Accounting for Variation in Technical Quality and Patient Satisfaction

BACKGROUND: The delivery of healthcare depends on individual providers, coordination within teams, and the structure of the work setting. We analyzed the amount of variation in technical quality and patient satisfaction accounted for at the patient, provider, team, and medical center level. METHODS: Data abstracted from Veterans Health Administration patient medical records for 2007 were used to calculate measures of technical quality based on adherence to best practice guidelines in 5 domains. Outpatient satisfaction was obtained from a 2007 standardized national mail survey. Hierarchical linear models that accounted for the clustering of patients within providers, providers within teams, and teams within medical centers were used to partition the variation in technical quality and satisfaction across patients and components of the system (ie, providers, teams, and medical centers). RESULTS: Providers accounted for the largest percent of system-level variance for all technical quality domains, ranging from 46.5% to 71.9%. For the single-item measure of patient satisfaction, medical centers, teams, and providers accounted for about the same percent of system-level variance (31%-34%). For the doctor/patient interaction scale providers explained 59.9% of system-level variance, more than double that of teams and medical centers. For all the measures, the residual variance (composed of patient-level and random error) explained the largest proportion of the total variance. CONCLUSIONS: Providers explained the greatest amount of system-level variation in technical quality and patient satisfaction. However, in both of these domains, differences between patients were the predominant source of nonrandom variance

Business · Explained variation · Family medicine · Health care · Multilevel model · Patient satisfaction · Quality (philosophy) · Statistics · Variance (accounting) · Accounting · Medicine · Nursing · Patient Safety and Medication Errors · Patient Satisfaction in Healthcare · Primary Care and Health Outcomes

• Satisfaction With Health Care Providers and Preventive Care Adherence

  Anthony Jerant, Joshua J Fenton et al.•Medical Care•2014

  Añadir item

• Measures Evaluating Patient Satisfaction in Integrated Health Care Settings

  Open Access•Denise Black, M L Held et al.•Community Mental Health Journal•2021

  Añadir item

• Provider Variation in Fast Track Treatment Time

  Melissa L McCarthy, Ru Ding et al.•Medical Care•2012

  Añadir item

• Building patient-centeredness

  Open Access•E Bromley•Social Science & Medicine•2012

  Añadir item

• The Quality of Care

  Avedis Donabedian•JAMA•1988

  Añadir item

• Using a single‐item approach to measure facet job satisfaction

  Open Access•Mark S Nagy•Journal of Occupational and…•2002

  Añadir item

• Using SAS PROC Mixed to Fit Multilevel Models, Hierarchical Models, and Individual Growth Models

  Open Access•Judith D Singer•Journal of Educational and…•1998

  Añadir item

• What Makes Teams Work

  Open Access•Susan G Cohen, D E Bailey•Journal of Management•1997

  Añadir item

• A 12-Item Short-Form Health Survey

  John E Ware, Mark Kosinski et al.•Medical Care•1996

  Añadir item

• Patient Satisfaction with the General Practitioner

  Herman J Sixma, H Sixma et al.•Medical Care•1998

  Añadir item

• Using Knowledge of Multiple Levels of Variation in Care to Target Performance Incentives to Providers

  Marc Turenne, Marc N Turenne et al.•Medical Care•2008

  Añadir item

• Patient Satisfaction With Hospital Care

  Gary J Young, Mark Meterko et al.•Medical Care•2000

  Añadir item

• Attributing Sources of Variation in Patients’ Experiences of Ambulatory Care

  Hector P Rodriguez, John F Scoggins et al.•Medical Care•2009

  Añadir item

• Gender Differences in Practice Style

  Jozien M Bensing, ATIE VAN DEN BRINK-MUINEN et al.•Medical Care•1993

  Añadir item

• Do Attending or Resident Physician Practice Styles Account for Variations in Hospital Resource Use

  Rodney A Hayward, Willard G Manning et al.•Medical Care•1994

  Añadir item

• Meaningful Variation in Performance

  Joseph V Selby, Julie A Schmittdiel et al.•Medical Care•2010

  Añadir item

• Meaningful Variation in Performance

  Vicki Fung, Julie A Schmittdiel et al.•Medical Care•2010

  Añadir item

• Patient satisfaction revisited

  Open Access•Karin Dorieke Hekkert, Karin Hekkert et al.•Social Science & Medicine•2009

  Añadir item