anne-marie j. audet, michelle m. doty, jamil shamasdin, and stephen c. schoenbaum may 2005
DESCRIPTION
Physicians’ Views on Quality of Care: Findings from the Commonwealth Fund National Survey of Physicians and Quality of Care. Anne-Marie J. Audet, Michelle M. Doty, Jamil Shamasdin, and Stephen C. Schoenbaum May 2005. - PowerPoint PPT PresentationTRANSCRIPT
1
Physicians’ Views on Quality of Care:Findings from the Commonwealth Fund
National Survey of Physiciansand Quality of Care
Anne-Marie J. Audet, Michelle M. Doty,Jamil Shamasdin, and Stephen C. Schoenbaum
May 2005
2
Chapter I
Information Technologies:Current Use, Future Plans,
and Perceived Barriers
3
Use of Information Technologiesin Clinical Practice
4
73
37
18 176 7
6
21
9 918 21
314
0
20
40
60
80
100
Electronic
Billing
Access
to Test
Results
Electronic
Medical
Records
Electronic
Ordering
Clinical
Decision
Support
with
Doctors
with
Patients
Percent indicating “routine” or “occasional” use
Chart I-1. Use of Information Technologies
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
58
27 27 2428
18
Yes, used routinely
Yes, used occasionally
* Electronic ordering of tests, procedures, or drugs.
*
79
5
1413
36
61
23 25
66
35 3746
57
87
0
25
50
75
100
Electronic Access to
Test Results
Electronic Medical
Records
Electronic Ordering
1 Physician 2–9 Physicians 10–49 Physicians 50+ Physicians
Chart I-2. Electronic Access to PatientTest Results, Electronic Medical Records,and Electronic Ordering, by Practice Size
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent who currently “routinely/occasionally” use the following
* Electronic ordering of tests, procedures, or drugs.
*
6
61
33
161719 21 21
13
2935
19
40
0
25
50
75
100
Clinical Decision Support E-mail with Doctors E-mail with Patients
1 Physician 2–9 Physicians 10–49 Physicians 50+ Physicians
Chart I-3. Use of Clinical Decision Support,E-mail with Doctors, and E-mail with Patients,
by Practice Size
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent who currently “routinely/occasionally” use the following
7
12 10 21
33
3126
0
50
100
Drug Alerts Follow-Up Alerts Reminders
Yes, using a manual system
Yes, using a computerized system
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart I-4. Use of Reminders or Alerts
Percent indicating following tasks currently performed in their office practice
38 41
54
8
21
31
1356
10 9
2217
11
2327
0
25
50
75
100
Drug Alerts Follow-Up Alerts Reminders
1 Physician 2–9 Physicians 10–49 Physicians 50+ Physicians
Chart I-5. Use of Electronic Drug Alerts,Follow-Up Alerts, and Reminders, by Practice Size
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent who currently use a “computerized system” for the following
9
Future Use of IT
10
614 20 19 17 12 11
15
27
53 53 5857
71
0
20
40
60
80
100
Electronic
Billing
Access
to Test
Results
Electronic
Medical
Records
Electronic
Ordering
Clinical
Decision
Support
E-mail with
Doctors
E-mail with
Patients
Percent expecting use
Chart I-6. Planned Future Use of IT
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
41
Not used, PLAN to use within next year
Not used, NO plan to use within next year
73 72 7569
82
* Electronic ordering of tests, procedures, or drugs.
