Patients' Global Ratings of Their Health Care Are Not Associated with the Technical Quality of Their Care

2 May 2006 | Volume 144 Issue 9 | Pages 665-672

Background: Patient global ratings of care are commonly used to assess health care. However, the extent to which these assessments of care are related to the technical quality of care received is not well understood.

Objective: To investigate the relationship between patient-reported global ratings of health care and the quality of providers' communication and technical quality of care.

Design: Observational cohort study.

Setting: 2 managed care organizations.

Patients: Vulnerable older patients identified by brief interviews of a random sample of community-dwelling adults 65 years of age or older who received care in 2 managed care organizations during a 13-month period.

Measurements: Survey questions from the second stage of the Consumer Assessment of Healthcare Providers and Systems program were used to determine patients' global rating of health care and provider communication. A set of 236 quality indicators, defined by the Assessing Care of Vulnerable Elders project, were used to measure technical quality of care given for 22 clinical conditions; 207 quality indicators were evaluated by using data from chart abstraction or patient interview.

Results: Data on the global rating item, communication scale, and technical quality of care score were available for 236 vulnerable older patients. In a multivariate logistic regression model that included patient and clinical factors, better communication was associated with higher global ratings of health care. Technical quality of care was not significantly associated with the global rating of care.

Limitations: Findings were limited to vulnerable elders who were enrolled in managed care organizations and may not be generalizable to other age groups or types of insurance coverage.

Conclusions: Vulnerable elders' global ratings of care should not be used as a marker of technical quality of care. Assessments of quality of care should include both patient evaluations and independent assessments of technical quality.

Editors' Notes Context Patients' overall ratings of their care could reflect its technical content, their interaction with the clinician, or both. Contribution The authors asked 236 vulnerable elderly patients to rate their care in the past 12 months and the interpersonal communication that they experienced. They also reviewed medical records for adherence to standards of care for common conditions. Overall ratings of care were high and directly correlated with ratings of interpersonal communication. Neither correlated with the ratings of technical quality of care, which were much lower. Cautions The respondents were frail and elderly. Implications Patients' overall ratings of their care are not a reliable indicator of adherence to practice norms. —The Editors

 

Author and Article Information

From the David Geffen School of Medicine at UCLA and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California; RAND Health, Santa Monica, California; and RAND Health, Arlington, Virginia.

Acknowledgments: The authors thank Robin P. Hertz, PhD, senior director of outcomes research and population studies at Pfizer Inc., for her valuable support. They also thank Patricia Smith for her technical assistance.

Grant Support: The ACOVE project was supported by a contract from Pfizer Inc. to RAND Health. Dr. Chang was supported by a National Research Service Award training grant (PE-19001) and the UCLA Specialty Training and Advanced Research (STAR) Program. Dr. Shekelle is a Senior Research Associate of the Veterans Affairs Health Services Research and Development Service. Dr. MacLean holds a Veterans Affairs Health Services Research and Development Service Career Development Award. Dr. Hays was supported in part by UCLA/DREW Project EXPORT, National Institutes of Health, National Center on Minority Health & Health Disparities (P20-MD00148-01), and UCLA Center for Health Improvement in Minority Elders/Resource Center for Minority Aging Research, National Institutes of Health, National Institute of Aging (AG-02-004).

Potential Financial Conflicts of Interest: Stock ownership or options (other than mutual funds): R.T. Young (Pfizer Inc.).

Requests for Single Reprints: John T. Chang, MD, MPH, David Geffen School of Medicine at UCLA, Division of General Internal Medicine and Health Services Research, 911 Broxton Avenue, Third Floor, Los Angeles, CA 90095-1736; e-mail, johnchang{at}mednet.ucla.edu.

Current Author Addresses: Drs. Chang, Hays, and Wenger: David Geffen School of Medicine at UCLA, Division of General Internal Medicine and Health Services Research, 911 Broxton Avenue, Third Floor, Los Angeles, CA 90095-1736.

Drs. Shekelle and MacLean: Greater Los Angeles Veterans Affairs Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.

Dr. Reuben: Division of Geriatrics, University of California, Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095-1736.

Ms. Roth and Drs. Solomon and Adams: RAND, 1776 Main Street, M-4E, Santa Monica, CA 90407-2138.

Ms. Kamberg: RAND Health, 1200 South Hayes Street, Arlington, VA 22202.

Dr. Young: Division of General Internal Medicine, University of California, Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095-1736.