Possible unintended consequences of a focus on performance: insights over time from the research association of practices network

Qual Manag Health Care. 2008 Jan-Mar;17(1):47-52. doi: 10.1097/01.QMH.0000308637.04850.ac.


Background: New pay-for-performance initiatives and quality improvement efforts over the last decade have focused on evidenced-based process measures of quality of care. The effect on preventive service delivery (PSD) measures and patient satisfaction is not well described. The goals of this study were to describe PSD and patient satisfaction trends over the past decade.

Methods: We evaluated delivery of US Preventive Services Task Force (USPSTF)-recommended clinical preventive services and patient satisfaction in 3 studies conducted in the same health care market in 1995, 2000, and 2006, respectively, using previously validated measures. Trends in these 2 factors were compared using data from cross-sectional samples of 4454, 3462, and 1240 patients seen at 84, 80, and 31 participating primary care practices, respectively.

Results: In the 3 time periods, patients' rate of being up to date on USPSTF-recommended preventive services increased from 29% to 33% to 38%. Similar trends were observed in subscores for counseling, screening, and immunization services. However, patient satisfaction decreased to a clinically meaningful extent from 4.26 in 1995 to 3.93 in 2006 (range = 1-5).

Conclusions: Quality improvement efforts focused on evidence-based recommendations appear to be working as intended, but with the possible unintended consequence of reduced patient satisfaction.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cross-Sectional Studies
  • Evidence-Based Medicine
  • Female
  • Humans
  • Male
  • Middle Aged
  • Ohio
  • Patient Satisfaction* / statistics & numerical data
  • Preventive Medicine / standards*
  • Primary Health Care
  • Quality Assurance, Health Care* / methods
  • Reimbursement, Incentive*
  • Surveys and Questionnaires