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Christie G. Regula, BA; Jeffrey J. Miller, MD; David T. Mauger, PhD; James G. Marks, MD

Arch Dermatol. 2007;143(12):1592-1593.

A growing number of measures, such as physician performance incentives, aim to improve the quality of health care in the United States. Patients and physicians, however, differ in their determination of quality of care and patient satisfaction.^1-2 The 2001 Institute of Medicine's Crossing the Quality Chasm: A New Health System for the 21st Century³ established guidelines for improving the current health care system to better meet patient needs. These guidelines provided a basis to define quality of care from a patient's perspective in an outpatient, university-based, dermatology setting.

Methods
Our survey, as approved by the institutional review board, was administered to patients older than 18 years who were waiting for their appointment in the dermatology outpatient clinic at the Penn State Milton S. Hershey Medical Center. The survey asked participants to indicate what they considered to be most important to the quality of their care and to rate the importance of 28 aspects of their overall care. Level of importance was rated on a 5-point scale: 1, not important; 2, of little importance; 3, no opinion; 4, important; and 5, very important. The 28 aspects of care were grouped into 5 categories: treatment, access to care, professional interactions, follow-up care, and environment of care. Participants were asked to also use a 5-point scale to rank these 5 categories of care from 1, most important, to 5, least important to the quality of their health care.

Results
A total of 220 patients were asked to participate in the study. Of these, 212 (96.4%) agreed to participate, and 174 of the surveys (82.1%) were fully completed. The mean ± SD age of participants was 52.5 ± 16.8 years. Nearly 60% of respondents were women; 22% of all participants were between ages 18 and 39 years; 38% were between ages 40 and 59 years; and 37% were 60 years or older. Most respondents had completed high school or college as their highest level of education (38.2% each), while 21% had completed graduate (postcollege) education.

The Table lists the percentages of patients who ranked each of the top 6 aspects of care as "5, very important" on the 5-point scale. The 22 aspects of care not included in the Table were proven to be statistically less important (P < .05) than the top-ranked aspect of care. Three of the 6 top-ranking aspects of care were categorized as professional interactions, and 3 as treatment. Demographic variables were not associated with a difference in ranking of these individual aspects of care.

View this table: [in this window] [in a new window] [as a PowerPoint slide]   Table. The 6 Most Important Patient-Rated Aspects of Medical Care

Of the 5 categories of care, treatment ranked as most important to most patients (58.9%). Most open-ended responses cited an aspect of either treatment or professional interactions as most important to the quality of health care. These included a knowledgeable physician (21.9%), concern/caring of physician (15.7%), and a physician who listens (10.1%).

Comment
Our patients believe that treatment is most important to the quality of their health care. The most important aspects of treatment were the patient's inclusion in the treatment process, discussion of treatment options, and instruction on the chosen treatment—not the treatment's speed or outcome. Patients seek quality in their personal interactions with a knowledgeable, thorough physician who listens, communicates well, and is focused on individualized care. Patients ranked such aspects above the length of time spent with the physician—clearly showing that the content of the visit, not its duration, is most important to a patient's definition of quality of care. Perhaps, as has been shown in other specialties, dermatology patients may be willing to forgo a treatment outcome in favor of other aspects of care.⁴ Quality goals can then be focused toward these ideals, and improvement in these aspects should yield an overall improvement in quality of care as determined by patients.

AUTHOR INFORMATION
Correspondence: Ms Regula, Penn State University College of Medicine, Milton S. Hershey Medical Center, 78 University Manor E, Hershey, PA 17033 (cregula{at}hmc.psu.edu).

Financial Disclosure: None reported.

REFERENCES
1. Ersser SJ, Surridge H, Wiles A. What criteria do patients use when judging the effectiveness of psoriasis management? J Eval Clin Pract. 2002;8(4):367-376. FULL TEXT | WEB OF SCIENCE | PUBMED 2. Zandbelt LC, Smets EM, Oort FJ, Godfried MH, de Haes HC. Satisfaction with the outpatient encounter. J Gen Intern Med. 2004;19(11):1088-1095. FULL TEXT | WEB OF SCIENCE | PUBMED 3. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2004:61-63.4. Ryan M. Using conjoint analysis to take account of patient preferences and go beyond health outcomes: an application to in vitro fertilization. Soc Sci Med. 1999;48(4):535-546. FULL TEXT | WEB OF SCIENCE | PUBMED

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