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

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.

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 in 16 states. We collected data on office size, ownership, and use of health information technologies 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 (3–15 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 (41–70 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.

This journal article is available for purchase.

Related Resources

Advocacy Webinar Recording
Public
All AHA webinars are free of charge but require advance registration. AHA does not offer continuing education credits for its webinars. They are always 60…
Case Studies
Public
Like many hospitals, SBH Health System uses the computerized provider order entry (CPOE) system. However, to reduce patient identification order entry errors,…
Advocacy Webinar Recording
Public
The AHA-McKesson Quest for Quality Prize recognizes leadership and innovation in quality improvement and safety. The 2016 honorees use innovative yet…
Case Studies
Public
In July 2016, the AHA/HRET Hospital Engagement Network (HEN) 2.0 hosted a state hospital association meeting that celebrated the spread and sustainability of…
Case Studies
Public
The AHA/HRET Hospital Engagement Network (HEN) 2.0 identifies best practices proven to reduce hospital-acquired conditions and shares these with hospitals and…
Case Studies
Public
By using evidence-based medicine and hardwiring concurrent review, HSHS St. Joseph's Hospital Highland has achieved 100 percent compliance with core…