The full content of Annals is available to subscribers

Subscribe/Learn More  >
Original Research |

Important Elements of Outpatient Care: A Comparison of Patients' and Physicians' Opinions

Christine Laine, MD, MPH; Frank Davidoff, MD; Charles E. Lewis, MD, ScD; Eugene C. Nelson, DSc, MPH; Elizabeth Nelson, RN, MSN; Ronald C. Kessler, PhD; and Thomas L. Delbanco, MD
[+] Article, Author, and Disclosure Information

From Jefferson Medical College and the American College of Physicians, Philadelphia, Pennsylvania; University of California, Los Angeles, School of Medicine and Public Health, Los Angeles, California; Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; University of Michigan, Ann Arbor, Michigan; and Harvard Medical School, Boston, Massachusetts. Disclaimer: The views presented here are those of the authors and not necessarily those of the Commonwealth Fund or its directors, officers, or staff. Acknowledgments: The authors thank Mary Dascola for managing the administration of the survey and the participating physician offices and patients for their voluntary contributions to this work. Grant Support: In part by grant 92-30 from the Commonwealth Fund. Dr. Laine is a Picker/Commonwealth Faculty Scholar (grant number 96041). Requests for Reprints: Christine Laine, MD, MPH, Jefferson Medical College, Center for Research in Medical Education and Health Care, 1025 Walnut Street, Room 119, Philadelphia, PA 19107. Current Author Addresses: Dr. Laine: Jefferson Medical College, Center for Research in Medical Education and Health Care, 1025 Walnut Street, Room 119, Philadelphia, PA 19107.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(8):640-645. doi:10.7326/0003-4819-125-8-199610150-00003
Text Size: A A A

Objective: To compare patients' and physicians' opinions on the importance of discrete elements of health care as determinants of the quality of outpatient care.

Design: Analysis of results of a mailed survey.

Setting: Community-based internal medicine practices.

Participants: 74 general internists and 814 patients randomly selected from the practices of these internists.

Measures: 125 elements of care that covered nine domains were identified: physician clinical skill, physician interpersonal skill, support staff, office environment, provision of information, patient involvement, nonfinancial access, finances, and coordination of care. Participants rated each element on its importance to high-quality care on a 4-point scale: 1 = not important; 2 = of medium importance; 3 = of high importance; and 4 = essential. Patients' and physicians' ratings were compared for individual elements of care and for elements aggregated into domains.

Results: Survey response rates were 93% for physicians and 60% for patients. In an element-by-element comparison of ratings, ratings by the two groups differed substantially for 58% of the attributes. The most striking difference was seen in the domain of provision of information (median ratings, 3.56 for patients and 2.85 for physicians; P < 0.001). Ratings by the two groups also differed in the domains of clinical skill (3.75 for patients and 3.35 for physicians; P < 0.001), nonfinancial access (3.00 for patients and 2.87 for physicians; P < 0.001), and finances (3.00 for patients and 2.80 for physicians; P = 0.006). When relative rankings of the domains were compared, both groups agreed that clinical skill is most important; however, patients ranked provision of information second in importance whereas physicians ranked it sixth.

Conclusions: Patients and physicians agreed that the most crucial element of outpatient care is clinical skill, but they disagreed about the relative importance of other aspects of care, particularly effective communication of health-related information. These differences in perception may influence the quality of interactions between physicians and patients.




Grahic Jump Location
Figure 1. The vertical bars represent the median importance ratings, the left ends of the bars represent the 25th percentile, and the right ends of the bars represent the 75th percentile. The values for the comparison of the median ratings in each domain were obtained by using the Mann-Whitney U test. Solid lines = patients; dashed lines = physicians.
Ratings of importance by patients and physicians.P
Grahic Jump Location




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Quality of life for patient with knee osteoarthritis. Ann Phys Rehabil Med 2016;59S():e158-e159.
Coordinate specialty care programs MPR. Ann Phys Rehabil Med 2016;59S():e165.
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.