Blending group and practice site scores to increase the reliability of physician quality information.

Objective: To use an empirical Bayesian approach, blending practice, and group quality data with physician results to increase the accuracy of quality of care measures.

Data Sources: Performance data on diabetes glycemic screening for 8,357 physicians collected from multiple payers as part of a statewide physician performance reporting initiative.

Study Design: A variance components analysis assessed the strength of group, practice, and physician effects compared with random error.

Measuring chronic care delivery: patient experiences and clinical performance.

Objective: To assess the relationship between clinical care metrics and patient experiences of care among patients with chronic disease.

Design: Cross-sectional survey and clinical performance data.

Setting: Eighty-nine medical groups across California caring for patients with chronic disease.

The effect of performance-based financial incentives on improving patient care experiences: a statewide evaluation.

Background: Patient experience measures are central to many pay-for-performance (P4P) programs nationally, but the effect of performance-based financial incentives on improving patient care experiences has not been assessed.

Methods: The study uses Clinician & Group CAHPS data from commercially insured adult patients (n = 124,021) who had visits with 1,444 primary care physicians from 25 California medical groups between 2003 and 2006. Medical directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the patient experience improvement activities adopted by groups.

Organizational and market influences on physician performance on patient experience measures.

Objective: To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures.

Data Sources: This study employs Clinician and Group CAHPS survey data (n=105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies.

Attributing sources of variation in patients' experiences of ambulatory care.

Background: Public reporting and pay-for-performance programs increasingly rely on patient experience data to evaluate individual physicians and guide quality improvement efforts. The extent to which performance variation is attributable to physicians versus other system-level units, however, remains unclear.

Methods: Using ambulatory care experience survey data from 61,839 patients of 1729 primary care physicians in California (response rate = 39.

Statewide evaluation of measuring physician delivery of self-management support in chronic disease care.

Background: Self-management support is an important component of improving chronic care delivery.

Objective: To validate a new measure of self-management support and to characterize performance, including comparisons across chronic conditions.

Design, Setting, Participants: We incorporated a new question module for self-management support within an existing annual statewide patient survey process in 2007.

The effect of item screeners on the quality of patient survey data: a randomized experiment of ambulatory care experience measures.

Background: The use of item screeners is viewed as an essential feature of quality survey design because only respondents who are 'qualified' to answer questions that apply to a subset of the sample are directed to answer. However, empirical evidence supporting this view is scant.

Objective: This study compares data quality resulting from the administration of ambulatory care experience measures that use item screeners versus tailored 'not applicable' options in response scales.

Measuring patients' experiences with individual specialist physicians and their practices.

This study assesses the reliability of patient-reported information about care received by individual specialist physicians. A patient questionnaire that included core composites from the Consumer Assessment of Healthcare Providers and Systems Clinician & Group survey was administered to random samples of patients visiting 1315 physicians from 14 specialties in California during 2005-2006 (n = 68 406 respondents). The quality of specialist-patient interaction and organizational access composites achieved adequate physician-level reliability (alpha(MD) = 0.

Physician effects on racial and ethnic disparities in patients' experiences of primary care.

Background: Few studies have clarified the mechanisms that contribute to racial and ethnic disparities in primary care quality among comparably-insured patients.

Objective: To examine relative contribution of "between-" and "within-" physician effects on disparities in patients' experiences of primary care.

Design: Regression models using physician fixed effects to account for patient clustering were specified to assess "between-" and "within-"physician effects on observed racial and ethnic disparities in patients' experiences of primary care.

Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention.

Background: Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any) should be deferred to a subsequent visit.

Patient samples for measuring primary care physician performance: who should be included?

Background: In measuring patients' experiences with individual primary care physicians (PCPs), the reliability and validity of data based on samples of "established" patients of a physician's panel have been shown. However, as large-scale initiatives seek the least costly approach to obtaining these data, little is known about the implications of expanding samples to include any patient who has seen the physician in the relevant time period.

Methods: A brief validated patient questionnaire was administered to a random sample of patients visiting 67 PCPs in California between January and October 2005.

Providing patients web-based data to inform physician choice: if you build it, will they come?

Background: Despite growing emphasis on public reporting of health care quality data, available data are often ignored.

Objective: To evaluate the usefulness of web-based physician-level data for patients choosing a new primary care physician (PCP).

Design: Patients seeking a new PCP (n = 2225) were invited to view web-based information including PCP credentials, personal characteristics, office location and hours, and patient experience scores.

Evaluating patients' experiences with individual physicians: a randomized trial of mail, internet, and interactive voice response telephone administration of surveys.

Background: There is increasing interest in measuring patients' experiences with individual physicians, and empirical evidence supports this area of measurement. However, the high cost of data collection remains a significant barrier. Survey modes with the potential to lower costs, such as Internet and interactive voice response (IVR) telephone, are attractive alternatives to mail, but their comparative response rates and data quality have not been tested.