You are increasingly being held accountable for the outcomes of the health care you deliver. Pay for performance; shared savings in ACOs; public report cards…the list of strategies to monitor and measure the effects of your efforts is lengthening. Many of you seem dismayed by the increased weight accorded to the patient experience of care ratings embedded in most of these programs. Here’s why you should embrace them: The care you deliver cannot improve our health outcomes or even maintain passable ones without the knowledgeable, active participation of us patients and our families.
There is good evidence linking patients' experience of care to important outcomes. Here are a couple of examples:
- Hospitalized Medicare beneficiaries who can't tell who is running the show and perceive conflicting messages from clinicians are much more likely to be readmitted within 30 days than those reporting good experiences. (Boulding 2011)
- People receiving care in practices with good access, less wasted time, and better communication are more likely to report that treatments have helped reduce problems with pain & emotions, have improved markers of chronic conditions, and reduced use of the hospital & emergency room. (Wasson 2006)
We think that if we adhere to evidence-based guidelines our patients will achieve excellent outcomes, but if we also know that if patients experience delays getting a timely appointment they are less likely to follow up for needed care (Lacy 2004), and people who experience in-office waits and delays are less likely to follow through on appropriate care recommendations (Ling 2006).
Clinician adherence to evidence-based guidelines only goes so far and all the best health information technology for disease tracking is of limited use if the health care team fails to communicate effectively with people who struggle to manage their conditions. Before we write people off as "non-compliant" we can and should ask ourselves if we have inadvertantly created a series of hurdles and barriers that negatively impacts our patients.
These fundamental attributes of primary care are a good starting point:
- Access: how easy is it for people to get a timely appointment? The ultimate answer comes from those you serve - don't just rely on administrative data.
- Person-focused care over time: what percent of your patients say that they can identify a 'go-to' medical person?
- Comprehensiveness: Recognizing that people must manage their own conditions the overwhelming majority of time, what percent of those with chronic conditions report that they understand what to do and have the confidence to manage?
We showed that it is possible to implement tools to measure and address these issues even in solo independent primary care practices. (Moore 2007)
I agree with Jessie Gruman that we should embrace patient experience data as a powerful addition to our understanding of system performance as well as insight into why some people struggle with effective self-managment.
L Gordon Moore
Boulding W, Glickman S, Manary M, Schulman K, Staelin R. Relationship between patient satisfaction with inpatient care and hospital readmission within 30 days Am J Manag Care 2011 17(1): 41-48
Lacy, N., Pullman, A. Reuter, M., Lovejoy, B. Why we don’t come: Patient perceptions on No-shows. Annals of Family Medicine 2004;2:541-545.
Ling BS, Klein WM, Dang Q. Relationship of communication and information measures to colorectal cancer screening utilization: results from HINTS. Journal of Health Communication. 11 Suppl 1:181-90, 2006.
Moore LG, Wasson JH. The Ideal Medical Practice Model: Maximizing Efficiency, Quality, and the Doctor-Patient Relationship. Family Practice Management September 2007 pp. 20-24.
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