Results from quasi-experimental trials show that joint primary care physician-specialist training is associated with significantly improved patient experience with the specialist.
In new results from a differential analysis of electronic health record (EHR) data from Harvard Medical School, a Boston-based research team found that when specialists received joint treatment, according to Press Ganey’s Medical Practice Surveys, We observed increased patient satisfaction with specialist care.trained in Primary care doctor In the past.
The findings suggest that more strategies that facilitate the formation of greater peer-to-peer relationships between physicians will continue to improve the patient experience.
Investigators led by Maximilian J. Punney, B.S. in the Department of Health Policy at Harvard Medical School, sought to determine the role of peer relationships between primary care physicians and specialists formed during training. As they noted, physician behavior is “a major driver of patient outcomes and healthcare costs,” and peer observation and approval may serve as an important motivation in medicine.
“Therefore, a familiar peer audience may improve physician performance by providing an opportunity not only to receive informed scrutiny but also to demonstrate commitment to what the profession values.” “If the motivational effect of peer interaction is strong, it can have a significant impact on the organization of care delivery. This includes promoting peer familiarity and visibility,” the researchers wrote. Potential benefits from the model include: Many aspects of care may benefit without the need for decision-specific intervention.”
Panney and colleagues used 2016-2019 EHR data based on full expert referrals from primary care physicians to study the results of primary care providers and trained professionals in medical school or graduate health programs. Patient ratings of specialist care were compared between seen patients and those seen by untrained professionals at the same primary care provider.
The analysis included 8655 patients who underwent 9920 specialist visits. Of these, 5562 were direct referrals. The average age of patients he was 57.4 years, and 62.9% were female. Patients have seen any of 502 professionals working in 13 different specialties. Only 3.1% (n = 306) of her specialist visits involved her two of her primary care physicians and specialists overlapping in training.
The team observed an 8.3 percentage point increase in the mean composite survey rating of specialist care for patients treated by a trained specialist along with their primary care physician (95% CI, 4.9 – 11.8; P. <.001). Adjusting for patient covariates, and treatment years and physician mean survey ratings, the association increased to a benefit of 9.0 percentage points (95% CI, 5.6 – 12.4; P. <.001).
“This difference corresponds to an effect size of 1.31 SD for the specialist-level distribution on the global assessment, which is similar to the improvement from median to 91st percentile performance among specialists,” the researchers emphasized. “Item-specific analysis revealed a consistently strong association between joint training and patient experience in 9 out of 10 items.”
The researchers further observed similar estimated benefits from the friendliness of co-training among patients being treated by specialists without a referral from their primary care physician.
Furthermore, Pany and colleagues found a 1.6 percentage point increase in drug prescribing (95% CI, 0.3 – 2.9) and a 1.2 percentage point increase in prescriptions for patients treated by co-trained professionals with primary care providers. Confirmed that it has increased. Images ordered at specialist appointment (95% CI, -0.7 to 3.0).
The team believes these findings indicate that greater patient feedback is specific to the relationship between primary care physicians and specialists, as opposed to single-physician- or patient-specific factors. These conclusions are supported by sustained improvement in scores in patients treated by a jointly trained medical team who indirectly referred them to specialists.
“The estimated effect of collaborative training on patient assessment of professional care is much greater than that of other policies, interventions, or efforts to improve the patient experience,” they wrote. The results of and their extensions suggest potentially significant quality gains from models that facilitate peer interaction, such as team-based care, digital consultations that facilitate direct communication, and thus the organization of care delivery. It can have a significant impact on: peer coaching, and multi-disciplinary case discussions.”
The investigators concluded that peer relationships between co-treatment team members and physicians may help broadly improve the quality of care and even reduce health-related drawbacks such as treatment disparities. rice field.
“More generally, our research suggests that non-economic strategies for exploiting physician professionalism, including the pressure to meet peer expectations, may be less effective when deployed in clinical settings. Our findings suggest that benefits may be generated in many aspects of care without the need for decision-specific interventions that carry the risk of eroding intrinsic motivation. is writing
the study, “Physician-peer relationships and patient experience with specialist care,” was published online at JAMA Internal Medicine.
