Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors.

Autor:	Roberts MJ; University of Exeter Medical School, St Lukes Campus, Exeter EX1 2LU, UK., Campbell JL; University of Exeter Medical School, St Lukes Campus, Exeter EX1 2LU, UK john.campbell@exeter.ac.uk., Abel GA; Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK., Davey AF; University of Exeter Medical School, St Lukes Campus, Exeter EX1 2LU, UK., Elmore NL; Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK., Maramba I; University of Exeter Medical School, St Lukes Campus, Exeter EX1 2LU, UK., Carter M; University of Exeter Medical School, St Lukes Campus, Exeter EX1 2LU, UK., Elliott MN; RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407-2138, USA., Roland MO; Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK., Burt JA; Cambridge Centre for Health Services Research, Institute of Public Health, Forvie Site, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK.
Jazyk:	angličtina
Zdroj:	BMJ (Clinical research ed.) [BMJ] 2014 Nov 11; Vol. 349, pp. g6034. Date of Electronic Publication: 2014 Nov 11.
DOI:	10.1136/bmj.g6034
Abstrakt:	Objectives: To determine the extent to which practice level scores mask variation in individual performance between doctors within a practice. Design: Analysis of postal survey of patients' experience of face-to-face consultations with individual general practitioners in a stratified quota sample of primary care practices. Setting: Twenty five English general practices, selected to include a range of practice scores on doctor-patient communication items in the English national GP Patient Survey. Participants: 7721 of 15,172 patients (response rate 50.9%) who consulted with 105 general practitioners in 25 practices between October 2011 and June 2013. Main Outcome Measure: Score on doctor-patient communication items from post-consultation surveys of patients for each participating general practitioner. The amount of variance in each of six outcomes that was attributable to the practices, to the doctors, and to the patients and other residual sources of variation was calculated using hierarchical linear models. Results: After control for differences in patients' age, sex, ethnicity, and health status, the proportion of variance in communication scores that was due to differences between doctors (6.4%) was considerably more than that due to practices (1.8%). The findings also suggest that higher performing practices usually contain only higher performing doctors. However, lower performing practices may contain doctors with a wide range of communication scores. Conclusions: Aggregating patients' ratings of doctors' communication skills at practice level can mask considerable variation in the performance of individual doctors, particularly in lower performing practices. Practice level surveys may be better used to "screen" for concerns about performance that require an individual level survey. Higher scoring practices are unlikely to include lower scoring doctors. However, lower scoring practices require further investigation at the level of the individual doctor to distinguish higher and lower scoring general practitioners. (© Roberts et al 2014.)
Databáze:	MEDLINE
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