The views of physicians on health care quality

Objectives: There are four primary goals for this research project: To develop an objective index of health care quality which represents, in the best practical way, a comprehensive range of services provided at the health region level. To develop a comparable measure representing physician assessments of health care quality, and compare this measure with the objective index. To develop an understanding of the relationships between physician ratings on the workplace issues of professional autonomy, stress, sense of equity and satisfaction and their views on health care quality.Based on the understanding of this research, provide recommendations to health care policy makers about the use of both physician viewpoints and objective measures of quality. Background: Health care in Canada has grown and evolved from a relatively simple offering of services, provided primarily by doctors and hospitals, to a complex conglomeration of programs and services, provided by a loose network of both public and private providers. As a result, physicians are under pressure to adapt to these changes and a power struggle which has always pitted physicians against policy makers. In dealing with changes to the health care system the use of statistics and evidence is gaining prominence as the basis for policy decisions, in addition to the less formal tools of rhetoric and politics.Design: Data from the 2004 Canada-wide survey “Emerging Issues in the Work of Physicians” is compared to a single index score of health care quality based on objective data from the annual Health Indicators Report published by Canadian Institute of Health Information and Statistics Canada (2005). These reports include a number of measures of quality and access to health care by health region and by province, using mandatory standardized data collection and reporting procedures. Measures: Nine reliable measures of health care quality were selected from the Health Indicators Reports for inclusion in the index: 30 day AMI risk; 30 day stroke risk; AMI readmission risk; asthma readmission risk; ACSC rate; hysterectomy readmission rate; prostatectomy rate; in-hospital hip fracture rate; and C-section rate. Index scores were developed for each of the measures, which were then assigned weights based on importance, resulting in a single overall index of health care quality. These scores are compared to a similar index score which is based on physician views on quality, as collected in the national survey.Results: Physician views on health care quality are aligned with the objective data when examined on an aggregate basis. However, there is a high degree of variability in physician responses which results in differences when examining the data on regional or individual bases. In addition, physician views on quality are influenced by factors in their work lives including autonomy, stress, equity and satisfaction. On each of these factors, those reporting high and low levels will generally over and under-rate health care quality as compared to those reporting moderate levels.Discussion: As policy makers make decisions on how to shape the future of health care, they must grapple with conflicting viewpoints of different stakeholder groups, and they must decide on the degree to which they rely on evidence (in the form of objective data) versus influence (as exerted by physicians and/or other stakeholder groups). This research shows that, while physician views on how well the health care system is performing are generally aligned with the objective data, those opinions vary greatly between individuals, and are influenced by work related factors including autonomy, stress, equity and satisfaction