Patient reported experience of care can be accurately measured and can identify important aspects of practice performance.(1) Patients who report good experience with key attributes are more likely to have good outcomes and cost the health system less.(2) Key attributes include: good access to care, good communication, support for self-management, good continuity, care coordination.
I love that we're seeing patient experience in more publications but I'm a bit perplexed by this article:
M. W. Friedberg, G. K. SteelFisher, M. Karp et al., "Physician Groups' Use of Data from Patient Experience Surveys," Journal of General Internal Medicine, published online Dec. 17, 2010.
It is an interesting observational study looking at how physician groups in Massachusetts used patient experience data to inform quality improvement.
The study tells us that financial incentives for patient experience measures predicts work on patient experience. No surprise, but it is good to confirm widely held belief in studies.
The summarizing conclusion seems to be a circular arguement. Here's the statement:
Groups with more integrated organizational models were especially likely to engage in group-wide improvement efforts, and all groups facing financial incentives based on patient experience reported improvement efforts of some kind.
Here's the authors' definition of integrated organizational models:
For this study, integrated medical groups were defined as those in which most decisions about policies, staffing, and resources were made by a group manager or management team.
So the authors have concluded that group wide activity is predicted by having an organization with a group leader.
Should we push independent or loosely affiliated groups into 'integrated' groups with central control? I don't think we can make the call based on this study. Community Care of North Carolina succeeds in improved population outcomes without resorting to centralized practice administration.
We mustn't mistake the means with the end. The goal is improved outcomes and bending the cost curve, it is not 'centralized administration of practices' unless and until we have definitive studies linking centralized administration with improved outcomes.
(1) Safran DG. Defining the future of primary care: what can we learn from patients? Ann Intern Med. 2003;138:248–55.
(2) Wasson, J. H., Johnson, D. J., Benjamin, R., Phillips, J., & MacKenzie, T. A. Patients report positive impacts of collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 199–206.