care. The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.

Key Finding

  • Clinical quality of care and measures of patient experience are only weakly associated in England and should be considered separately in an overall assessment of medical care.


  • The quality of clinical care and the quality of interpersonal care should be considered separately to give an overall assessment of medical care.

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