Combined training of a primary care physician and specialists is associated with significantly improved patient experiences with specialists, according to results of a quasi-experimental trial.
In new findings from a difference-of-variance analysis of electronic health record (EHR) data from Harvard Medical School, a team of Boston-based investigators noted better patient satisfaction according to Press Ganey’s Medical Practice Surveys with regard to their specialized care when specialists participated in training with Primary care physicians In the past.
The findings suggest that more strategies that encourage more peer-to-peer relationships between clinicians will continue to improve the patient experience.
Led by Maximilian J. Bunny, BA, of the Department of Health Care Policy at Harvard Medical School, researchers sought to determine the role of peer relationships between primary care physicians and specialists formed during training. As they note, physician behavior is “the primary driver of patient outcomes and healthcare spending,” with peer observation and approval potentially an important motivator in medicine.
“Accordingly,” the investigators wrote, “an audience of familiar peers can raise a physician’s standard of performance, not only by subjecting him to informed scrutiny, but also by providing an opportunity to demonstrate commitment to what the profession values.” “If the motivational effects of peer interaction are strong, it could have profound implications for the organization of caregiving, including potential gains from models that encourage peers of intimacy and insight — gains that can be made on many dimensions of care without the need for decision-specific interventions.” .”
Pani and colleagues used electronic health record data from 2016 to 2019 based on completed specialty referrals from primary care physicians to compare patient ratings for specialty care between those seen by specialists who trained with their primary care provider either in medical school or in graduate medical programs, and those who were seen by a specialist who did not train with the same primary care provider.
The analysis included 8,655 patients who underwent 9,920 specialist visits. Of these, 5,562 resulted from directed referrals. The mean age of the patients was 57.4 years and 62.9% were female. Patients saw any of 502 specialists working in 13 different specialties. Only 3.1% (n = 306) of specialist visits involved a primary care physician-specialist with overlapping training.
The team noted an 8.3 percentage point increase in the average composite survey rating of specialty care among patients to be treated by a specialist jointly trained with their primary care physician (95% CI, 4.9–11.8; s <.001). When adjusting for patient covariates, as well as for year of treatment and average physician survey ratings, the association increased to a benefit of 9.0 percentage points (95% CI, 5.6–12.4; s <.001).
This difference corresponds to an effect size of 1.31 SDs for the specialist-level distribution in composite ratings, comparable to the improvement from mean performance among specialists to the 91st percentile. “Item-specific analyzes revealed consistently strong associations between combined training and patient experiences for 9 out of 10 survey items.”
Investigators also noted a similar estimated benefit of common training familiarity among patients treated by specialists over undirected referral from their primary care physician.
Furthermore, Pani and colleagues saw a 1.6 percentage point increase in drug prescriptions for patients treated by specialists who trained jointly with primary care providers (95% CI, 0.3–2.9), as well as a 1.2 percentage point increase in pictures requested during appointment. Specialist (95% CI, -0.7 to 3.0).
The team believes these findings show that the patients’ greatest responses were specific to the relationship between primary care physicians and specialists — as opposed to the individual physician — or to patient-specific factors. Such a conclusion is supported by the continuous improvement in scores among patients treated by a jointly trained healthcare team who referred indirectly to specialists.
“The estimated effects of co-training on patients’ evaluations of specialized care are much greater than the effects of policies, interventions, or other efforts to improve patient experiences, including public reporting, accountable care institutions, health plan effects, and hospital characteristics,” they wrote. Accordingly, the findings of the current study, and its extensions, could have significant implications for the organization of care delivery, as they point to potentially significant quality gains from models that encourage peer interaction – such as team-based care, digital counseling that promotes face-to-face communication, peer coaching and discussions. Multidisciplinary cases.
The investigators concluded that peer relationships between members of a collaborative care team and clinicians may broadly improve quality of care and even help mitigate health care-related deficiencies such as treatment disparities.
Overall, our study suggests that non-monetary strategies for harnessing clinician professionalism, including pressure to live up to peer expectations, can generate gains on many dimensions of care without the need for decision-specific interventions that may erode intrinsic motivation when Post it in collage,” they wrote.
studying, “Physician-peer relationships and patient experiences with specialized careOn the Internet at JAMA Internal Medicine.