*
21
11
16 13 10
344344
0
50
100
Drug Alerts Follow-Up Alerts Reminders
Not done, NO plan to in next year
Not done, PLAN to in next year
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart I-7. Planned Future Use ofReminders or Alerts
Percent expecting future use of the following
60 56
44
12
28 22
53 73 37
22
211320
56
0
50
100
Total 1 Physician 2–9
Physicians
10–49
Physicians
50+
Physicians
Not used, NO plan to use within next year
Not used, PLAN to use within next year
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart I-8. Planned Future Use ofElectronic Medical Records, by Practice Size
Percent expecting use
73
8677
65
44
13
Perceived Barriers to IT Adoption
14
56%
39%
37%
26%
21%
16%
28%
40%
44%
46%
38%
49%
47%
15%
14%
16%
15%
35%
29%
36%
44%
Start-up costs
Lack of uniform standards
Lack of time
Maintenance costs
Lack of evidence of effectiveness
Privacy concerns
Lack training/knowledge
Major Barrier Minor Barrier Not a Barrier
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart I-9. Barriers to Adoption
15
1115
30
40
62 59
2417
49
17 19
43
0
25
50
75
100
Start-Up Costs Scientific Evidence Privacy Concerns
1 Physician 2–9 Physicians 10–49 Physicians 50+ Physicians
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart I-10. Barriers to Adoption ofInformation Technologies, by Practice Size
Percent indicating start-up costs, scientific evidence, or privacy concernsas a “major barrier” to greater use of information technologies
16
Chapter II
Practice-Level and Performance Data: Availability,
Sources,and Willingness to Share
17
Access to Patient Panel Data
18
Chart II-1. Physicians’ Access toPatient Panel Data
51 55
83 84
43
0
50
100
Age Group Diagnosis/
Health Risk
Lab Results Current
Medications
Any Data
Percent indicating “very/somewhat” difficult or cannot generate lists of patients by
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
19
6157 6150
58
0
50
100
Total 1 Physician 2–9
Physicians
10–49
Physicians
50+
Physicians
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart II-2. Physicians’ Access toAny Patient Panel Data, by Practice Size
Percent indicating “very/somewhat” easy to generate lists of patients using any* criteria
* Indicates “very/somewhat” easy to generate lists of patients using any of the following criteria:age group, diagnosis/health risk, lab results, or current medications.
20
27 27
1212
3946
12 12
46
22 20
45
0
25
50
75
100
Diagnosis/Health Risk Lab Results Current Medications
1 Physician 2–9 Physicians 10–49 Physicians 50+ Physicians
Chart II-3. Physicians’ Access toPatient Panel Data, by Practice Size
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent indicating “very/somewhat” easy to generate lists of patients by
21
Chart II-4. Physicians’ Access to Any PatientPanel Data, by Electronic Medical Record Use
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
5762
55
0
50
100
Total EMR Used Routinely/
Occasionally
Do Not Use EMR
Percent indicating “very/somewhat” easy to generate lists of patients using any* criteria
* Indicates “very/somewhat” easy to generate lists of patients using any of the following criteria:age group, diagnosis/health risk, lab results, or current medications.
22
Access to Quality-of-Careor Performance Data
23
Chart II-5. Physicians’ Access toQuality-of-Care or Performance Data
20 1825
33
0
50
100
Process of Care
Data
Clinical
Outcomes Data
Patient Survey
Data
Any Data
Percent receiving data on the following aspects of patient care
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
24
27
1511
1421 18
2420 23
29
44
27
0
25
50
75
100
Process of Care Clinical Outcomes Data Patient Survey Data
1 Physician 2–9 Physicians 10–49 Physicians 50+ Physicians
Chart II-6. Physicians’ Access toQuality-of-Care Data, by Practice Size
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent receiving data on the following aspects of patient care
25
25
13
7
7
4
3
3
1
3No answer
Other
Employer groups
Regulatory agencies
CMS
Professional societies
Accreditation agencies
Internal sources
Health plans
Percent of physicians indicating each as a source of quality of care data
Chart II-7. Physicians’ Sources ofQuality-of-Care Data
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
26
1121
28
611
20
0
50
100
1 Physician 2–9
Physicians
10–49
Physicians
50+
Physicians
EMR Used
Routinely/
Occasionally
Do Not Use
EMR
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart II-8. Physicians’ Ability to GenerateAny Quality-of-Care Data Internally
Percent indicating they receive quality-of-care data from internal sources
27
Ability to Benchmark
28
3%
1%
1%
11%
19%
22%
24%
No comparison with other physicians possible
Some other comparison group
Other hospitals/clinics/health centers
Other physicians nationally
Other physicians in practice/local area
Other physicians in the same health plan
Other physicians in specialty
Percent of physicians able to compare themselves to
Chart II-9. Physicians’ Ability toCompare Performance
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
29
Sharing Performance Information
30
Medical leadership
Physicians’ own patients
General public
Willingness to share data with:*
27%
44%
69%
Chart II-10. Physicians’ Willingnessto Share Quality-of-Care Data
No, Definitely/ Probably Not
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Yes, Definitely/ Probably
71%
55%
29%
Other physicians 26%72%
* Answers to survey question: “To improve high quality of care in the U.S., which of the following do you think should have access to ‘Quality of Care’ data about individual physicians?”
31
Chapter III
Physicians’ Involvementin Quality Improvement
Activities
32
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent indicating involvement in redesign and collaborative efforts
Chart III-1. Physicians’ Participation in Redesign and Collaborative Activities, by Practice Size
43
20
3339
50
32
47
35
24
34
0
50
100
Redesign Efforts Collaborative Efforts
Total 10–49 Physicians1 Physician 50+ Physicians2–9 Physicians
* Indicates physicians who responded yes to participating in local, regional, or national collaboratives in the past 2 years.
