This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Results From the Medical Outcomes Study

Haya R. Rubin, MD, PhD; Barbara Gandek, MS; William H. Rogers, PhD; Mark Kosinski, MA; Colleen A. McHorney, PhD; John E. Ware, Jr, PhD

JAMA. 1993;270(7):835-840.

Abstract
Objective.
—To determine how patients in different kinds of practices—solo or single specialty (SOLO), multispecialty group (MSG), or health maintenance organizations (HMOs)—and with fee-for-service (FFS) or prepaid physician payment arrangements evaluate their medical care.

Design.
—Survey of adult outpatients after office visits, with sample weighted to represent population of patients visiting physicians in each practice type.

Setting.
—Offices of 367 internists, family practitioners, endocrinologiste, cardiologists, and nurse practitioners, in HMOs (prepaid only), MSGs (prepaid and FFS), and SOLO practices (prepaid and FFS).

Patients.
—Adults (N=17671) at start of the Medical Outcomes Study.

Outcome Measures.
—Overall rating of the visit (five choices from excellent to poor). A random half of the sample also rated the provider's technical skills, personal manner, and explanations of care as well as time spent during the visit, the appointment wait, the office wait, the convenience of the office location, and telephone access.

Results.
—Fifty-five percent of patients rated their visit overall as excellent, 32% very good, 11% good, and 2% fair or poor. Patients of SOLO practitioners were more likely (64%) to rate their visit excellent than MSG (48%) or HMO (49%) patients (P<.001 ). Patients of SOLO practitioners rated all aspects of care better than HMO patients did, most markedly appointment waits (64% vs 40% excellent; P<.0001) and telephone access (64% vs 33% excellent; P<.0001). Within SOLO and MSG practices, FFS patients rated most specific aspects better than prepaid patients, but these differences were not statistically significant and were inconsistent across cities. Adjusting for patients' demographics, diagnoses and self-rated health did not change results. Physicians with visit ratings in the lowest 20% were nearly four times as likely to be left by patients within 6 months than physicians in the highest 20% (16.7% vs 4.6%; P<.001).

Conclusion.
—Of the five practice type and payment method combinations, SOLO FFS patients rated their visits best and HMO patients worst. Whether FFS or prepaid, care was rated better in small than in large practices. Our study shows that a brief visit rating form can be used to compare practice settings and health plans, and that patient ratings predict what proportion of patients, on average, will leave their physicians in the next several months.

(JAMA. 1993;270:835-840)

Author Affiliations
From the Departments of Medicine and Health Policy and Management and the Program for Medical Technology and Practice Assessment, The Johns Hopkins Medical Institutions, Baltimore, Md (Dr Rubin); The Health Institute, New England Medical Center Hospitals, Boston, Mass (Ms Gandek, Mr Kosinski, and Drs McHorney and Ware); and RAND, Santa Monica, Calif (Dr Rogers).

Footnotes
Reprint requests to The Johns Hopkins University, 1830 E Monument St, Suite 8015, Baltimore, MD 21205 (Dr Rubin).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Patient Satisfaction and Its Relationship With Quality and Outcomes of Care After Acute Myocardial Infarction
Lee et al.
Circulation 2008;118:1938-1945.
ABSTRACT | FULL TEXT  

Prevalence, Impact, and Prognosis of Multisomatoform Disorder in Primary Care: A 5-Year Follow-up Study
Jackson and Kroenke
Psychosom. Med. 2008;70:430-434.
ABSTRACT | FULL TEXT  

Chronically ill Australians' satisfaction with accessibility and patient-centredness
Jayasinghe et al.
Int J Qual Health Care 2008;20:105-114.
ABSTRACT | FULL TEXT  

Improving Quality and Patient Satisfaction in Dermatology Office Practice
Poulos et al.
Arch Dermatol 2008;144:263-265.
FULL TEXT  

Outcome and Impact of Mental Disorders in Primary Care at 5 years
Jackson et al.
Psychosom. Med. 2007;69:270-276.
ABSTRACT | FULL TEXT  

Perceived pain and satisfaction with medical rehabilitation after hospital discharge
Berges et al.
Clin Rehabil 2006;20:724-730.
ABSTRACT  

The development and validation of the Concise Outpatient Department User Satisfaction Scale
Tso et al.
Int J Qual Health Care 2006;18:275-280.
ABSTRACT | FULL TEXT  

