To determine if providing primary care clinicians with information about quality of care reported by people with significant physical disability or serious mental illness improves such patients’ perceptions of their care
|Randomized controlled trial
|27 Massachusetts primary care practices with ≥50 One Care members with significant physical disability or serious mental illness
- Quarterly YESHealth reports along with results from the PDQ-S
- PDQ-S results only
- No reports or results (control)
Patient perceptions of care
|12-month follow-up for study outcome
This randomized controlled trial included 27 primary care practices in Massachusetts. Each practice served 50 or more One Care members with significant physical disability or serious mental illness. One Care is a health insurance program in Massachusetts for persons who are dually eligible for Medicare and Medicaid and who are ages 21 to 64. Researchers tested the effect of two initiatives reporting patients’ perceptions of care to primary care practices:
- YESHealth. This one-year initiative aimed to engage physicians in discussing healthcare quality directly with One Care members with significant physical disability or serious mental illness. To gather information, disability advocates designed brief quarterly surveys about topics important to One Care members, including care plans and care teams, communication, long-term services and supports, and transportation. Disability advocates developed quarterly one-page summaries of YESHealth survey responses along with recommendations for improving care.
- Persons with Disabilities Quality Survey (PDQ-S). People with significant physical disability or serious mental illness joined with researchers to develop and validate the PDQ-S, which the researchers then administered to One Care members prior to the start of YESHealth. A report from these PDQ-S baseline findings included three domains: independent living principles, perceptions of experiences and feelings about daily life, and perceptions of experiences with primary care clinicians.
The research team administered the PDQ-S at baseline to a group of 720 patients with One Care who received care at the primary care practices in the study. Twelve months later, the researchers administered the PDQ-S a second time, with significant overlap with the first set of respondents, to assess changes in One Care members’ perceptions of care.
Researchers assigned each of the 27 practices to one of three groups by chance. Each group included nine practices.
- YESHealth plus PDQ-S results were sent to individual physicians in each of the nine practices in the first group. In addition, disability advocates reached out to practices to try to engage physicians in discussing the YESHealth survey results.
- PDQ-S results only were sent to individual physicians in each of the nine practices in the second group.
- Control. Researchers did not send any reports to physicians at practices in the third group.
From baseline to 12-month follow-up, patients’ perceptions of care did not show more improvement at the practices that received either both the YESHealth and PDQ-S reports or only the PDQ-S report as compared with primary care practices that received no reports.
However, despite extensive outreach efforts by disability advocates, physicians in the nine practices assigned to YESHealth did not respond to these individuals’ requests to discuss One Care quality as planned. Researchers mailed both the YESHealth and PDQ-S reports to these doctors’ offices instead.
Physicians did not respond to the disability advocates’ requests to discuss YESHealth results. Because researchers could not confirm if the physicians in the study reviewed the reports, researchers could not determine whether physicians found consumer-generated information to be helpful in efforts to improve care.
Conclusions and Relevance
Providing reports of patient experience data to primary care practices did not improve patients’ perceptions of care in this study. However, disability advocates were not able to engage with physicians as originally planned.
Future Research Needs
Future research could examine why physicians did not agree to meet with disability advocates. Studies could also consider other ways to engage physicians in improving care quality for patients with significant physical disability or serious mental illness.