Borowsky S J, Davis M K, Goertz C, Lurie N
Department of Medicine, Minneapolis Veterans Affairs Medical Center, MN 55417, USA.
JAMA. 1997 Sep 17;278(11):917-21.
The health care market is demanding increasing amounts of information regarding quality of care in health plans. Physicians are a potentially important but infrequently used source of such information.
To assess physicians' views on health plan practices that promote or impede delivery of high-quality care in health plans and to compare ratings between plans.
Minneapolis-St Paul, Minn.
One hundred physicians in each of 3 health plans. Each physician rated 1 health plan.
Likert-type items that assessed health plan practices that promote or impede delivery of high-quality care.
A total of 249 physicians (84%) completed the survey. Fewer than 20% of all physicians gave plans the highest rating (excellent or strongly agree) for health plan practices that promote delivery of high-quality care (such as providing continuing medical education for physicians, identifying patients needing preventive care, and providing physicians feedback about practice patterns). Barriers to delivering high-quality care related to sufficiency of time to spend with patients, covered benefits and copayment structure, and utilization management practices. Ratings differed across health plans. For example, the percentage of physicians indicating that they would recommend the plan they rated to their own family was 64% for plan 1, 92% for plan 2, and 24% for plan 3 (P<.001 for all comparisons).
Physician surveys can highlight strengths and weaknesses in health plans, and their ratings differ across plans. Physician ratings of health plan practices that promote or impede delivery of high-quality care may be useful to consumers and purchasers of health care as a tool to evaluate health plans and promote quality improvement.
医疗保健市场对健康计划中医疗质量的信息需求日益增加。医生是此类信息的一个潜在重要但很少被利用的来源。
评估医生对健康计划中促进或阻碍高质量医疗服务提供的实践的看法，并比较不同计划之间的评分。
明尼苏达州明尼阿波利斯 - 圣保罗市。
3个健康计划中各有100名医生。每位医生对1个健康计划进行评分。
评估促进或阻碍高质量医疗服务提供的健康计划实践的李克特式项目。
共有249名医生（84%）完成了调查。在促进高质量医疗服务提供的健康计划实践（如为医生提供继续医学教育、识别需要预防保健的患者以及向医生提供关于执业模式的反馈）方面，不到20%的医生给予计划最高评分（优秀或强烈同意）。提供高质量医疗服务的障碍与与患者相处的时间充足性、涵盖的福利和共付结构以及利用管理实践有关。不同健康计划的评分有所不同。例如，表示会向自己家人推荐他们所评分计划的医生百分比，计划1为64%，计划2为92%，计划3为24%（所有比较P<.001）。
医生调查可以突出健康计划的优势和劣势，且不同计划的评分存在差异。医生对促进或阻碍高质量医疗服务提供的健康计划实践的评分，对于医疗保健消费者和购买者而言，可能是评估健康计划和促进质量改进的有用工具。
