Patients' preferences for technical versus interpersonal quality when selecting a primary care physician

Health Services Research, August, 2005 by Constance H. Fung, Marc N. Elliott, Ron D. Hays, Katherine L. Kahn, David E. Kanouse, Elizabeth A. McGlynn, Mark D. Spranca, Paul G. Shekelle

The introductory pages, which included an overview of the role of primary care physicians, instructed participants to imagine that they had moved to a new city. With the help of family, friends, and co-workers, they had narrowed their list of new primary care physicians to two that were equal in all respects, except for the information contained in the health care report cards provided to them by a trustworthy nonprofit organization.

Subjects then learned that the report cards contained the following categories of evaluations of physicians: (1) limited sickness or injury care (acute care), (2) care for ongoing health conditions (chronic care), (3) preventive care, (4) communication, (5) courtesy and respect, and (6) promptness. We identified the first three categories as technical quality and labeled them "Technical Evaluation." We labeled the last three categories "Patient Experiences," which represented the concepts of interpersonal quality and getting care quickly. In these introductory pages, we informed subjects that ratings for "Technical Evaluation" came from review of medical charts and insurance bills and ratings for "Patient Experiences" came from asking patients about their experience with the doctor. In constructing the introductory pages that provided this information, we ensured that the two categories were also similar visually, with definitions of similar length and symmetric placement on the screen.

The ratings assigned to five of the seven pairs of physicians forced participants to make varying degrees of tradeoff between technical and interpersonal quality for each decision. For example, one physician had high technical quality and low interpersonal quality ratings, while the other physician had low technical quality and high interpersonal quality ratings (Table 1). Two of the seven pairs tested for internal validity by including a physician who was superior in both dimensions, and who was therefore the dominant choice regardless of which dimension the patient considered more important. Although "Technical Evaluation" and "Patient Experiences" each had three subheadings, the ratings among the three subheadings were highly correlated, enabling us to test tradeoffs only between technical and interpersonal quality rather than among the different subheadings of technical and interpersonal quality. High correlation among the "Patient Experiences" subheadings (communication, courtesy/respect, promptness) has been found in the community (Hargraves, Hays, and Cleary 2003).

Details about Report Cards

Previous studies in this area have focused primarily on health plan report cards (Hibbard, Slovic, and Jewett 1997; Hibbard et al. 2000, 2001) and have demonstrated that multiple factors affect consumer use of health care report cards, including presentation format (Jewett and Hibbard 1996; Knutson et al. 1996; Hibbard, Slovic, and Jewett 1997; Hibbard et al. 2000, 2001, 2002; Marshall et al. 2000; Harris-Kojetin et al. 2001; Scanlon et al. 2002; Vaiana and McGlynn 2002). In designing our report cards, we incorporated key features in the literature on health care report card use.