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Based on their study on the performance of general practices,
Salisbury et al concluded that it is better to measure the experiences of
patients instead of their satisfaction with health care. They argued that
patient experiences discriminate more effectively between general
practices than patient satisfaction. The authors, however, compared very
different aspects of care. They asked for experiences with waiting times,
a feature of the practice, and satisfaction with the communication by the
GP, a characteristic of the individual practitioner.
In the Netherlands, the Consumer Quality Index (CQ-index) is the
national standard for measuring patients experiences with health care.
There is also a CQ-index focussing on the quality of general practices,
the CQ-index Family Practice. In 2008, 5539 patients of 32 general
practices completed this questionnaire. Multilevel analyses showed that
general practices (GP) differed most in accessibility, 15% of the
variation in experiences depended on differences between practices
(Meuwissen et al., 2008). Differences between practices were much smaller
for the communication by the GP, with 5% of the variation in experiences
depending on differences between practices. In addition, people indicated
their general satisfaction with the practice on a 0 to 10 scale. It was
found that 6% of the variation in satisfaction was due to differences
between practices.
In short, GP practices differ clearly in accessibility, but once
patients are in the doctors office differences between practices are much
smaller. No matter whether we ask for patient experiences or patient
satisfaction.
Finding differences between caregivers should also not be an end in
itself. In the Netherlands, we explicitly choose to measure patient
experiences rather than patient satisfaction with health care. The
rationale is, however, that experiences are more useful for quality
improvement (Clearly et al., 1997). And should this not be the ultimate
goal: to improve the quality of health care and to ensure that health care
services fulfil the needs of the patient?
References
Meuwissen LE, De Bakker DH. CQ-index huisartsenzorg:
meetinstrumentontwikkeling. Kwaliteit van de zorg in de huisartsenpraktijk
vanuit het perspectief van pati?nten: de ontwikkeling van het instrument,
de psychometrische eigenschappen en het discriminerend vermogen. [CQ-index
Family Practice: development of the instrument. Quality of care in the
family practice seen from the patients' perspective: the development of
the instrument, psychometric features and discriminative power] Utrecht:
NIVEL, 2008.
Cleary P, Edgman-Levitan S. Health care quality. Incorporating
consumer perspectives. JAMA 1997;19:1608-12.
Competing interests:
No competing interests
07 December 2010
Michelle Hendriks
programm coordinator
Herman Sixma, Jany Rademakers
NIVEL (Netherlands institute for health services research)
I thought it was a truth universally acknowledged that no amount of
statistical manipulation can overcome confounding of variables.
Unfortunately that would seem to be exactly the situation regarding the 3
variables which form the subjects of this study: each set of patients is
linked to one group of doctors who comprise one practice. Are the authors
claiming that "multilevel modelling" can overcome such a basic problem
with the nature of their data?
Do patient experiences indeed reveal differences between practices more effectively than patient satisfaction?
Based on their study on the performance of general practices,
Salisbury et al concluded that it is better to measure the experiences of
patients instead of their satisfaction with health care. They argued that
patient experiences discriminate more effectively between general
practices than patient satisfaction. The authors, however, compared very
different aspects of care. They asked for experiences with waiting times,
a feature of the practice, and satisfaction with the communication by the
GP, a characteristic of the individual practitioner.
In the Netherlands, the Consumer Quality Index (CQ-index) is the
national standard for measuring patients experiences with health care.
There is also a CQ-index focussing on the quality of general practices,
the CQ-index Family Practice. In 2008, 5539 patients of 32 general
practices completed this questionnaire. Multilevel analyses showed that
general practices (GP) differed most in accessibility, 15% of the
variation in experiences depended on differences between practices
(Meuwissen et al., 2008). Differences between practices were much smaller
for the communication by the GP, with 5% of the variation in experiences
depending on differences between practices. In addition, people indicated
their general satisfaction with the practice on a 0 to 10 scale. It was
found that 6% of the variation in satisfaction was due to differences
between practices.
In short, GP practices differ clearly in accessibility, but once
patients are in the doctors office differences between practices are much
smaller. No matter whether we ask for patient experiences or patient
satisfaction.
Finding differences between caregivers should also not be an end in
itself. In the Netherlands, we explicitly choose to measure patient
experiences rather than patient satisfaction with health care. The
rationale is, however, that experiences are more useful for quality
improvement (Clearly et al., 1997). And should this not be the ultimate
goal: to improve the quality of health care and to ensure that health care
services fulfil the needs of the patient?
References
Meuwissen LE, De Bakker DH. CQ-index huisartsenzorg:
meetinstrumentontwikkeling. Kwaliteit van de zorg in de huisartsenpraktijk
vanuit het perspectief van pati?nten: de ontwikkeling van het instrument,
de psychometrische eigenschappen en het discriminerend vermogen. [CQ-index
Family Practice: development of the instrument. Quality of care in the
family practice seen from the patients' perspective: the development of
the instrument, psychometric features and discriminative power] Utrecht:
NIVEL, 2008.
Cleary P, Edgman-Levitan S. Health care quality. Incorporating
consumer perspectives. JAMA 1997;19:1608-12.
Competing interests: No competing interests