Satisfaction With Care and Ease of Using Health Care Services Among Parents of Children With Special Health Care Needs: The Roles of Race/Ethnicity, Insurance, Language, and Adequacy of Family-Centered Care
Ngui and Flores
Pediatrics 2006;117:1184-1196.
ABSTRACT | FULL TEXT  

Health Information Technology and Physician-Patient Interactions: Impact of Computers on Communication during Outpatient Primary Care Visits
Hsu et al.
J. Am. Med. Inform. Assoc. 2005;12:474-480.
ABSTRACT | FULL TEXT  

Open Access in Primary Care: Results of a North Carolina Pilot Project
Bundy et al.
Pediatrics 2005;116:82-87.
ABSTRACT | FULL TEXT  

Patient, provider, and clinic characteristics associated with public STD clinic patient satisfaction
Mehta et al.
Sex. Transm. Infect. 2005;81:150-154.
ABSTRACT | FULL TEXT  

Communication Skills for Patient-Centered Care. Research-Based, Easily Learned Techniques for Medical Interviews That Benefit Orthopaedic Surgeons and Their Patients
Tongue et al.
JBJS 2005;87:652-658.
FULL TEXT  

Expectations and Outcomes in Cataract Surgery: A Prospective Test of 2 Models of Satisfaction
Pager
Arch Ophthalmol 2004;122:1788-1792.
ABSTRACT | FULL TEXT  

Two Decades of Organizational Change in Health Care: What Have we Learned?
Bazzoli et al.
Med Care Res Rev 2004;61:247-331.
ABSTRACT  

What Matters to Low-Income Patients in Ambulatory Care Facilities?
Delia et al.
Med Care Res Rev 2004;61:352-375.
ABSTRACT  

Modeling Patients' Acceptance of Provider-delivered E-health
Wilson and Lankton
J. Am. Med. Inform. Assoc. 2004;11:241-248.
ABSTRACT | FULL TEXT  

Patient Ratings of Dialysis Care With Peritoneal Dialysis vs Hemodialysis
Rubin et al.
JAMA 2004;291:697-703.
ABSTRACT | FULL TEXT  

Risk Factors for Nonelective Hospitalization in Frail and Older Adult, Inner-City Outpatients
Damush et al.
Gerontologist 2004;44:68-75.
ABSTRACT | FULL TEXT  

Physician-Elder Interaction in Community Family Practice
Callahan et al.
J Am Board Fam Med 2004;17:19-25.
ABSTRACT | FULL TEXT  

Explaining Low Ratings of Patient Satisfaction Among Asian-Americans
Saha and Hickam
American Journal of Medical Quality 2003;18:256-264.
ABSTRACT  

Gender and Symptoms in Primary Care Practices
Jackson et al.
Psychosomatics 2003;44:359-366.
ABSTRACT | FULL TEXT  

Benefits of and Barriers to Large Medical Group Practice in the United States
Casalino et al.
Arch Intern Med 2003;163:1958-1964.
ABSTRACT | FULL TEXT  

A Paradigm Shift in Patient Satisfaction Assessment
Otani et al.
Med Care Res Rev 2003;60:347-365.
ABSTRACT  

Continuity of Primary Care: To Whom Does It Matter and When?
Nutting et al.
Ann Fam Med 2003;1:149-155.
ABSTRACT | FULL TEXT  

Accepting Critically Ill Transfer Patients: Adverse Effect on a Referral Center's Outcome and Benchmark Measures
Rosenberg et al.
ANN INTERN MED 2003;138:882-890.
ABSTRACT | FULL TEXT  

Defining the Future of Primary Care: What Can We Learn from Patients?
Safran
ANN INTERN MED 2003;138:248-255.
ABSTRACT | FULL TEXT  

Caller Satisfaction With After-Hours Telephone Advice: Nurse Advice Service Versus On-Call Pediatricians
Lee et al.
Pediatrics 2002;110:865-872.
ABSTRACT | FULL TEXT  

Scale to Measure Patient Satisfaction With Physical Therapy
Monnin and Perneger
ptjournal 2002;82:682-691.
ABSTRACT | FULL TEXT  

Consumer Beliefs and Health Plan Performance: It's Not Whether You Are in an HMO but Whether You Think You Are
Reschovsky et al.
Journal of Health Politics, Policy and Law 2002;27:353-378.
ABSTRACT  

Primary Care Quality in the Medicare Program: Comparing the Performance of Medicare Health Maintenance Organizations and Traditional Fee-for-Service Medicare
Safran et al.
Arch Intern Med 2002;162:757-765.
ABSTRACT | FULL TEXT  

Profiling Care Provided by Different Groups of Physicians: Effects of Patient Case-Mix (Bias) and Physician-Level Clustering on Quality Assessment Results
Greenfield et al.
ANN INTERN MED 2002;136:111-121.
ABSTRACT | FULL TEXT  

Incentivized Digital Outcomes Collection
Isenberg et al.
American Journal of Medical Quality 2001;16:202-211.
ABSTRACT  

Managed Care Takes to the Highway: Implications for Insureds
Gilchrist
J Law Med Ethics 2001;29:203-219.
 

