Quality Monitoring of Physicians: Linking Patients' Experiences of Care to Clinical Quality and Outcomes

An abstract is available at:
http://www.springerlink.com/content/x422513112862r54/

In the Literature

Synopsis

A study evaluating the association between clinical performance and patients' care experiences found modest correlations between the two areas, suggesting they are related but distinct domains that may require separate goals and improvement activities.

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The Issue

Quality measurement and reporting programs are widespread in health care today. Clinical performance measures—which examine both processes and outcomes of care—are used for public reporting and pay-for-performance programs. Meanwhile, patients' health care experiences are also an important part of quality measurement and improvement efforts. Clinical performance measures represent efforts to standardize care based on proven protocols and best practices. But the delivery of patient-centered care may ultimately rely on customizing care to meet the needs of particular patients. As health care providers strive to deliver both clinically effective and patient-centered care, it is important to better understand the association between these two different sets of measures.

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Key Findings

• Among 42 possible correlations, the majority were positive at the practice-site level (71%) and physician level (67%), meaning that measures of patient experiences were positively, though modestly, correlated with process measures of clinical quality.
• Good clinical team interactions and care coordination at the practice level are positively associated with preventive care, such as cervical and colorectal cancer screening, and disease management, including annual monitoring of hemoglobin levels for diabetics.
• At the individual physician level, good communication, clinical team interactions, and access to care are positively related to preventive care screenings, such as mammograms.

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Addressing the Problem

The study's findings show that improving clinical care delivery and patients' experiences should be mutually reinforcing. That is, improvements in either area can be expected to support and not undermine progress in the other. Quality measurement programs must take steps to include measurement of both domains to obtain a comprehensive evaluation of care. Monitoring both patient experience and clinical quality can ensure that efforts to improve patient care experiences do not come at the cost of ensuring the highest possible clinical performance. It is also important to note, the researchers say, that the majority of all correlations examined were positive. Thus, delivering high-quality care did not appear to be in conflict with positive patient experiences.

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About the Study

The researchers used statewide data in Massachusetts to evaluate the association between clinical measures of quality and measures of patient experiences at the level of the physician practice site and the individual physician. Using Healthcare Effectiveness Data and Information Set and Ambulatory Care Experiences Survey data, the team produced composite measures on clinical quality (care processes and outcomes) and patients' experiences (quality of clinical interactions and organizational features of care).

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The Bottom Line

Patients' care experiences in primary care practices are modestly linked with clinical process measures. Clinical quality and patient experiences appear to be linked but distinct domains that will require separate efforts at measurement and improvement.