Online Program

Can planned visits improve provider-patient interactions? a case-control study

Tuesday, November 5, 2013 : 5:15 p.m. - 5:30 p.m.

Gerald Arnold, PhD, MPH, ABIM, American Board of Internal Medicine, Philadelphia, PA
Rebecca Baranowski, MEd, MS, ABIM, American Board of Internal Medicine, Philadelphia, PA
Lauren Duhigg, MPH, ABIM, American Board of Internal Medicine, Philadelphia, PA
Few studies on the effectiveness of planned visits for patients with chronic conditions exist; instead, researchers have focused on the Chronic Care Model overall. Planned visits ensure that clinical teams prepare, and provide patients with evidence-based care and condition-specific self-management training. We investigated whether primary care practices completing components in a planned visit protocol (PVP) had better patient-visit experiences than matched-control practices not using PVP. Better experiences included higher patient ratings on quality of communication, shared decision-making, and overall quality of care. The study included 1,323 internists from practices reporting specific chronic illnesses as the most important condition among their patients. Participants completed ABIM's Practice Improvement Module (PIM)® on Communication for maintenance of certification. In this PIM, patients complete CG-CAHPS-based surveys. 23,927 eligible respondents made three or more visits per year. 197 physicians used PVP; 197 of 1,126 practices without PVP were controls. We created three patient rating scores for: 1) physician communication (0-35 score, Cronbach's α = .86); 2) level of shared decision-making (0-9 score; Cronbach's α = 0.77); and 3) overall physician rating (0-10 score; Cronbach's α = 0.82). We hypothesized practices using PVP have higher ratings than practices that do not. Propensity-score matching formed case-control pairs. One score matched 28 physician and practice variables. A second score matched 11 patient demographic and survey variables; this weighted score adjusted for patient clustering within physicians. Pairs were matched by shortest Mahalanobis distances. Scores were compared using Wilcoxon signed-rank tests with a two-tailed α = 0.1 significance. PVP cases had a higher communication mean than controls, but the difference between means was not significant (mean and (SD)): cases, 27.7 (2) versus controls, 27.6 (2); difference = 0.09, 90% CI: -.28 to .45, p = .50. PVP cases had a higher shared decision-making mean than controls, but the difference was not significant: cases, 7.4 (1) versus controls, 7.3 (1); difference = .14, 90% CI: -.07 to .36, p = .20. Mean overall ratings for matched pairs were nearly identical and again not significantly different: cases, 9.4 (0.6) versus controls, 9.4 (0.6); difference < 0.01, 90% CI: -.10 to .10, p = .60. Practices utilizing the PVP for patients with chronic illnesses show no significant differences in quality ratings, compared with practices not using the protocol. Implementing planned visits alone, however, may not be sufficient to improve the quality of interactions during visits. Whether improved interactions result from planned visits is inconclusive.

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public

Learning Objectives:
Discuss the role of planned visit interventions in the Chronic Care Model by Wagner, et al (2001 & 2002). Define the planned visit protocol for primary care. Compare patient experience measures in primary care practices that do and do not use planned visit protocols for patients with chronic conditions. Discuss how Clinical and Group CAHPS surveys can be used to evaluate the quality of patient care in primary care practices. Describe the propensity score methodology for controlling bias in observational studies. Discuss the self-evaluation requirements and objectives of maintenance of certification and it role in improving patient care.

Keyword(s): Quality of Care, Patient Perspective

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a statistician with the American Board of Internal Medicine and provide expertise in study design, biostatistics, probability sampling, and psychometrics. I have worked in medical certification and performance assessment in medicine and education for more than 30 years for universities, medical schools, medical professional and board certification organizations, and state departments of education. Research includes observational studies designs for validity evidence of performance assessments and psychometric methods for evaluating patient-reported outcomes.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
ABIM certification Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.