Rodriguez Hector P, von Glahn Ted, Chang Hong, Rogers William H, Safran Dana Gelb
Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, Washington 98195-7660, USA.
Med Care. 2007 Oct;45(10):989-96. doi: 10.1097/MLR.0b013e318074ce63.
In measuring patients' experiences with individual primary care physicians (PCPs), the reliability and validity of data based on samples of "established" patients of a physician's panel have been shown. However, as large-scale initiatives seek the least costly approach to obtaining these data, little is known about the implications of expanding samples to include any patient who has seen the physician in the relevant time period.
A brief validated patient questionnaire was administered to a random sample of patients visiting 67 PCPs in California between January and October 2005. We evaluated the concordance between administrative and patient-reported information on whether the physician was the patient's PCP. Response rates, data quality, and experiences reported by confirmed "established" patients were compared with those of "unestablished" patients.
Administrative data designating patients as established to a PCP were highly concordant with patient self-report (96.5%). For unestablished patients, concordance was considerably lower (40.0%). Response rates among established patients were higher than those of patients believed to be unestablished (35.5% vs. 22.2%). Compared with established patients of a PCP's practice, unestablished patients reported significantly less favorable experiences with the doctor (interaction quality, P < 0.001; health promotion, P < 0.001; access, P < 0.001; integration, P < 0.05). The ranking of individual physicians differed for established and unestablished patient samples.
Initiatives measuring patients' experiences with individual primary care physicians will achieve different results (response rates, physician scores) if samples include any patient who has seen the physician versus those whom administrative data indicate as established members of the physician's panel.
在衡量患者对个体初级保健医生（PCP）的就医体验时，基于医生诊疗小组中“已确定”患者样本的数据可靠性和有效性已得到证实。然而，随着大规模项目寻求以成本最低的方式获取这些数据，对于扩大样本范围以纳入在相关时间段内看过该医生的任何患者所产生的影响，我们却知之甚少。
2005年1月至10月期间，对加利福尼亚州67位初级保健医生的就诊患者进行随机抽样，并向其发放一份经过验证的简短患者问卷。我们评估了行政记录与患者报告的关于该医生是否为其初级保健医生信息之间的一致性。将确诊的“已确定”患者与“未确定”患者的回复率、数据质量及就医体验进行了比较。
行政数据将患者指定为某初级保健医生的已确定患者，与患者自我报告的一致性很高（96.5%）。对于未确定患者，一致性则低得多（40.0%）。已确定患者的回复率高于被认为未确定的患者（35.5%对22.2%）。与初级保健医生诊疗小组中的已确定患者相比，未确定患者报告的与医生的就医体验明显较差（互动质量，P<0.001；健康促进，P<0.001；就医便利性，P<0.001；整合性，P<0.05）。已确定和未确定患者样本对个体医生的排名有所不同。
如果样本包括看过该医生的任何患者，而非行政数据显示为医生诊疗小组已确定成员的患者，那么衡量患者对个体初级保健医生就医体验的项目将会得出不同的结果（回复率、医生评分）。
