Article

The Increasing Importance of Patient Surveys. Now That Sound Methods Exist, Patient Surveys Can Facilitate Improvement

BMJ Clinical Research (Impact Factor: 14.09). 10/1999; 319(7212):720-1. DOI: 10.1136/bmj.319.7212.720
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Available from: Paul D Cleary, Aug 29, 2015
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    • "There now are valid and reliable instruments that ask cancer patients objective questions about aspects of care that both clinicians and patients think represent quality. Newer surveys and reports can provide results that are interpretable and suggest specific areas for quality improvement efforts.10 The choice of a questionnaire depends upon the type of cancer under investigation, the availability of resources including human resources and the motives behind the collection of the data. "
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    ABSTRACT: Cancer is one of the leading causes of morbidity and mortality in the United States. It places considerable mental, physical, and emotional stress on patients and requires them to make major adjustments in many key areas of their lives. As a consequence, the demands on health care providers to satisfy the complex care needs of cancer patients increase manifold. Of late, patient satisfaction has been recognized as one of the key indicators of health care quality and is now being used by health care institutions for monitoring health care improvement programs, gaining accreditation, and marketing strategies. The patient satisfaction information is also being used to compare and benchmark hospitals, identify best-performance institutions, and discover areas in need of improvement. However, the existing literature on patient satisfaction with the quality of cancer care they receive is inconsistent and heterogeneous because of differences in study designs, questionnaires, study populations, and sample sizes. The aim of this review was therefore to systematically evaluate the available information on the distribution and determinants of patient satisfaction in oncology.
    Patient Preference and Adherence 11/2009; 3:287-304. · 1.49 Impact Factor
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    • "Patient experience surveys have become central to performance measurement activities nationwide, including pay-for-performance and public reporting initiatives (Cleary 1999; Damberg et al. 2005). Little is known about the extent to which characteristics and activities of medical groups and market factors are related to individual physician performance on patient care experience measures. "
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    ABSTRACT: To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures. This study employs Clinician and Group CAHPS survey data (n=105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices. We used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects. Compared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication ( p=.007) and care coordination ( p=.03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care ( p=.04). Physicians located in PCSAs with higher area-level deprivation had worse performance on the access to care ( p=.04) and care coordination ( p<.001) measures. Physicians from integrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing in markets with high concentrations of vulnerable populations may be disadvantaged by constraints that affect performance. Future studies should clarify the extent to which performance deficits associated with area-level deprivation are modifiable.
    Health Services Research 07/2009; 44(3):880-901. DOI:10.1111/j.1475-6773.2009.00960.x · 2.49 Impact Factor
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    • "been aimed at patient or enrollee satisfaction with care, perceptions of the quality of care, health outcomes, and quality of life. A few studies have included views of the doctor–patient relationship (including trust and the perception of incentives), or measures of organizational ethics (Cleary et al. 1991, 1993; Ware and Sherbourne 1992; Cleary and Edgman-Levitan 1997; Safran et al. 1998; Ware and Gandek 1998; Cleary 1999; Kaegi 1999; Thom et al. 1999; Wynia et al. 2001; Hall et al. 2002; Hojat et al. 2002; Van der Feltz- Cornelis et al. 2004). Measures aimed at patient perceptions of the organizational and economic aspects of health care or enrollee perceptions of fairness, trust, or trustworthiness are scant (Zheng et al. 2002; Rose et al. 2004), despite the popularity of similar measures in other organizational settings (Kramer and Tyler 1996; Petersen 2002). "
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    ABSTRACT: Patient-centered assessments are increasingly important. Patients repeatedly emphasize the importance of trust in health care institutions and personnel. (1) Develop a conceptual framework for trust in health care organizations and a comprehensive, reliable measure of trust in health insurers. (2) Examine predictors and correlates of trust in insurers. A conceptual framework for trust in health organizations based on theory and empirical studies was used to develop items for a structured telephone survey, which also included measures of health and utilization, doctor-patient trust, and satisfaction with care. Principal components factor analyses identified hypothesized domains of trust in health insurers and identified items for scales. Internal consistency assessment used Cronbach's alpha. Univariate analyses used Pearson's r or Student's t-tests. Insured residents of Southeastern Michigan (n=400). Respondents were diverse in age, gender, ethnicity, health, and socioeconomic status. One dominant factor (eigenvalue>10) included hypothesized domains: administrative competence, clinical competence, advocacy and beneficence, fairness, honesty and openness, and one global item. Multidimensional scales were reliable (long version 13 items, alpha=0.95, short: 9 items, alpha=0.91). Insurer trust correlated strongly with trust in doctors (r=0.49 and 0.46) and satisfaction with care (r=0.70 and 0.66), and with an item assessing overall worry about health insurance (r=-0.37 and -0.35). Those with less trust in their insurer were more likely to say that they would change insurance plans (p<.001). This well-grounded, reliable measure of enrollee trust in insurers can be a useful patient-centered assessment tool.
    Health Services Research 02/2006; 41(1):58-78. DOI:10.1111/j.1475-6773.2005.00456.x · 2.49 Impact Factor
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