1
Physicians’ Views on Quality of Care:
Findings from the Commonwealth Fund
National Survey of Physicians
and Quality of Care
Anne-Marie J. Audet, Michelle M. Doty,
Jamil Shamasdin, and Stephen C. Schoenbaum
May 2005
2
Chapter I
Information Technologies:
Current Use, Future Plans,
and Perceived Barriers
3
Use of Information Technologies
in Clinical Practice
4
Chart I-1. Use of Information Technologies
Percent indicating “routine” or “occasional” use
100
Yes, used occasionally
80
79
6
Yes, used routinely
58
60
21
40
73
20
37
27
27
9
9
18
17
0
Electronic Electronic
24
28
18
18
21
6
7
Clinical
E-mail
E-mail
with
with
Doctors
Patients
Electronic
Access
Billing
to Test
Medical
Ordering * Decision
Results
Records
Support
* Electronic ordering of tests, procedures, or drugs.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
14
3
Chart I-2. Electronic Access to Patient
Test Results, Electronic Medical Records,
and Electronic Ordering, by Practice Size
Percent who currently “routinely/occasionally” use the following
100
1 Physician
2–9 Physicians
10–49 Physicians
50+ Physicians
87
75
61
66
57
46
50
36
37
35
25
23
25
13
14
Electronic Access to
Electronic Medical
Electronic Ordering *
Test Results
Records
0
* Electronic ordering of tests, procedures, or drugs.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
5
Chart I-3. Use of Clinical Decision Support,
E-mail with Doctors, and E-mail with Patients,
by Practice Size
Percent who currently “routinely/occasionally” use the following
100
1 Physician
2–9 Physicians
10–49 Physicians
75
61
50
40
19
21
33
35
29
25
50+ Physicians
17
21
16
13
19
0
Clinical Decision Support
E-mail with Doctors
E-mail with Patients
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
6
Chart I-4. Use of Reminders or Alerts
Percent indicating following tasks currently performed in their office practice
100
Yes, using a manual system
Yes, using a computerized system
54
50
38
41
33
0
26
31
12
10
21
Drug Alerts
Follow-Up Alerts
Reminders
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
7
8
Chart I-5. Use of Electronic Drug Alerts,
Follow-Up Alerts, and Reminders, by Practice Size
Percent who currently use a “computerized system” for the following
100
1 Physician
2–9 Physicians
10–49 Physicians
50+ Physicians
75
50
31
27
25
6
10
21
17
5
9
11
22
23
13
0
Drug Alerts
Follow-Up Alerts
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Reminders
9
Future Use of IT
10
Chart I-6. Planned Future Use of IT
Percent expecting use
Not used, NO plan to use within next year
Not used, PLAN to use within next year
100
80
63
62
75
53
53
58
20
19
17
82
69
60
41
40
20
0
21
15
6
57
71
27
14
12
11
Electronic
Access
Electronic
Electronic
Clinical
E-mail with
E-mail with
Billing
to Test
Medical
Ordering*
Decision
Doctors
Patients
Results
Records
Support
* Electronic ordering of tests, procedures, or drugs.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart I-7. Planned Future Use of
Reminders or Alerts
Percent expecting future use of the following
100
Not done, NO plan to in next year
Not done, PLAN to in next year
60
56
50
44
44
0
43
34
16
13
10
Drug Alerts
Follow-Up Alerts
Reminders
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
11
Chart I-8. Planned Future Use of
Electronic Medical Records, by Practice Size
Percent expecting use
Not used, NO plan to use within next year
Not used, PLAN to use within next year
100
86
73
50
53
77
65
73
56
37
44
22
0
20
Total
28
22
13
21
1 Physician
2–9
10–49
50+
Physicians
Physicians
Physicians
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
12
13
Perceived Barriers to IT Adoption
14
Chart I-9. Barriers to Adoption
Major Barrier
Start-up costs
Minor Barrier
28%
56%
Lack of uniform standards
Not a Barrier
15%
40%
44%
14%
Lack of time
39%
44%
16%
Maintenance costs
37%
46%
15%
Lack of evidence of effectiveness
Privacy concerns
Lack training/knowledge
26%
21%
16%
38%
49%
47%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
35%
29%
36%
Chart I-10. Barriers to Adoption of
Information Technologies, by Practice Size
Percent indicating start-up costs, scientific evidence, or privacy concerns
as a “major barrier” to greater use of information technologies
100
1 Physician
2–9 Physicians
10–49 Physicians
50+ Physicians
