ASSESSING PATIENTS EXPECTATIONS IN AMBULATORY MEDICAL-PRACTICE - DOESTHE MEASUREMENT APPROACH MAKE A DIFFERENCE

To compare three different approaches to the measurement of patients' expectations for care, we conducted a randomized controlled trial. Med ical outpatients (n = 318) of a small (six-physician), single-specialt y (internal medicine), academically affiliated private practice in Sac ramento, California, were contacted by telephone the night before a sc heduled office visit and enrolled over a 5-month period in early 1994. Patients were randomly assigned to receive: (1) a self-administered, structured, previsit questionnaire combined with a postvisit questionn aire: (2) an interviewer-administered, semistructured, previsit interv iew combined with a postvisit questionnaire: or (3) a postvisit questi onnaire only. We assessed the number and content of patients' expectat ions by previsit questionnaire versus interview; the interaction betwe en sociodemographic characteristics and survey method in predicting nu mber of reported expectations: the effect of unfulfilled expectations elicited by questionnaire and interview an visit satisfaction: and the effect of unfulfilled expectations elicited directly and indirectly o n visit satisfaction. Patients reported more expectations by structure d questionnaire than semistructured interview (median 12 vs 3, p = .00 01). Although there was no main effect of sociodemographic characteris tics on expectations, nonwhite patients reported more expectations tha n white patients by questionnaire and fewer by interview. The number o f interventions desired before the visit but not received (indirectly reported unfulfilled expectations) was associated with lower visit sat isfaction regardless of whether a questionnaire or interview was used to elicit previsit expectations (p value for the interaction between n umber of expectations and survey method, > .20). Having more indirectl y reported unfulfilled expectations was significantly associated with lower visit satisfaction even after controlling for the number of dire ctly reported unfulfilled expectations (p = .021), but the incremental change in classification accuracy was small (increase in receiver-ope rating characteristic curve area, 3%). In conclusion, studies of patie nts' expectations for care must contend with a substantial ''method ef fect.'' In this study from a single group practice, patients checked o ff more expectations using a structured questionnaire than they disclo sed in a semistructured interview, but both formats predicted visit sa tisfaction. Asking patients about interventions received in relation t o their previsit expectations added little to simply asking them direc tly about omitted care. The interaction of survey method with ethnicit y and other sociodemographic characteristics requires further study.