*
33
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart III-2. Physicians’ Participation in Redesign and Collaborative Activities, by Physician Type
Percent indicating involvement in redesign and collaborative efforts
3036
3231
4234
0
50
100 Total Primary care physician Specialist
Redesign Efforts Collaborative Efforts
* Indicates physicians who responded yes to participating in local, regional, or national collaboratives in the past 2 years.
*
34
67
23
8 6
0
50
100 No, have not been involved Yes, a LOCAL effort
Yes, a REGIONAL effort Yes, a NATIONAL effort
Chart III-3. Physicians’ Involvement in Collaborative Efforts to Improve Quality of Care
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent indicating involvement in any collaborative efforts in past two years*
* Multiple answers possible.
Involved in at least one effort (32%)
35
817683
6877
0
50
100
Total 1 Physic ian 2-9
Physic ians
10-49
Physic ians
50+
Physic ians
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart III-4. Physicians’ Opinions on Effectiveness of Collaborative Activities, by Practice Size
Percent saying that involvement in collaborative effortsis “very/somewhat” effective in improving quality of care
36
Chapter IV
Coordination of Careand Referrals
37
Patient’s medical record, test results, or other relevant clinical information were not available at the time of the scheduled visit
Tests or procedures had to be repeated because findings were unavailable or inadequate for interpretation
Patient’s care was compromised because he/she received conflicting information from different doctors or other health professionals
Patient experienced a problem following discharge from a hospital because physician did not receive needed information from the hospital in a timely manner
Coordination of care problems
72%
34%
28%
26%
Chart IV-1. Coordination of Care ProblemsPhysicians Observe
Percent who observed problem sometimes or
often in past 12 months
Patient had a positive test result that was not followed-up appropriately 15%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Patient received the wrong drug, wrong dose, or had a preventabledrug-drug interaction
11%
38
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
76
44
333333
7874
64
0
50
100
Clinical InformationNot Available at Visit
Tests Repeated
10–49 Physicians1 Physician 50+ Physicians2–9 Physicians
Chart IV-2. Coordination of Care Problems, by Practice Size
Percent who say “often/sometimes” observed the following
39
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
22
13 14109
171510
0
50
100
Test ResultsNot Followed Up Properly
Wrong Dose/Medication
Chart IV-3. Coordination of Care Problems, by Practice Size
Percent who say “often/sometimes” observed the following
10–49 Physicians1 Physician 50+ Physicians2–9 Physicians
40
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
29 2734
243129
2425
0
50
100
Patient Experienced Coordination Problem Post
Hospital Discharge*
Patient’s Care Compromised Because He/She Received
Conflicting Information
Chart IV-4. Coordination of Care Problems, by Practice Size
Percent who say “often/sometimes” observed the following
10–49 Physicians1 Physician 50+ Physicians2–9 Physicians
* A patient experienced a problem following discharge from a hospital becausehis/her physician did not receive needed information from the hospital in a timely manner.
41
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
32
23
37
28
0
50
100
Tests Repeated
Primary care physician Specialist
Chart IV-5. Coordination of Care Problems, by Physician Type
Percent who say “often/sometimes” observed the following
Patient Experienced Coordination Problem
Post-Hospital Discharge*
* A patient experienced a problem following discharge from a hospital becausehis/her physician did not receive needed information from the hospital in a timely manner.
42
152317
43
54
46
0
50
100
Total Primary Care Physician Specialist
Often
Always
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart IV-6. Ability of Physicians to ProvideSame-Day Appointments, by Physician Type
Percent indicating how often they can provide same-day appointments
64
77
58
43
Chart IV-7. Receipt of TimelyReferral Information
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent who say they receive timely information about the results of a referral
Often54%
Sometimes28%
Rarely6%
Always11%
34%
44
67 66
55 58
7162
0
25
50
75
100
1
Physician
2–9
Physicians
10–49
Physicians
50+
Physicians
Primary
Care
Physician
Specialist
Chart IV-8. Receipt of TimelyReferral Information
Percent who say they “always/often” receive timely informationabout the results of a referral
Practice Size Physician Type
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
45
Chart IV-9. Availability of Quality-of-Care Data When Making Referrals
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent indicating how often they have any data about a physician’squality of care when making referrals
Often14%
Sometimes16%
Rarely32%
Always5%
Never32%
64%
46
2417 15 17 18
11
22
0
25
50
75
100
1 Physician 2–9
Physicians
10–49
Physicians
50+
Physicians
10 Years or
Less
11–15
Years
16+ Years
Years in PracticePractice Size
Chart IV-10. Availability of Quality-of-Care Data When Making Referrals
Percent indicating they “always/often” have data about a physician’squality of care when making a referral
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
47
Physician’s technical qualifications (e.g., training, education, board certification)
Experiences with the physician
Physician’s bedside manner, as reported by patients
25%
64%
25%
Chart IV-11. Relative Importance ofQuality-of-Care Data
Percent indicating following information is MORE
important than quality-of-care data*
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Physician’s reputation among peers 42%
* Indicates physicians who responded that the above information was more important than quality-of-care data.