75
62
50
59
49
43
40
24
25
30
17
17
11
19
15
0
Start-Up Costs
Scientific Evidence
Privacy Concerns
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
15
16
Chapter II
Practice-Level and
Performance Data:
Availability, Sources,
and Willingness to Share
17
Access to Patient Panel Data
18
Chart II-1. Physicians’ Access to
Patient Panel Data
Percent indicating “very/somewhat” difficult
or cannot generate lists of patients by
100
83
51
84
55
43
50
0
Age Group
Diagnosis/
Health Risk
Lab Results
Current
Medications
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Any Data
Chart II-2. Physicians’ Access to
Any Patient Panel Data, by Practice Size
Percent indicating “very/somewhat” easy to
generate lists of patients using any*
criteria
100
57
50
50
58
61
61
0
Total
1 Physician
2–9
10–49
Physicians Physicians
50+
Physicians
* Indicates “very/somewhat” easy to generate lists of patients using any of the following criteria:
age group, diagnosis/health risk, lab results, or current medications.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
19
20
Chart II-3. Physicians’ Access to
Patient Panel Data, by Practice Size
Percent indicating “very/somewhat” easy to generate lists of patients by
100
1 Physician
2–9 Physicians
10–49 Physicians
50+ Physicians
75
50
39
46
46
45
27
27
22
25
12
12
20
12
12
0
Diagnosis/Health Risk
Lab Results
Current Medications
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart II-4. Physicians’ Access to Any Patient
Panel Data, by Electronic Medical Record Use
Percent indicating “very/somewhat” easy to
generate lists of patients using any*
criteria
100
57
62
55
50
0
Total
EMR Used Routinely/
Do Not Use EMR
Occasionally
* Indicates “very/somewhat” easy to generate lists of patients using any of the following criteria:
age group, diagnosis/health risk, lab results, or current medications.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
21
22
Access to Quality-of-Care
or Performance Data
Chart II-5. Physicians’ Access to
Quality-of-Care or Performance Data
Percent receiving data on the following aspects of patient care
100
50
25
20
18
Process of Care
Clinical
Patient Survey
Data
Outcomes Data
Data
33
0
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Any Data
23
24
Chart II-6. Physicians’ Access to
Quality-of-Care Data, by Practice Size
Percent receiving data on the following aspects of patient care
100
2–9 Physicians
1 Physician
10–49 Physicians
50+ Physicians
75
44
50
25
14
21
20
27
11
18
23
27
24
29
15
0
Process of Care
Clinical Outcomes Data
Patient Survey Data
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
25
Chart II-7. Physicians’ Sources of
Quality-of-Care Data
Percent of physicians indicating each as a source of quality of care
data
25
Health plans
13
Internal sources
Accreditation agencies
7
Professional societies
7
4
CMS
Regulatory agencies
3
Employer groups
3
Other
No answer
1
3
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart II-8. Physicians’ Ability to Generate
Any Quality-of-Care Data Internally
Percent indicating they receive quality-of-care data from internal sources
100
50
6
11
20
28
21
11
0
1 Physician
2–9
10–49
50+
EMR Used
Do Not Use
Physicians
Physicians
Physicians
Routinely/
EMR
Occasionally
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
26
27
Ability to Benchmark
28
Chart II-9. Physicians’ Ability to
Compare Performance
Percent of physicians able to compare themselves to
24%
Other physicians in specialty
22%
Other physicians in the same health plan
19%
Other physicians in practice/local area
11%
Other physicians nationally
Other hospitals/clinics/health centers
1%
Some other comparison group
1%
No comparison with other physicians possible
3%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
29
Sharing Performance Information
Chart II-10. Physicians’ Willingness
to Share Quality-of-Care Data
Willingness to share data with:*
Yes,
Definitely/
Probably
No,
Definitely/
Probably Not
Medical leadership
71%
27%
Physicians’ own patients
55%
44%
General public
29%
69%
Other physicians
72%
26%
* Answers to survey question: “To improve high quality of care in the U.S., which of the following
do you think should have access to ‘Quality of Care’ data about individual physicians?”
