The Relationship of Self-Report of Quality to Practice Size and Health Information Technology

Journal Name: 
The Journal of the American Board of Family Medicine
Authors: 
Gorman,Paul N.
O'Malley,Jean P.
Fagnan,Lyle J.
Abstract: 
Background: Assessment of patient safety culture has recently expanded in inpatient settings, but the majority of medical encounters occurs in office settings, and less is known about the determinants of perceived quality and safety in ambulatory care. The Medical Office Survey of Patient Safety was developed to assess perceived quality of care and patient safety culture in medical offices, including a domain to assess the quality criteria as defined by the Institute of Medicine: patient-centered, effective, timely, efficient, and equitable.Methods: We surveyed 6534 clinicians and staff in 306 medical practices from 11 practice based research networks (PBRNs) in 16 states. We collected data on office size, ownership, and use of health information technologies (HIT) and assessed perceived patient safety and quality of care with the Medical Office Survey of Patient Safety's overall quality domain. Using a mixed model that adjusted for the role of respondents, we examined the relationship between perceived safety and quality of care and office size, ownership, and the degree of implementation of HIT.Results: Small practices (3GÇô15 personnel) reported the highest proportion of positive perceptions of quality and safety. The lowest proportion of positive perceptions of quality and safety occurred in large (41GÇô70 personnel) and very large practices (>70 personnel). After controlling for office size, we found no relationship between perceived quality and safety and practice ownership. The relationship of HIT implementation to perceived quality and safety was not clear. We found the highest proportion of positive perceptions in practices with the least HIT and those with the most HIT and the lowest proportion in practices with intermediate levels of HIT.Conclusions: Personnel in small practices reported the highest overall quality and safety of care, and perceived quality and safety declined with increasing office size. No clear relationship was found between perceived quality and safety and implementation of HIT
9
2012
Volume: 
25
Pages: 
614-624
Keywords: 
Ambulatory, Ambulatory Care, criteria, Culture, Health, information, medical, Medicine, Ownership, patient, patient safety, Perception, perceptions, quality, Research, Role, Safety, Self Report, survey