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Author List:
Fung CH (VA Greater Los Angeles Healthcare System; RAND; David Geffen School of Medicine at UCLA)
Elliott MN (RAND)
Hays RD (RAND)
Kahn KL (RAND, David Geffen School of Medicine at UCLA)
Kanouse DE (RAND)
McGlynn EA (RAND)
Spranca MD (RAND)
Shekelle PG (VA Greater Los Angeles Healthcare System, RAND, David Geffen School of Medicine at UCLA)
Objectives:
Previous studies have helped us understand the values patients place on technical and interpersonal quality in a primary care setting, although few studies have examined how patients would set priorities, if forced to make tradeoffs between technical and interpersonal quality in the primary care setting. We assessed patients’ use of and preferences for information about technical and interpersonal quality when using report cards to select a primary care provider.
Methods:
We recruited a quota sample to achieve equal numbers by gender, race/ethnicity (non-Hispanic Caucasian, Hispanic, Asian/Pacific Islander, Black), and age (18-34; 35-49; 50-64; > 65). We constructed computerized report cards for seven pairs of hypothetical individual primary care physicians. Participants were instructed to select the physician that they preferred. Two pairs provided an internal validity check. Five pairs forced participants to make tradeoffs between technical and interpersonal quality. We recorded the number of times participants selected the physician who was higher in technical quality versus interpersonal quality. A questionnaire collected demographic information.
Results:
The study included 304 participants. Ninety percent of the sample selected the dominant physician (high technical and interpersonal quality ratings) for both validity checks, indicating a level of attention to task comparable to prior studies. When forced to make trade-offs between technical and interpersonal quality, two-thirds of the sample (95% CI: 62%, 72%) chose the physician who was higher in technical quality at least three out of five times (one-sample binomial test of proportion). Age, gender, and ethnicity were not significant predictors of choosing the physician who was higher in technical quality.
Implications:
A majority of participants showed a strong preference for physicians of high technical quality when forced to make tradeoffs between technical and interpersonal quality, but a substantial proportion of the sample preferred physicians of high interpersonal quality.
Impacts:
Our results may be relevant to primary care physicians, clinics, and healthcare systems such as the VA, which uses provider profiling for internal quality improvement. Without a portfolio that contains both technical and interpersonal quality measures, such profiling systems will neglect aspects of care that patients value.
