Patient Ratings of the Overall Quality of Care in 2 Managed Care Organizations Were Not Associated with Measures of the Technical Quality of Care

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The summary below is from the full report titled "Patients' Global Ratings of Their Health Care Are Not Associated with the Technical Quality of Their Care." It is in the 2 May 2006 issue of Annals of Internal Medicine (volume 144, pages 665-672). The authors are J.T. Chang, R.D. Hays, P.G. Shekelle, C.H. MacLean, D.H. Solomon, D.B. Reuben, C.P. Roth, C.J. Kamberg, J. Adams, R.T. Young, and N.S. Wenger.

What is the problem and what is known about it so far?

Health care organizations, such as insurance companies and hospitals, commonly use patient ratings of care to evaluate the quality of care delivered within the organization. However, it is not known whether patient ratings are associated with other more technical measures of quality of care.

Why did the researchers do this particular study?

To see how patient ratings of health care relate to measures of technical quality of care.

Who was studied?

236 patients older than 65 years of age who received care in 1 of 2 managed care organizations between July 1998 and July 1999. All of the patients in the study lived in the community (not nursing homes) but were considered to have health conditions that put them at risk for becoming dependent on others for daily care or dying within the next 2 years.

How was the study done?

All of the patients included in the study completed a survey that asked them to rate the overall quality of their health care and the quality of communication with their health care providers over the past year. The researchers reviewed patients' medical records to see whether care for 22 conditions met previously developed quality-of-care criteria for 22 different health conditions. Each patient was only eligible for the technical measures related to health conditions that he or she had. The researchers then examined the relationship between patient rating of care and technical quality of care measured by review of medical records.

What did the researchers find?

Patient ratings of overall quality of care were associated with ratings of communication. In other words, patients who rated overall quality as poor were also likely to rate communication with their health providers as poor. However, patient ratings of overall quality of care were not associated with technical quality of care measured by medical record review. In other words, patients who rated care as very good may have had poor care according to review of medical records and vice versa.

What were the limitations of the study?

The study included only elderly patients at risk for worsening health in 2 managed care programs. The results may not apply to other types of patients.

What are the implications of the study?

Patient ratings of health care do not appear to be good markers of technical quality of care. Measuring quality of care should include both patient ratings and other independent measures of technical quality.