Patients' ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study.
Patients' ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study.
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DOI：
10.1001/jama.1993.03510070057036
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发表时间：
1993-08
期刊：
影响因子：
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通讯作者：
H. Rubin;B. Gandek;W. Rogers;M. Kosinski;C. McHorney;J. Ware
中科院分区：
文献类型：
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作者：
H. Rubin;B. Gandek;W. Rogers;M. Kosinski;C. McHorney;J. Ware
目的：确定不同类型的实践中的患者-单独或单一专业（SOLO），多专业组（MSG）或健康维护组织（HMO）-以及收费服务（FFS）或预付医生付款安排如何评估他们的医疗保健。设计调查门诊就诊后的成人患者，样本加权代表每种执业类型的就诊患者人群。367名内科医生、家庭医生、内分泌学家、心脏病学家和执业护士的办公室，在HMO（仅预付费）、MSG（预付费和FFS）和SOLO实践（预付费和FFS）。患者：在医学结局研究开始时的成人（N = 17，671）。观察指标：访视的总体评分（从优到差五项选择）。随机一半的样本还评价了提供者的技术技能，个人态度和护理解释以及在访问期间花费的时间，预约等待，办公室等待，办公室位置的便利性和电话访问。结果：55%的患者将他们的就诊总体评价为优秀，32%非常好，11%良好，2%一般或差。SOLO从业者的患者更可能（64%）比MSG（48%）或HMO（49%）患者（P <0.001）将其访视评为优秀。SOLO从业者的患者对护理的各个方面都比HMO患者更好，最明显的是预约等待（64%对40%优秀; P < .0001）和电话访问（64%对33%优秀; P < .0001）。在SOLO和MSG实践中，FFS患者对大多数特定方面的评分优于预付费患者，但这些差异在统计学上并不显著，并且在不同城市之间不一致。调整患者的人口统计学，诊断和自我评估的健康状况并没有改变结果。就诊率最低的20%的医生在6个月内被病人离开的可能性是最高的20%的医生的近4倍（16.7%对4.6%; P < .001）。结论：在五种实践类型和支付方式的组合中，SOLO FFS患者对他们的访问评价最好，HMO患者最差。无论是FFS或预付费，护理被评为更好的小比大的做法。我们的研究表明，一个简短的访问评级表可以用来比较实践环境和健康计划，病人评级预测什么比例的病人，平均来说，将离开他们的医生在未来几个月。
OBJECTIVE To determine how patients in different kinds of practices--solo or single specialty (SOLO), multispecialty group (MSG), or health maintenance organizations (HMOs)--and with fee-for-service (FFS) or prepaid physician payment arrangements evaluate their medical care. DESIGN Survey of adult outpatients after office visits, with sample weighted to represent population of patients visiting physicians in each practice type. SETTING Offices of 367 internists, family practitioners, endocrinologists, cardiologists, and nurse practitioners, in HMOs (prepaid only), MSGs (prepaid and FFS), and SOLO practices (prepaid and FFS). PATIENTS Adults (N = 17,671) at start of the Medical Outcomes Study. OUTCOME MEASURES Overall rating of the visit (five choices from excellent to poor). A random half of the sample also rated the provider's technical skills, personal manner, and explanations of care as well as time spent during the visit, the appointment wait, the office wait, the convenience of the office location, and telephone access. RESULTS Fifty-five percent of patients rated their visit overall as excellent, 32% very good, 11% good, and 2% fair or poor. Patients of SOLO practitioners were more likely (64%) to rate their visit excellent than MSG (48%) or HMO (49%) patients (P < .001). Patients of SOLO practitioners rated all aspects of care better than HMO patients did, most markedly appointment waits (64% vs 40% excellent; P < .0001) and telephone access (64% vs 33% excellent; P < .0001). Within SOLO and MSG practices, FFS patients rated most specific aspects better than prepaid patients, but these differences were not statistically significant and were inconsistent across cities. Adjusting for patients' demographics, diagnoses and self-rated health did not change results. Physicians with visit ratings in the lowest 20% were nearly four times as likely to be left by patients within 6 months than physicians in the highest 20% (16.7% vs 4.6%; P < .001). CONCLUSION Of the five practice type and payment method combinations, SOLO FFS patients rated their visits best and HMO patients worst. Whether FFS or prepaid, care was rated better in small than in large practices. Our study shows that a brief visit rating form can be used to compare practice settings and health plans, and that patient ratings predict what proportion of patients, on average, will leave their physicians in the next several months.