 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
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| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Charles G. Humble, PhD, Performance Analysis Center for Excellence, Department of Veterans Affairs, 615 Davis Drive, Suite 800, Morrisville, NC 27560, 919-993-3035 x224, charles.humble@med.va.gov, Mark M. Meterko, PhD, MDRC, Department of Veterans Affairs, 150 S. Huntington Ave., Boston, MA 02130, Mark Graber, MD, Chief, Medical Service, Northport VAMC, 79 Middleville Rd., Bldg. 200/A3-36, Northport, NY 11768, Antonette Zeiss, PhD, Psychology Service (116B), VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA 94304, Stuart Gilman, MD, Employee Education System, Department of Veterans Affairs, VA Medical Center, Bldg. 11, 5901 East Seventh St, Long Beach, CA 90822, and David Aron, MD, Cleveland VA Medical Center, Department of Veteran Affairs, 10701 East Blvd., Cleveland, OH 44106.
BACKGROUND How patients perceive the quality of their medical care has become an important measure of overall quality. The purpose of our study was to compare both inpatient and outpatient perceptions of their medical care with the ratings medical residents gave the training they received at the same Department of Veterans Affairs (VA) healthcare centers.
METHODS / DESIGN Trainee satisfaction with training and aspects of patient care was measured in the VA’s 2001 Learners Perception Survey. Surveys were sent to 3269 physician residents and data from the 1702 respondents (52%) were analyzed. Trainees answered both general and specific questions in 4 domains: Clinical Faculty, Work Environment, Learning Environment and Physical Environment. In the same season of the same year, patient “satisfaction” (i.e., overall rating of the quality of their healthcare) was assessed from the responses of 10,816 discharged inpatients (57% response) and 77,917 outpatients (74% response). Group level comparisons between patient and resident satisfaction were limited to the 83 medical centers with at least 5 trainee responses. Associations were assessed via bivariate correlation and multiple regression modeling. Bonferoni adjustment for multiple comparisons was used to screen out marginal associations in the initial correlations.
RESULTS Both outpatient and inpatient ratings of the quality of their care were significantly correlated (p < 0.01) with residents’ overall ratings of the Learning Environment, but not with overall ratings of any other domain in the Learners Perception Survey. Outpatient satisfaction with the quality of their care was also correlated with the numeric score residents gave their current VA training experience (Spearman rho = 0.3097, p=0.0044.) After adjustment for specific components of the Learning Environment in ordinary least squares regression models, resident satisfaction with quality of care remained a significant predictor (p = 0.017) of outpatient ratings of care while resident satisfaction with degree of supervision had a marginally significant association (p< 0.051) with inpatient ratings of care.
CONCLUSIONS 1) There is commonality in how both patients and medical residents perceive the overall quality of medical care. This tends to validate the use of satisfaction surveys as a measurement of quality. 2) Centers where outpatients rate the quality of care more highly also have greater satisfaction with training among residents. 3) Emphasis on quality of patient care may enhance the VA’s educational mission.
Learning Objectives:
Keywords: Health Care Quality, Patient Satisfaction
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.