Hays R D, Brown J A, Spritzer K L, Dixon W J, Brook R H
RAND, Santa Monica, Calif 90407-2138, USA.
Arch Intern Med. 1998 Apr 13;158(7):785-90. doi: 10.1001/archinte.158.7.785.
Satisfaction with health plan performance has been assessed frequently, but assessment of physician group performance is rare.
To present ratings of the care provided by physician groups to enrollees in a variety of capitated health maintenance organization plans.
A random sample was drawn of adult enrollees receiving managed health care from 48 physician groups in a group practice association. Each individual in the sample was mailed a 12-page questionnaire and 7093 were returned (59% response rate). The mean age of those returning the questionnaire was 51 years; 65% were women.
Reliability estimates for 6 multi-item satisfaction scales were excellent, and noteworthy differences in ratings among groups were observed. In particular, ratings of overall quality ranged from a low of 28 to a high of 68 (mean, 50; SD, 10). Average scores for physician groups were strongly correlated across all scales, but no single group scored consistently highest or lowest on the different scales. Negative ratings of care were significantly related to the following: intention to switch to another physician group, difficulty in getting appointments, lengthy waiting periods in the reception area and examination room, the inability to get consistent care from one physician for routine visits, and not being informed by the office staff when there was a delay in seeing the primary care provider.
Monitoring of health care quality at the physician group level is possible, and could be used for benchmarking, internal quality improvement, and for providing information to the public about how these physician groups will meet its needs.
对健康计划绩效的满意度已被频繁评估，但对医师团队绩效的评估却很少见。
呈现医师团队为各种按人头付费的健康维护组织计划的参保人提供的护理评级。
从一个团体医疗协会的48个医师团队中随机抽取接受管理式医疗护理的成年参保人样本。向样本中的每个个体邮寄一份12页的问卷，共返回7093份（回复率59%）。回复问卷者的平均年龄为51岁；65%为女性。
6个多项目满意度量表的信度估计极佳，且观察到各团队之间在评级上存在显著差异。特别是，总体质量评级从低至28分到高至68分不等（均值为50分；标准差为10分）。所有量表上医师团队的平均得分高度相关，但没有一个团队在不同量表上始终获得最高分或最低分。对护理的负面评级与以下因素显著相关：转至另一个医师团队的意向、预约困难、在候诊区和检查室等待时间过长、在常规就诊时无法从同一位医师获得持续护理，以及当看初级保健提供者出现延迟时办公室工作人员未告知患者。
对医师团队层面的医疗质量进行监测是可行的，可用于基准比较、内部质量改进，以及向公众提供有关这些医师团队如何满足其需求的信息。
