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A Massachusetts Surprise

 |  By jcantlupe@healthleadersmedia.com  
   July 01, 2010

Barbra Rabson, executive director of the Massachusetts Health Quality Partners, spent a few months with her staff evaluating patients' responses to questions about how patients reacted to their primary care physicians in the wake of the state's landmark healthcare reform law. After the MHQP questioned 80,000 people, Rabson says she had her fingers crossed.

Contrary to her expectations, doctors and patients seem to be talking more than ever, and physicians seem to be trying more than ever to learn about their patients, she says, referring to the findings of the MHQP's latest statewide survey.

"We had our fingers crossed on this one," she says. "I was really surprised. One of the big surprises is that patients report as good experience as they do, given all that is going on in the marketplace, after we implemented healthcare reform, and insured over 400,000 new people in Massachusetts."

The Massachusetts healthcare reform law was enacted in 2006, and one of its provisions is a requirement that every resident obtain a minimum level of health insurance. The federal government's healthcare reform includes a provision that would add 32 million people to the insurance roles in the next few years.

The MHQP survey -- Quality Insights: Patient Experiences in Primary Care -- showed some improvements in how commercially insured patients rated their experience with primary care physicians, compared to two years ago. MHQP is a non-independent coalition of healthcare leaders who say they use quality measures to improve health services in Massachusetts.

MHQP polled 56,000 adult patients and 22,000 parents of pediatric patients about their experiences with primary care physicians. Some 500 adult and pediatric primary care practices statewide participated.

The MHQP report is based on what patients say about their actual experiences with their primary care physicians, including: how well the doctors listen to and communicate with their patients; their knowledge about their patients' medical history, values and beliefs, how they coordinate their patients' care with specialists and provide preventive care and advice, and whether patients would recommend their personal doctors to family and friends.

The report also assesses how well physician offices handle patients' access, service and care needs, such as whether they feel they get timely appointments, care and information, and whether they feel they can see their own doctors when they need an appointment, and whether they feel they get adequate level of service from office staff.

In one of the most important response categories, "Knowledge of Patient," there was increased patient satisfaction reported in the survey, Rabson said. Patients reported:

 

  • 70% of physicians "always knew important information" about patients in 2009 compared to 67% in 2007
  • 70% of pediatricians "always knew important information" about patients, compared to 73%

 

In a sampling of questions in 2009, patients were asked about interactions with their adult care physicians' the previous 12 months:

 

  • 83% said their physicians were easy to understand
  • 82% said their physician listened carefully
  • 59% said their physicians were informed and up-to-date
  • 38% of patients said they saw their doctor within 15 minutes of an appointment

 

In a sampling of 2009 questions of families of pediatric patients:

  • 86% said physicians listened carefully
  • 86% said physicians gave clear instructions
  • 64% said physicians seemed informed and up-to-date about their child

 

"Doctor-patient relationships improved over time," Rabson says of the survey findings. "There were so many people who feared that with healthcare reform in the state there would be an impact on patients' attitudes about physicians -- that it was going to get worse in Massachusetts. It didn't happen."

Despite' Rabson's upbeat reaction to the survey results following healthcare reform in Massachusetts, there were some "negatives" in the poll findings. In the latest survey, 40% of adult patients and 35% of parents of pediatric patients reported that their physician did not always seem well informed about the care they received from specialists to whom they had been referred. In addition, the survey found that about 30% of adults and pediatric patients did not always receive follow-up reports on test results from the doctor's office visit, unchanged from 2007.

"Everybody is talking about the importance of patient care," she adds. "You have to work really hard for it. We believe that patients should expect certain things when they see a doctor, and while we acknowledge that most of our primary work is in a fragmented system, we still can't blame the system."

"MHQP's survey asks about aspects of the primary care experience that are fundamental to high quality care," Rabson says. "The survey allows us to understand how patients are experiencing care during this time of great change in our healthcare system."

Framingham Pediatrics in Massachusetts is one practice where there have been high expectations of families of patients, and they often have been met, according to the MHQP survey. Nancy Rosselot, MD, says the practice uses the MHQP data to evaluate their performance and progress. Each of the physician offices whose patients participated in the MHQP survey is provided with detailed information on its own scores, so they can compare themselves with their peers and use the data to focus on quality improvement efforts, the MHQP said.

"We've been pleased that patients feel good about their access to care," Rosselot says, referring to specific data findings related to Framingham Pediatrics. "There are small things that could be identified as needs for improvement. We as a team are working how we can improve coordination of care. We need to go that extra step. We're tracking patient calls and making appointments in a timely fashion."

After participating in the MHQP survey, Framingham Pediatrics established a new position -- medical home coordinator -- to improve coordination of care, Rosselot says. The new position has been especially important in tracking test results and working to ensure a coordinated relationship with patient specialists, she adds.

The improvements that Framingham Pediatrics is making reflect the "exhaustive work by some physicians to improve communication with patients," Rabson says.

As Massachusetts goes forward with its healthcare reform, there's more work to be done, and each step it takes is a lesson for the nation too, Rabson adds.

Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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