Saturday August 22, 2009 at 15:37
Planet Money Blog : NPR - patient experience as reliable indicator of quality of care
Just listed to the 8/21 podcast describing a consumer web site measuring patient satisfaction with their doctors. This is a good move - consumers taking charge of measurement.
Patient satisfaction = ‘were you satisfied with….’
E.g. “were you treated with respect” or “do you like your doctor”
Patient experience = ‘has X happened to you’
E.g. “Have you had to stay in the hospital overnight in the past 12 months?”
I have to let you in on a secret. Doctors and others in the know in health care don’t think too much about patient satisfaction. We all know cases where people express great satisfaction with doctors who are frankly scary and dangerous - but bedside manner is sure great!
So we tend to roll our eyes when we hear about rating doctors on satisfaction.
Rating doctors on experience of care is a whole different ballgame.
It turns out that patients actually do know stuff and can accurately report things like:
“When I visit my doctor’s office it is well organized, efficient, and seldom wastes my time”
and
“I can get care when and how I need it.”
What’s fascinating about these experience questions is the link between them and outcomes that really matter both to people and policy makers.
From studies by John H Wasson and others at Dartmouth we find some doctors are better at delivering care where patients agree with the experience questions posed above (and others).
People who receive care in practices that score well on these attributes are less likely to end up in the hospital or emergency room (outcomes that really matter) even when you compare like patient samples.
Studies by Dana Safran (et al) at Tufts show the same thing.
Bottom line: patient experience of care can shed a huge light on the quality of care delivered in an office practice, reflecting outcomes that really matter.
I hope that the Patient Central folks and others can pick some more meaningful questions - ones better linked to meaningful outcomes - and figure out a way to get at the full practice panel & not be hamstrung by insurer biased samples as they are currently.
Wasson’s survey is available to the public for free and doesn’t suffer from the restrictions imposed by insurance financing.
Wasson, J. H., Keller, A., Rubenstein, L. V., Hays, R. D., Nelson, E. C., Johnson, D., & the Dartmouth Primary Care COOP Benefits and obstacles of health status assessment in ambulatory settings: The clinician’s point of view. Medical Care, 1992 30(5 Suppl.), MS42– MS49.
Safran DG, Karp M, Koltin K, et al. Measuring Patients’ Experiences with Individual Primary Care Physicians Results of a Statewide Demonstration Project J GEN INTERN MED 2006; 21:13–21.