48
Chapter V
Strategies to Improve Quality of Care
49
21%
23%
25%
35%
41%
52%
Better treatment guidelines for common conditions
Better information on best specialized
physicians/centers
More use of computer technology
Improved teamwork and communication
Better patient access to preventive care
Having more time to spend with patients
Percent of physicians who indicate the followingare “very effective” in improving quality of care
Chart V-1. Physicians’ Opinions on Strategiesto Improve Quality of Care
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
50
The team process makes care more cumbersome
The involvement of multiple team members increasesthe likelihood of medical errors
32%
24%
Chart V-2. Physicians’ Opinion on Team Care
Percent indicatingthey “agree” or
“strongly agree” that*
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
The give and take among team members results inbetter decisions regarding patient care
73%
* Indicates physicians who, based on their experience working in teams,said that they agree or disagree with the above.
51
Chart V-3. Physicians’ Opinion on Team Care,by Practice Size
65
3732
73
3323
80
2819
81
2717
0
50
100
The give and take among team
members results in better
decisions regarding patient
care
The team process makes care
more cumbersome
The involvement of multiple
team members increases the
likelihood of medical errors
1 Physician 2–9 Physicians 10–49 Physicians 50+ Physicians
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent who agree/strongly agree
52
4133 32
45
0
25
50
75
100
Primary Care
Physician
Specialist Male Female
GenderPhysician Type
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart V-4. Physicians’ Opinions on Team Care,by Physician Type
Percent who say improved teamwork would be“very effective” in improving quality of care
53
Chapter VI
Incentives and Disincentives to Providing Quality Care and
Physicians’ Satisfactionwith Current Practice
54
8%
11%
58%
15%
19%
19%
28%
14%
80%
72%
72%
60%
27%
4%
8%
Quality Bonus/Incentive Payments from
Insurance Plans
Patient Surveys/ Experience
Measures of Clinical Care
Board Re-Certification Status
Productivity/ Billing
Major Factor Minor Factor Not a Factor
Chart VI-1. Factors AffectingPhysicians’ Compensation
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Percent indicating the following as factorsin determining compensation or income
72%
39%
27%
27%
19%
55
4641
5258
51
0
50
100
Total 1 Physician 2–9
Physicians
10–49
Physicians
50+
Physicians
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart VI-2. Financial Consequences of Providing High Quality of Care, by Practice Size
Percent indicating that providing high quality of care“often/sometimes” means less income
56
Very satisfied33%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart VI-3. Physicians’ Satisfaction withCurrent Medical Practice
Somewhat satisfied45%
Somewhat dissatisfied17%
Very dissatisfied5%
57
14
2119
27
21
0
25
50
Total 1 Physician 2–9
Physicians
10–49
Physicians
50+
Physicians
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart VI-4. Physicians’ Dissatisfaction withCurrent Practice, by Practice Size
Percent “very or somewhat” dissatisfied with current practice
58
Appendix
Profile ofPhysician Respondents
59
Practice Characteristics Total1
Physician2–9
Physicians10–49
Physicians50+
Physicians
Percent Distribution 27% 41% 17% 12%
100% 100% 100% 100%
Practice Setting
Hospital or public clinic 14 5 15 20 23
Single or multi-specialty group 52 — 78 69 55
Solo 25 93 — — —
Other 9 2 6 11 22
Salary Status
Salaried (yes) 41 16 43 53 72
Ownership of Practice
Full owner 36 90 20 13 7
Part owner 28 2 45 35 24
Not an owner 35 8 34 52 68
Physician Type
Primary care 29 26 29 37 28
Specialist 71 74 71 63 72
Hours in Direct Care
20 hours or fewer 8 10 6 7 8
21–40 hours 30 32 16 35 34
More than 40 hours 62 58 68 58 57
Chart A-1. Characteristics of Small and Large Group Physician Practices
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.