Provider Perspectives of Patient Experience Measurement and Quality Improvement in Primary Care.

Abstract

Goal: Provider buy-in to leadership priorities, patient experience measurement, and quality improvement (QI) is necessary for sustained improvements in care. However, little is documented about provider perceptions of patient experience measurement and QI in primary care. We examined provider perceptions of the work environment, patient care issues, measurement of and improvement in care quality, as well as their knowledge and perceived usefulness of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group (CG-CAHPS) Survey measures for QI.

Methods: We surveyed and interviewed providers about their use of CG-CAHPS for QI. Of the 143 providers at a large urban Federally Qualified Health Center (FQHC), 74 (52% response) completed a web-based survey; 19 were also interviewed. We asked questions about the clinic environment, use of the CG-CAHPS survey, patient interactions, burnout, job satisfaction, and compensation. We replicated measures from six relevant surveys.

Principal findings: Providers reported working in supportive environments that encouraged QI efforts, having leadership and colleagues who facilitated improvements that enabled them to do their job better (M = 3.8 on a 5-point scale), and serious efforts to solve problems (M = 3.7). Providers also reported significant barriers to patient care (e.g., time pressure and patient complexity). Interviews highlighted providers' difficulty in managing visit duration and ensuring effective patient-provider communication. Participants expressed mixed views on the usefulness of CG-CAHPS scores for QI (M = 2.5), suggesting a need for leadership to discuss and engage with CG-CAHPS performance more regularly. QI in primary care is often guided by patient experience outcomes. The time pressures faced by FQHC providers to care for patients with complex needs heighten the need for targeted interventions that enhance provider support. Providers also identified several areas that needed improvement, some of which are measured by CAHPS items: tools to communicate laboratory or other test results to patients, tools to elicit information on patient concerns, improved access to interpreter services, training for other care team staff, and more discussion of best practices.

Practical applications: To improve the patient experience, primary care organizations should foster environments that support QI and invest more in QI that better incorporates patient feedback and experience measures in ways that are relevant to providers and actionable by organizations to improve care experiences. Addressing these issues has the potential to improve both patient care outcomes and provider satisfaction. This is both practical and important given that CAHPS measures or other standardized patient experience measures, although not mandated, are increasingly in use.