A 58-Year-Old Woman Dissatisfied With Her Care
Daley
JAMA 2001;285:2629-2635.
FULL TEXT  

Measuring Patients' Expectations and Requests
Kravitz
ANN INTERN MED 2001;134:881-888.
ABSTRACT | FULL TEXT  

The Effect of Unmet Expectations among Adults Presenting with Physical Symptoms
Jackson and Kroenke
ANN INTERN MED 2001;134:889-897.
ABSTRACT | FULL TEXT  

Managed Care Takes to the Highway: Implications for Insureds
Gilchrist
J Law Med Ethics 2001;29:203-219.
 

Satisfaction of Forensic Psychiatric Patients With Remote Telepsychiatric Evaluation
Brodey et al.
Psychiatr. Serv. 2000;51:1305-1307.
ABSTRACT | FULL TEXT  

Acceptability of Telepsychiatry to a Rural Population
Rohland et al.
Psychiatr. Serv. 2000;51:672-674.
ABSTRACT | FULL TEXT  

Impact of Tympanostomy Tubes on Child Quality of Life
Rosenfeld et al.
Arch Otolaryngol Head Neck Surg 2000;126:585-592.
ABSTRACT | FULL TEXT  

Quality Assessment in Nursing Home Facilities: Measuring Customer Satisfaction
Mostyn et al.
American Journal of Medical Quality 2000;15:54-61.
ABSTRACT  

Primary Care Outcomes in Patients Treated by Nurse Practitioners or Physicians: A Randomized Trial
Mundinger et al.
JAMA 2000;283:59-68.
ABSTRACT | FULL TEXT  

Physician Practice Management Organizations: Their Prospects and Performance
Conrad et al.
Med Care Res Rev 1999;56:307-339.
ABSTRACT  

Resolving the Gatekeeper Conundrum: What Patients Value in Primary Care and Referrals to Specialists
Grumbach et al.
JAMA 1999;282:261-266.
ABSTRACT | FULL TEXT  

Development and Testing of a Visit-Specific Patient Satisfaction Questionnaire: The Princess Margaret Hospital Satisfaction With Doctor Questionnaire
Loblaw and Bezjak
JCO 1999;17:1931-1931.
ABSTRACT | FULL TEXT  

Difficult Patient Encounters in the Ambulatory Clinic: Clinical Predictors and Outcomes
Jackson and Kroenke
Arch Intern Med 1999;159:1069-1075.
ABSTRACT | FULL TEXT  

Patient-Physician Racial Concordance and the Perceived Quality and Use of Health Care
Saha et al.
Arch Intern Med 1999;159:997-1004.
ABSTRACT | FULL TEXT  

Variations in the Management of Primary Care: Effect on Cost in an HMO Network
Rich et al.
Arch Intern Med 1998;158:2363-2371.
ABSTRACT | FULL TEXT  

Strategic Management or Environmental Change: Which Determines Success in Health Care Organizations?
Barr
Administration & Society 1998;30:374-392.
ABSTRACT  

Utilizing Patient Satisfaction Data to Assess Quality Improvement in Community-Based Medical Practices
Isenberg and Stewart
American Journal of Medical Quality 1998;13:188-194.
ABSTRACT  

Patients' Views of Direct Access to Specialists: An Israeli Experience
Tabenkin et al.
JAMA 1998;279:1943-1948.
ABSTRACT | FULL TEXT  

Does Dissatisfaction with Access to Specialists Affect the Desire to Leave a Managed Care Plan?
Kerr et al.
Med Care Res Rev 1998;55:59-77.
ABSTRACT  

Patient Satisfaction and Ambulatory Encounters Involving Medical Students
Barclay III et al.
JAMA 1998;279:18-19.
FULL TEXT  

Choice of a Personal Physician and Patient Satisfaction in a Health Maintenance Organization
Schmittdiel et al.
JAMA 1997;278:1596-1599.
ABSTRACT  

Patient Satisfaction: Quality of Care From the Patients' Perspective
Kirsner and Federman
Arch Dermatol 1997;133:1427-1431.
ABSTRACT  

