Primary Care Short on Goal Setting

While Massachusetts patients give their physicians very high ratings for communication, many also report that they and their physicians have not talked about their overall health goals or what might make it hard to meet those goals. This finding from a statewide patient experience survey conducted by MHQP highlights a major opportunity for improving the way physicians engage with their patients about what happens between office visits.

“We asked patients whether their doctor listened carefully, explained clearly, showed respect, and spent enough time with them during office visits, and the response was overwhelmingly positive,” MHQP’s President and CEO Barbra Rabson explained. “But what was missing for many patients, was a conversation and guidance that would help them gain better personal control over their health and wellness.”

(Read a related article, "A doctor discovers an important question patients should be asked," from the Washington Post.) 

On the cumulative measure of how well physicians communicate with their patients, the statewide mean score for all adult practices was 93.6 out of a potential 100 points and 96.7 for pediatric practices, both all-time highs for the MHQP survey. However, for the measure of whether primary care providers talked with patients about their goals for health or if there were things that made it hard for them to take care of their health, the statewide mean score for all adult practices was 55.3 out of a potential 100 points and 46 for pediatric practices. (Pediatric scores are based on responses by patients’ parents or other adult caretakers.) 

Yogman Pediatric Associates in Cambridge is among the pediatric practices with the highest scores for talking to parents about goals for their children’s health and whether anything makes it hard for them to take care of their children’s health. Dr. Michael Yogman says the group is continuously focused on meeting patients’ and parents’ needs, not only during office visits. For example, clinicians and office staff meet regularly with a parent advisory group that includes mothers and fathers of children with diverse medical needs and backgrounds, along with an adolescent “peer partner”. The practice also includes a clinical social worker who addresses behavioral health concerns and helps families connect with needed community-based services. “We want to make sure we do everything possible to meet the needs of the whole child and the family,” Dr. Yogman says, “and especially those who are living with chronic conditions or behavioral health issues. Our parent advisory group is an invaluable way for us to stay attuned to the needs and concerns of all the families we serve.”

Behavioral health has become increasingly important for adult and pediatric primary care practices, and in 2016, the MHQP survey found significant statewide improvements in patients’ evaluation of their care experiences. MHQP added behavioral health to the patient experience survey in 2014, with questions about whether or not primary care providers asked their patients about feeling depressed, feeling stressed, or experiencing problems with alcohol, drugs, or a mental or emotional illness. The 2016 survey’s statewide mean score for the cumulative behavioral health measure was 59.6 of a possible 100 points, up by 12.2 percent from a mean score of 53.1 two years earlier.

Unlike satisfaction surveys that ask about general perceptions, MHQP’s patient experience survey asks people what actually happened when they or their children needed primary care. The 2016 survey included nearly 65,000 patients from more than 500 primary care practices representing about 4,000 physicians across the state. Complete results can be found at www.healthcarecompassma.org. In addition to the public release of the survey results, MHQP shares detailed data with the participating providers to help them assess their own performance, compare it to their peers, and set goals for improvement.

“By listening to patients through our survey, we’ve identified an important opportunity for providers to better support their patients and help them to address barriers to health improvement,” noted Rabson. “MHQP is committed to leading the advancement of patient engagement, and in order to do this we must clarify what effective patient engagement looks like so we can meaningfully measure and advance it.”  

About MHQP’s Patient Experience Survey

MHQP’s Patient Experience Survey, first conducted in 2005, asks patients to rate the quality of certain doctor-patient interactions and other aspects of care including: whether they felt their doctor knew them; how well they could communicate with their doctor and office staff; whether they had access to timely appointments and information; whether follow-up care with other doctors was well-coordinated; and whether they would recommend their doctor to a friend or family member. The survey also asks about organizational aspects of care including: access, self-management support, and interactions with office staff. MHQP’s annual survey continually expands to measure aspects of care that are important to patients and their providers.

The 2016 survey was fielded with commercially-insured patients using a 60-question, nationally developed and accepted survey instrument. Sample sizes per practice varied in order to obtain reliable information at the practice-site level.

The following organizations invested resources to support MHQP’s 2016 Patient Experience Survey and sustain statewide transparency of patient experience in Massachusetts: Blue Cross and Blue Shield of Massachusetts, Inc.; Cooley Dickinson Physician Hospital Organization; Fallon Community Health Plan; Harvard Pilgrim Health Care, Inc.; Health New England; The Lowell General Physician Hospital Organization; Mount Auburn Cambridge IPA, New England Quality Care Alliance, Inc.; Northeast Physician Hospital Organization; Partners HealthCare, Inc.; The Pediatric Physicians Organization at Children’s; Steward Health Care Network; Tufts Health Plan; UMass Memorial Health Care; and Winchester Physician Hospital Organization.

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