PATIENTS RATINGS OF OUTPATIENT VISITS IN DIFFERENT PRACTICE SETTINGS - RESULTS FROM THE MEDICAL OUTCOMES STUDY

Objective.-To determine how patients in different kinds of practices-s olo or single specialty (SOLO), multispecialty group (MSG), or health maintenance organizations (HMOs)-and with fee-for-service (FFS) or pre paid physician payment arrangements evaluate their medical care. Desig n.-Survey of adult outpatients after office visits, with sample weight ed to represent population of patients visiting physicians in each pra ctice type.Setting.-Offices of 367 internists, family practitioners, e ndocrinologists, cardiologists, and nurse practitioners, in HMOs (prep aid only), MSGs (prepaid and FFS), and SOLO practices (prepaid and FFS ). Patients.-Adults (N=17 671) at start of the Medical Outcomes Study. Outcome Measures.-Overall rating of the visit (five choices from exce llent to poor). A random half of the sample also rated the provider's technical skills, personal manner, and explanations of care as well as time spent during the visit, the appointment wait, the office wait, t he convenience of the office location, and telephone access. Results.- Fifty-five percent of patients rated their visit overall as excellent 32% very good, 11% good, and 2% fair or poor. Patients of SOLO practit ioners were more likely (64%) to rate their visit excellent than MSG ( 48%) or HMO (49%) patients (P<.001). Patients of SOLO practitioners ra ted all aspects of care better than HMO patients did, most markedly ap pointment waits (64% vs 40% excellent; P<.0001) and telephone access ( 64% vs 33% excellent; P<.0001). Within SOLO and MSG practices, FFS pat ients rated most specific aspects better than prepaid patients, but th ese differences were not statistically significant and were inconsiste nt across cities. Adjusting for patients' demographics, diagnoses and self-rated health did not change results. Physicians with visit rating s in the lowest 20% were nearly four times as likely to be left by pat ients within 6 months than physicians in the highest 20% (16.7% vs 4.6 %; P<.001). Conclusion.-Of the five practice type and payment method c ombinations, SOLO FFS patients rated their visits best and HMO patient s worst. Whether FFS or prepaid, care was rated better in small than i n large practices. Our study shows that a brief visit rating form can be used to compare practice settings and health plans, and that patien t ratings predict what proportion of patients, on average, will leave their physicians in the next several months.