Direct Observation of Community-Based Ambulatory Encounters Involving Medical Students
Frank et al.
JAMA 1997;278:712-716.
ABSTRACT  

Concerns and Expectations in Patients Presenting With Physical Complaints: Frequency, Physician Perceptions and Actions, and 2-Week Outcome
Marple et al.
Arch Intern Med 1997;157:1482-1488.
ABSTRACT  

Multisomatoform Disorder: An Alternative to Undifferentiated Somatoform Disorder for the Somatizing Patient in Primary Care
Kroenke et al.
Arch Gen Psychiatry 1997;54:352-358.
ABSTRACT  

Do We Understand the Effects of 'Managed Care' in Ophthalmology? A Review and Analysis
Asch et al.
Arch Ophthalmol 1997;115:531-536.
ABSTRACT  

The Elderly and Poor in the Medical Outcomes Study
Barrett and Juhn
JAMA 1996;276:1952-1952.
ABSTRACT  

Project Solo: An Independent Practitioner Initiative for Confidential Self-Assessment of Quality
Isenberg et al.
American Journal of Medical Quality 1996;11:214-221.
ABSTRACT  

Payment by Capitation and the Quality of Care- Part Five of Six
Berwick
NEJM 1996;335:1227-1231.
FULL TEXT  

Health Care Utilization and Outcomes Among Persons With Rheumatoid Arthritis in Fee-for-Service and Prepaid Group Practice Settings
Yelin et al.
JAMA 1996;276:1048-1053.
ABSTRACT  

The Use of Patient Satisfaction Data to Assess the Impact of Continuous Quality Improvement Efforts
Piccirillo
Arch Otolaryngol Head Neck Surg 1996;122:1045-1048.
ABSTRACT  

Quality of Care -- What is It?- Part One of Six
Blumenthal
NEJM 1996;335:891-894.
FULL TEXT  

Effects of Structured Encounter Forms on Pediatric House Staff Knowledge, Parent Satisfaction, and Quality of Care: A Randomized, Controlled Trial
Zenni and Robinson
Arch Pediatr Adolesc Med 1996;150:975-980.
ABSTRACT  

Evaluation of Medicaid Managed Care: Satisfaction, Access, and Use
Sisk et al.
JAMA 1996;276:50-55.
ABSTRACT  

Patients' Perceptions of Office Medical Practice: Judging Quality through the Patients' Eyes
Epstein et al.
American Journal of Medical Quality 1996;11:73-80.
ABSTRACT  

Patients' Expectations for Medical Care: An Expanded Formulation Based on Review of the Literature
Kravitz
Med Care Res Rev 1996;53:3-27.
ABSTRACT  

Patient-Centered Medicine: A Professional Evolution
Laine and Davidoff
JAMA 1996;275:152-156.
ABSTRACT  

Diabetes in a Managed Care System
Quickel
ANN INTERN MED 1996;124:160-163.
ABSTRACT | FULL TEXT  

Outcomes of Patients With Hypertension and Non--insulin-dependentn Diabetes Mellitus Treated by Different Systems and Specialties: Results From the Medical Outcomes Study
Greenfield et al.
JAMA 1995;274:1436-1444.
ABSTRACT  

Physician Specialty, Systems of Health Care, and Patient Outcomes
Fihn
JAMA 1995;274:1473-1474.
ABSTRACT  

Preoperative Functional Expectations and Postoperative Outcomes Among Patients Undergoing First Eye Cataract Surgery
Tielsch et al.
Arch Ophthalmol 1995;113:1312-1318.
ABSTRACT  

Access to Specialty Care
Kassirer
NEJM 1994;331:1151-1153.
FULL TEXT  

A Better-Quality Alternative: Single-Payer National Health System Reform
Schiff et al.
JAMA 1994;272:803-808.
ABSTRACT  

Anticipated Changes in the Doctor-Patient Relationship in the Managed Care and Managed Competition of the Health Security Act of 1993
Puma
Arch Fam Med 1994;3:665-671.
ABSTRACT  

Primary Care Performance in Fee-for-Service and Prepaid Health Care Systems: Results From the Medical Outcomes Study
Safran et al.
JAMA 1994;271:1579-1586.
ABSTRACT  

Managed Care Plan Performance Since 1980: A Literature Analysis
Miller and Luft
JAMA 1994;271:1512-1519.
ABSTRACT  

Patients' Satisfaction With HMO Visits
Younes
JAMA 1994;271:1401-1401.
ABSTRACT