Do primary care patient experiences vary by teaching versus nonteaching facility?

Abstract

Background: Patient experiences are important components of the patient-centered medical home. Competing demands of primary care and resident education contribute to inefficiencies at teaching sites, which may contribute to poor patient experiences. Educational commitments of residencies may also produce positive experiences. The objective of this study was to compare patient experiences in teaching versus nonteaching sites.

Methods: Patients across 6 primary care sites (3 teaching and 3 nonteaching) completed surveys. Patient experiences assessed using (1) Consumer Assessment of Health care Providers and Systems (CAHPS) across 3 domains: access to care, communication, clerk/receptionist courtesy (scores range from 1 [worst] to 6 [best]) and (2) Patient Assessment of Chronic Illness Care, measuring chronic care experiences (scores range from 1 [worst] to 5 [best]).

Results: Approximately 70% of participants were female and >40% were Latino. The adjusted mean score for patient-reported access at teaching sites was 4.35; at nonteaching sites it was 5.14 (P = .01). The total mean score for chronic disease was 4.02 for teaching sites and 3.79 for nonteaching sites (P = .01). Four of the 5 Patient Assessment of Chronic Illness Care subscale scores were better at teaching sites.

Conclusions: Worse access scores among teaching sites may reflect the complexities of residencies. Better chronic care scores are encouraging and potentially indicate focused training. Residencies might continue chronic disease training while considering efforts to improve access.

Keywords: Health Services Research; Medical Home; Medical Residency; Patient Satisfaction; Patient-Centered Care; Quality of Health Care.