IMPORTANT ELEMENTS OF OUTPATIENT CARE - A COMPARISON OF PATIENTS AND PHYSICIANS OPINIONS

Objective: To compare patients' and physicians' opinions on the import ance of discrete elements of health care as determinants of the qualit y of outpatient care. Design: Analysis of results of a mailed survey. Setting: Community-based internal medicine practices. Participants: 74 general internists and 814 patients randomly selected from the practi ces of these internists. Measures: 125 elements of care that covered n ine domains were identified: physician clinical skill, physician inter personal skill, support staff office environment, provision of informa tion, patient involvement, nonfinancial access, finances, and coordina tion of care. Participants rated each element on its importance to hig h-quality care on a 4-point scale: 1 = not important; 2 = of medium im portance; 3 = of high importance; and 4 = essential. Patients' and phy sicians' ratings were compared for individual elements of care and for elements aggregated into domains. Results: Survey response rates were 93% for physicians and 60% for patients. In an element-by-element com parison of ratings, ratings by the two groups differed substantially f or 58% of the attributes. The most striking difference was seen in the domain of provision of information (median ratings, 3.56 for patients and 2.85 for physicians; P < 0.001). Ratings by the two groups also d iffered in the domains of clinical skill (3.75 for patients and 3.35 f or physicians: P < 0.001), nonfinancial access (3.00 for patients and 2.87 for physicians; P < 0.001), and finances (3.00 for patients and 2 .80 for physicians; P - 0.006). When relative rankings of the domains were compared, both groups agreed that clinical skill is most importan t; however, patients ranked provision of information second in importa nce whereas physicians ranked it sixth. Conclusions: Patients and phys icians agreed that the most crucial element of outpatient care is clin ical skill, but they disagreed about the relative importance of other aspects of care, particularly effective communication of health-relate d information. These differences in perception may influence the quali ty of interactions between physicians and patients.