Comparing physician and patient perceptions of quality in ambulatory care.

Objective: If quality improvement interventions, value-based purchasing and/or certification are based on patient assessments, a common definition of quality should be shared by clinicians and patients. The study's objectives were to determine (i) how patients and clinicians define quality care, (ii) in what ways patients' and physicians' definitions differ and (iii) whether patients' definitions vary by ethnicity.

Design: We used the critical incident technique to interview participants about behaviors that resulted in office visits being considered either good or poor quality and compared the prevalence of different types of 'quality' behaviors reported to identify commonalities and differences.

Setting: Hawaii and Chicago.

Participants: A total of 168 patients and 39 clinicians.

Results: We developed a taxonomy, comprising 9 major categories and 106 subcategories of behaviors responsible for quality visits. Almost all clinicians and patients agreed that clinical skill, rapport and health-related communication behaviors were key elements. Patients were more likely to report behaviors demonstrating thoroughness in routine examinations, spending enough time with them, engaging them and being treated with courtesy and respect as drivers of a quality office visit than were physicians.

Conclusions: Increased clinician awareness of the behaviors that patients believe are the drivers of a quality office visit can help clinicians improve patients' experience of care and experience-based measures of quality.