MHQP survey assesses patients' experiences with primary care since health reform law implementation

A report released today by Massachusetts Health Quality Partners (MHQP) provides the first comprehensive assessment of how patients rate their experiences with primary care since the state's groundbreaking health reform law was implemented.

“The survey allows us to understand how patients are experiencing care during this time of great change in our health care system.”

Almost 80,000 commercially insured patients responded to the statewide survey and reported overall improvements in several dimensions of the doctor-patient relationship, such as communication and knowledge of their patients, compared to prior MHQP survey results. Similar improvement trends, however, were absent in organizational features of care such as access, and there continue to be important aspects of doctor-patient communications that present opportunities for improvement.

Barbra Rabson, executive director of MHQP emphasized that it is vitally important to understand how health reform is affecting the care that patients are experiencing. "MHQP's survey asks about aspects of the primary care experience that are fundamental to high quality care," she says. "The survey allows us to understand how patients are experiencing care during this time of great change in our health care system."

James Conway, chair of the Partnership for Healthcare Excellence and Senior Fellow at the Institute for Healthcare Improvement says that MHQP's patient experience survey results also empower patients and families with information on what they should expect in a patient-centered environment. "When patients understand what to expect from their care, they are able to engage and take an active role. The quality of care and the patient experience improve when patients are engaged," he states.

There is broad agreement that there are important dimensions of care that patients and their families should expect to receive from their primary care practice. Key findings in MHQP's latest patient experience survey highlight where there continues to be room for improvement in these aspects of care, including:

• Knowledge of the patient: When asked if their primary care physician seemed to know their medical history and to know them as a person, both adults and the parents of pediatric patients reported improvements compared with 2007; but 30 percent of adult patients and 25 percent of parents say their primary care physicians do not always know important medical history information.
• Informed of test results: The survey found that about 30 percent of adult and pediatric patients did not always receive follow-up reports on test results from their doctor's office, unchanged from 2007.
• Coordination between primary care doctors and specialists: About 40 percent of adult patients and 35 percent of parents of pediatric patients reported that their physician did not always seem well-informed about the care they received from specialists to whom they had been referred. Pediatric results were slightly better than two years ago, while adult ratings were unchanged.

"These results reflect the ongoing challenges primary care physicians face working within the current fragmented health care system," according to Alice Coombs, M.D., president of the Massachusetts Medical Society. "The good news is that so many physician practices in Massachusetts are performing very well in a less-than-ideal health care system and meeting their patients' expectations for excellent, patient-centered care."

Results drive physician groups' improvement initiatives

Each of the physician offices whose patients participated in the MHQP survey is provided with detailed information on its own scores, so they can compare themselves with their peers and use the data to focus on quality improvement efforts. When Dr. Lester Hartman, the medical director at Westwood-Mansfield Pediatric Associates, reviewed his group's MHQP patient experience survey results two years ago, his initial reaction was disbelief. "We thought we were doing much better than the data indicated," he says, "so we conducted our own email survey of a thousand parents of our pediatric patients." The results, Hartman says, were "humbling," because MHQP's report was right on the mark.

Since that time, the physicians and nurse practitioners at Westwood-Mansfield have worked with the practice's administrator and other staff to make systematic improvements in many areas, including communication with patients and parents; appointment scheduling and patient flow; urgent care access; lab test tracking and reporting; health promotion and education; and using MHQP data to gauge their progress. So far, the results are impressive: patients have reported improvements across the board, especially in communication, knowledge of the patient, integration of care, and willingness to recommend the practice.

Framingham Pediatrics is another practice that is using MHQP data to improve their performance and monitor their progress. "We've learned a lot about how to use the data to identify areas for improvement and prioritization," says Dr. Nancy Rosselot, a pediatrician with the practice. To help optimize the patient experience, the practice created a new position - Medical Home Coordinator - with responsibilities for ensuring coordination and continuity of care, especially when a patient is referred to a specialist outside the practice or has an emergency room visit. In the case of a referral, for instance, the Medical Home Coordinator facilitates the appointment, makes sure the specialist's notes get to the patient's pediatrician after the visit, and tracks any test results to ensure that they are reported to the pediatrician and the patient or parents.

Framingham Pediatrics performs consistently high across all of the dimensions of care measured by the patient experience survey and is looked to as a model for how other practices can be more patient-centered; including by Westwood-Mansfield Pediatric Associates. And, Drs. Hartman and Rosselot agree that improving the patient experience is not only a point of pride for the doctors, nurses and other staff, but that it creates a more positive and satisfying work environment by allowing clinicians to do what they were trained to do - improve the health and well-being of their patients.