Connoisseurs of Care? Unannounced Standardized Patients’ Ratings of Physicians

BACKGROUND: Patient satisfaction surveys can be informative, but bias and poor response rates may limit their utility as stable measures of physician performance. Using unannounced standardized patients (SPs) may overcome some of these limitations because their experience and training make them able judges of physician behavior. OBJECTIVES: We sought to understand the reliability of unannounced SPs in rating primary care physicians when covertly presenting as real patients. STUDY DESIGN: Data from 2 studies (Patient Centered Communication [PCC]; Social Influences in Practice [SIP]) were included. For the PCC study, 5 SPs made 192 visits to 96 physicians; for the SIP study, 18 SPs made 292 visits to 146 physicians. SPs visits to physicians were randomized, thus avoiding mutual selection bias. Each SP rated 16 to 38 physicians on interpersonal skills (autonomy support: PCC, SIP), technical skills (information gathering: SIP-only), and overall satisfaction (SIP-only). We evaluated SP evaluation consistency (physician vs. total variance rho), and SPs' overall satisfaction with specific dimensions of physician performance. RESULTS: Scale reliability varied from 0.71 to 0.92. Physician rhos (95% confidence intervals) for autonomy support were 0.40 (0.22-0.58; PCC) and 0.30 (0.14-0.45; SIP); information gathering rho was 0.46 (0.33-0.59; SIP). Overall SP satisfaction rho was 0.47 (0.34-0.60; SIP). SPs varied significantly in adjusted overall satisfaction levels, but not other dimensions. CONCLUSIONS: These analyses provide some evidence that medical connoisseurship can be learned. When adequately sampled by trained SPs, some physician skills can be reliably measured in community practice settings

Family medicine · MEDLINE · Political science · Healthcare professionals’ stress and burnout · Medicine · Patient Satisfaction in Healthcare · Patient-Provider Communication in Healthcare · Psychology

• Self-Report Adherence Measures in Chronic Illness

  Anthony Jerant, Robin DiMatteo et al.•Medical Care•2008

  Incluir item

• The Values and Value of Patient-Centered Care

  Open Access•Ronald M Epstein, Richard L Street•The Annals of Family Medicine•2011

  Incluir item

• Developing Physician Communication Skills For Patient-Centered Care

  Wendy Levinson, Cara S Lesser et al.•Health Affairs•2010

  Incluir item

• Patients’ participation in medical care

  Open Access•Sheldon Greenfield, Sherrie H Kaplan et al.•Journal of General Internal…•1988

  Incluir item

• Patient Satisfaction With Primary Care

  Douglas W Roblin, Edmund R Becker et al.•Medical Care•2004

  Incluir item

• Personal, Organizational, and Market Level Influences on Physicians’ Practice Patterns

  Bruce E Landon, James Reschovsky et al.•Medical Care•2001

  Incluir item

• Understanding the Causal Relationship Between Patient-Reported Interpersonal and Technical Quality of Care for Depression

  Maria Orlando, Lisa S Meredith•Medical Care•2002

  Incluir item

• Patient Satisfaction with Primary Medical Care Evaluation of Sociodemographic and Predispositional Factors

  GREGORY L WEISS•Medical Care•1988

  Incluir item

• Variation and Quality of Self-Report Health Data

  Lisa S Meredith, Albert L Siu•Medical Care•1995

  Incluir item

• Patient Satisfaction and Change in Medical Care Provider

  M Susan Marquis, Allyson Ross Davies et al.•Medical Care•1983

  Incluir item

• Are Better Ratings of the Patient-Provider Relationship Associated With Higher Quality Care for Depression

  Lisa S Meredith, Maria Orlando et al.•Medical Care•2001

  Incluir item

• Methods For Measuring Patient Satisfaction With Specific Medical Encounters

  John E Ware, Ron D Hays•Medical Care•1988

  Incluir item

• How Many Patients Are Needed to Provide Reliable Evaluations of Individual Clinicians

  Eugene C Nelson, Mary Anne Gentry et al.•Medical Care•2004

  Incluir item

• Impact of Sociodemographic Case Mix on the Hedis Measures of Health Plan Quality

  Alan M Zaslavsky, John N Hochheimer et al.•Medical Care•2000

  Incluir item

• Motivational predictors of weight loss and weight-loss maintenance

  George C Williams, Geoffrey C Williams et al.•Journal of Personality and Social…•1996

  Incluir item

• Predictors of patient satisfaction

  Open Access•Jeffrey L Jackson, Judith Chamberlin et al.•Social Science & Medicine•2001

  Incluir item