Using web-based quality data to choose a primary care physician: which information do patients rely on most?
Gary Fanjiang, Ted von Glahn, Hong Chang, William H. Rogers, Dana Gelb-Safran Funding provided by RWJF and AHRQ
Background
• Despite growing demand, quality of care indicators are often ignored.
• Patients are most interested in data to inform their physician choice but few data are available.
Study Aims
• To examine if patients seeking a new PCP make use of web-based physician specific information. • To evaluate which types of information users find most important.
The Website
• Information on physician credentials and characteristics, office location and hours, and patient survey scores.
• Patient survey scores from the Ambulatory Care Experiences Survey (ACES).
Patient Survey Scores (ACES)
• Five summary measures:
– Appointment access – Interpersonal quality – Coordination of care – Health promotion – Willingness to recommend the physician
Website
Doctor A Doctor B Doctor C Doctor D Doctor E Doctor F Doctor G
Doctor H
Study Sample
• 2225 adult patients seeking a new PCP at two California medical groups were invited by mail. • 17 percent viewed the website (n=382). • 80 percent of those viewing the site completed a follow-up questionnaire (n=306).
Ratings of Importance
Type of information Office hours & location Physician characteristics Physician credentials Survey-based ACES measures Advice from professionals Advice from friends % who cited as important 39 25 38 51 27 24
Relative Importance of Survey Measures
Among Patients Who Said Survey Measures were Important to Their Choice
Survey-based ACES Measure
Appointment access
% who cited as most important
16
Interpersonal quality
Coordination of care Health promotion Willingness to recommend physician
37
5 2 41
Concordance between survey-based measures priority and PCP chosen
Survey-based measure cited by patient as most important Scored best Distribution of patients’ physician choices (Rows sum to 100%) Scored highly 18 (28%) 50 (88%) 13 (52%) 4 (57%) 0 (0%) Scored average 6 (9%) 2 (4%) 7 (28%) 1 (14%) 2 (67%) Scored lowest 0 (0%) 0 (0%) 3 (12%) 1 (14%) 0 (0%) Score unavailablea 4 (6%) 5 (9%) 2 (8%) 1 (14%) 1 (33%)
Willingness to recommend physician (n=64)
36 (56%)
Interpersonal quality (n=57)
N/Ab
Appointment access (n=25)
N/Ab
Coordination of care (n=7)
N/Ab
Health promotion (n=3)
a b
N/Ab
Physician chosen did not have survey-based data presented on the Find a Doctor website. No physicians presented on the Find a Doctor website scored in this range.
Limitations
• Limited to only 2 medical groups.
• Information priorities may be different in people who do not use the internet. • Unknown if participants formalized their physician choice.
Conclusions
• One in six patients seeking a new physician logged-on and used the webbased data to inform their choice. • High participation rates suggest the value of “just-in-time” information.
Conclusions
• Of the different types of information, patient survey results were widely regarded as a priority. • Of the survey results, interpersonal quality and willingness to recommend the physician were valued most. • Choice of physician was highly concordant with patients’ stated priorities – suggesting users are capable of using web-based information to inform their choice appropriately.
Conclusions
• The results underscore the value of developing a national standard for measuring patients’ experiences with individual physicians and their practices.
Acknowledgements
• • • • • • • • Dana Gelb-Safran, Tufts-New England Medical Center, Boston, MA Ted von Glahn, Pacific Business Group on Health, San Francisco, CA Hong Chang, Tufts-New England Medical Center, Boston, MA William H. Rogers, Tufts-New England Medical Center, Boston, MA Michael Nelson and the participating medical groups Andrew Maxfield, Margaret Gerteis, and BearingPoint, Inc. Kara Cassidy, Pacific Business Group on Health, San Francisco, CA Angela Li, Tufts-New England Medical Center, Boston, MA