Patients' Education and Doctors' "Report Cards"

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The summary below is from the full report titled "Influence of Patient Education on Profiles of Physician Practices." It is in the 16 November 1999 issue of Annals of Internal Medicine (volume 131, pages 745-751). The authors are K. Fiscella and P. Franks.

What is the problem and what is known about it so far?

Over recent years, managed care organizations and others have begun to develop "report cards" to measure the quality of doctors' practices. How well a physician does on these report cards has a lot to do with how sick the doctor's patients are. For example, a doctor who cares for many cancer patients will undoubtedly have a higher patient death rate than will a doctor who cares for mainly young, healthy people. It is very important that these "report cards" account for the levels of sickness of the patients a doctor cares for. However, experts do not know whether these report cards should also account for other patient factors, like education.

Why did the researchers do this particular study?

The researchers wanted to find out whether adjusting doctors' "report cards" for the educational level of their patients would change how well the doctors did.

Who was studied?

The researchers studied 100 doctors in a managed care organization in New York State and 50 patients seen by each of these doctors.

How was the study done?

The researchers asked patients to rate their overall health and their satisfaction with their doctors. The researchers then rated the doctors according to how healthy and how satisfied the patients reported being. First, the researchers adjusted the "report cards" for patient age, sex, and illness. Next, they adjusted them for patient education in addition to adjusting for age, sex, and illness.

What did the researchers find?

For doctors who cared for many patients with low educational levels, performance on the report cards that rated doctors according to how healthy their patients felt improved after the researchers adjusted for patient education. Adjusting the report cards for patient education did not influence how well doctors did on the report cards that rated doctors according to patient satisfaction.

What were the limitations of the study?

The researchers were able to determine that adjusting for patient education may influence how a doctor performs on some types of "report cards," such as those that rate doctors according to how healthy their patients feel. However, this study was unable to determine whether this is because less educated patients are generally less healthy regardless of the type of care they get or because doctors provide worse care for people with low educational levels. Education did not appear to influence report cards that judged doctors by how satisfied patients are. Similarly, patient education may not influence "report cards" that rate doctors according to whether patients receive certain health care services, such as mammograms or cholesterol tests.

What are the implications of the study?

It may be reasonable for some kinds of doctor "reports cards" to account for patient education in addition to patients' levels of sickness, but this issue requires additional study.