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Improving Patient Care |

Patients' Global Ratings of Their Health Care Are Not Associated with the Technical Quality of Their Care

John T. Chang, MD, MPH; Ron D. Hays, PhD; Paul G. Shekelle, MD, PhD; Catherine H. MacLean, MD, PhD; David H. Solomon, MD; David B. Reuben, MD; Carol P. Roth, RN, MPH; Caren J. Kamberg, MSPH; John Adams, PhD; Roy T. Young, MD; and Neil S. Wenger, MD, MPH
[+] Article and Author Information

From the David Geffen School of Medicine at UCLA and Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, California; RAND Health, Santa Monica, California; and RAND Health, Arlington, Virginia.


Acknowledgments: The authors thank Robin P. Hertz, PhD, senior director of outcomes research and population studies at Pfizer Inc., for her valuable support. They also thank Patricia Smith for her technical assistance.

Grant Support: The ACOVE project was supported by a contract from Pfizer Inc. to RAND Health. Dr. Chang was supported by a National Research Service Award training grant (PE-19001) and the UCLA Specialty Training and Advanced Research (STAR) Program. Dr. Shekelle is a Senior Research Associate of the Veterans Affairs Health Services Research and Development Service. Dr. MacLean holds a Veterans Affairs Health Services Research and Development Service Career Development Award. Dr. Hays was supported in part by UCLA/DREW Project EXPORT, National Institutes of Health, National Center on Minority Health & Health Disparities (P20-MD00148-01), and UCLA Center for Health Improvement in Minority Elders/Resource Center for Minority Aging Research, National Institutes of Health, National Institute of Aging (AG-02-004).

Potential Financial Conflicts of Interest: Stock ownership or options (other than mutual funds): R.T. Young (Pfizer Inc.).

Requests for Single Reprints: John T. Chang, MD, MPH, David Geffen School of Medicine at UCLA, Division of General Internal Medicine and Health Services Research, 911 Broxton Avenue, Third Floor, Los Angeles, CA 90095-1736; e-mail, johnchang@mednet.ucla.edu.

Current Author Addresses: Drs. Chang, Hays, and Wenger: David Geffen School of Medicine at UCLA, Division of General Internal Medicine and Health Services Research, 911 Broxton Avenue, Third Floor, Los Angeles, CA 90095-1736.

Drs. Shekelle and MacLean: Greater Los Angeles Veterans Affairs Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.

Dr. Reuben: Division of Geriatrics, University of California, Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095-1736.

Ms. Roth and Drs. Solomon and Adams: RAND, 1776 Main Street, M-4E, Santa Monica, CA 90407-2138.

Ms. Kamberg: RAND Health, 1200 South Hayes Street, Arlington, VA 22202.

Dr. Young: Division of General Internal Medicine, University of California, Los Angeles, 200 Medical Plaza, Los Angeles, CA 90095-1736.


Ann Intern Med. 2006;144(9):665-672. doi:10.7326/0003-4819-144-9-200605020-00010
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The ACOVE project developed and applied a quality assessment system for vulnerable older persons. The measurement system consisted of process measures and covered the spectrum of care for 22 conditions that are important in the care of vulnerable elders. Methods for selecting conditions, developing the quality indicators (2021), and identifying vulnerable elders (22) have been described elsewhere. The 236-item ACOVE quality indicator set (Appendix) was assembled by formal group judgment process and is grounded in the medical literature. Better quality of care as measured by this set of quality indicators (a higher score for technical quality of care) was associated with lower 3-year mortality rates (23).

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Figures

Grahic Jump Location
Figure 1.
Conceptual model of factors predicting patient global rating of health care.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Relationship of patient global rating of care to technical quality of care.

Each dot represents a data point for a participant. To help visualize overlapping data points, a small amount of random jitter is added to each global care rating so that patients with identical ratings on both scales are not superimposed.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Relationship of patient global rating of care to patient report about provider communication.

Each dot represents a data point for a participant. To help visualize overlapping data points, a small amount of random jitter is added to each global care rating so that patients with identical ratings on both scales are not superimposed.

Grahic Jump Location

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Summary for Patients

Patient Ratings of the Overall Quality of Care in 2 Managed Care Organizations Were Not Associated with Measures of the Technical Quality of Care

The summary below is from the full report titled “Patients' Global Ratings of Their Health Care Are Not Associated with the Technical Quality of Their Care.” It is in the 2 May 2006 issue of Annals of Internal Medicine (volume 144, pages 665-672). The authors are J.T. Chang, R.D. Hays, P.G. Shekelle, C.H. MacLean, D.H. Solomon, D.B. Reuben, C.P. Roth, C.J. Kamberg, J. Adams, R.T. Young, and N.S. Wenger.

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