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AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Topic Suggestion Description

View Topic Suggestion Disposition (PDF) 1.2 MB

Date submitted: July 27, 2012

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
It would be very helpful to have a thorough, authorative evidence synthesis on the matter of patient experience measures' relationship to outcomes of care -- including health outcomes, behavioral outcomes like adherence, utilization, and business outcomes (like malpractice risk, practice loyalty). There is a substantial literature that shows favorable patient experiences linked to better outcomes (clinical, behavioral, utilization, business). But there have been a couple of recent articles that suggest a negative assocation -- that is patient experience linked to less favorable outcomes (including higher mortality). Fenton et al (Archives of Internal Medicine) is one such article that gathered a lot of attention and raised questions about the appropriate role of patient experience measures in accountability programs (P4P, public reporting, etc). While my reading is that these recent studies are quite flawed methodologically, there is no authoritative and comprehensive synthesis of the evidence on nature of relationships between patient experience results and outcomes; nor any synthesis of evidence on the relationship among patient experience and clinical quality measures. Such a definitive synthesis of the literature seems particularly important and timely in light of the role that patient experience measures play (and expanded role they are projected to play) in value-based purchasing, ACO payment models, and other delivery system reform and payment reform efforts.
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
It includes all groups of patients -- but would particularly focus on patients using ambulatory care (emphasis on primary care as opposed to specialty care) and hospital care. These settings have the most robust and routine assessments of patient experiences -- so would be most well represented in a proposed evidence synthesis. There would be more on adults than children -- and probably somewhat more on older adults than younger. Patients actively using care (including those with chronic illnesses) will be better represented in the literature than those who are healthy and/or barely engage with the system.
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
Per comment above, -- patients with specific health needs (e.g., chronic conditions) may be particularly well represented in the literature that would be synthesized.
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
Improved patient-centered care -- and with it, improved adherence, reduced symptoms, improved clinical status.
Describe any health-related risks, side effects, or harms that you are concerned about.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Arthritis and nontraumatic joint disorders
  • Cancer
  • Cardiovascular disease, including stroke and hypertension
  • Depression and other mental health disorders
  • Diabetes mellitus
  • Functional limitations and disability
  • Infectious diseases, including HIV/AIDS
  • Obesity
  • Peptic ulcer disease and dyspepsia
  • Pregnancy, including preterm birth
  • Pulmonary disease/asthma
  • Substance abuse
AHRQ Priority Populations
  • Low income groups
  • Minority groups
  • Women
  • Children
  • Elderly
  • Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care
Federal Health Care Program
  • Medicaid
  • Medicare


Describe why this topic is important.
See response to first question above. Patient-based measures -- including patient care experiences -- have a central and increasing role in "accountability" uses of measures (P4P, public reporting, tiered network products). This domain of measurement is included as a core component of value based payment, ACO model performance incentives, and so on. An authorative summary of the evidence for how patient experiences are related to varied outcomes (health outcomes, behaviors, utilization, business outcomes) is critical in this context.
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
See response to first question above -- recent flurry of articles calling into question the relationship between patient experience and outcomes -- and suggesting that better patient experiences lead to worse outcomes (including mortality). This appears counter to a large literature that I'm aware of -- and the new studies appear methodologically flawed in some important ways. There is no authorative synthesis of the evidence on these issues.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
If yes, please explain:
As noted above -- new evidence conflicts with a large literature that suggests patient experiences are positively related to favorable outcomes. Given "high stakes" uses of patient experience measures nationally -- it is important to understand the extent to which patient experiences and outcomes are related, and in what direction.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?
I lead Performance Measurement and Improvement for BCBS-Massachusetts. We use patient experience measures in our ambulatory and hospital performance incentive programs, public reporting/transparency, patient engagement tools, and tiered network products. If this synthesis showed that patient experience is largely associated with inferior outcomes -- we would quite dramatically change our use of these measures in our payment reform and delivery system reform efforts.
Describe the timeframe in which an answer to your question is needed.
6-9 months
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
doesn't apply

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
  • Health Care Payer/Purchaser (Employer, Federal Government)
  • Researcher
Are you making a suggestion as an individual or on behalf of an organization?
Organization - Blue Cross Blue Shield of Massachusetts
Please tell us how you heard about the Effective Health Care Program
A colleague mentioned it