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
30
31
Chapter III
Physicians’ Involvement
in Quality Improvement
Activities
32
Chart III-1. Physicians’ Participation in Redesign
and Collaborative Activities, by Practice Size
Percent indicating involvement in redesign and collaborative efforts
Total
1 Physician
2–9 Physicians
10–49 Physicians
50+ Physicians
100
50
43
35
34
24
50
47
33
32
39
20
0
Redesign Efforts
Collaborative Efforts*
* Indicates physicians who responded yes to participating in local, regional, or national collaboratives in the past 2 years.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
33
Chart III-2. Physicians’ Participation in Redesign
and Collaborative Activities, by Physician Type
Percent indicating involvement in redesign and collaborative efforts
100
Total
50
34
Primary care physician
Specialist
42
31
32
36
30
0
Redesign Efforts
Collaborative Efforts*
* Indicates physicians who responded yes to participating in local, regional, or national collaboratives in the past 2 years.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
34
Chart III-3. Physicians’ Involvement in
Collaborative Efforts to Improve Quality of Care
Percent indicating involvement in any collaborative efforts in past two years*
100
No, have not been involved
Yes, a LOCAL effort
Yes, a REGIONAL effort
Yes, a NATIONAL effort
67
50
Involved in at least one effort (32%)
23
8
0
* Multiple answers possible.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
6
35
Chart III-4. Physicians’ Opinions on Effectiveness
of Collaborative Activities, by Practice Size
Percent saying that involvement in collaborative efforts
is “very/somewhat” effective in improving quality of care
100
76
68
77
81
83
50
0
Total
1 Physician
2-9
10-49
50+
Physicians
Physicians
Physicians
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
36
Chapter IV
Coordination of Care
and Referrals
Chart IV-1. Coordination of Care Problems
Physicians Observe
Coordination of care problems
Percent who
observed problem
sometimes or often
in past 12 months
Patient’s medical record, test results, or other relevant clinical
information were not available at the time of the scheduled visit
72%
Tests or procedures had to be repeated because findings were
unavailable or inadequate for interpretation
34%
Patient experienced a problem following discharge from a hospital because
physician did not receive needed information from the hospital in a timely manner
26%
Patient’s care was compromised because he/she received conflicting
information from different doctors or other health professionals
28%
Patient had a positive test result that was not followed-up appropriately
15%
Patient received the wrong drug, wrong dose, or had a preventable
drug-drug interaction
11%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
37
Chart IV-2. Coordination of Care Problems,
by Practice Size
38
Percent who say “often/sometimes” observed the following
1 Physician
2–9 Physicians
10–49 Physicians
50+ Physicians
100
74
78
76
64
44
50
33
33
0
Clinical Information
Not Available at Visit
Tests Repeated
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
33
Chart IV-3. Coordination of Care Problems,
by Practice Size
39
Percent who say “often/sometimes” observed the following
1 Physician
2–9 Physicians
10–49 Physicians
50+ Physicians
100
50
10
15
17
22
9
10
13
14
0
Test Results
Not Followed Up Properly
Wrong Dose/Medication
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart IV-4. Coordination of Care Problems,
by Practice Size
40
Percent who say “often/sometimes” observed the following
1 Physician
2–9 Physicians
10–49 Physicians
50+ Physicians
100
50
25
24
29
29
31
24
27
34
0
Patient Experienced
Coordination Problem Post
Hospital Discharge*
Patient’s Care Compromised
Because He/She Received
Conflicting Information
* A patient experienced a problem following discharge from a hospital because
his/her physician did not receive needed information from the hospital in a timely manner.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart IV-5. Coordination of Care Problems,
by Physician Type
Percent who say “often/sometimes” observed the following
100
Primary care physician
Specialist
50
37
28
32
23
0
Tests Repeated
Patient Experienced
Coordination Problem
Post-Hospital Discharge*
* A patient experienced a problem following discharge from a hospital because
his/her physician did not receive needed information from the hospital in a timely manner.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
41
Chart IV-6. Ability of Physicians to Provide
Same-Day Appointments, by Physician Type
Percent indicating how often they can provide same-day appointments
Often
100
77
Always
64
50
58
54
46
0
43
17
23
Total
Primary Care Physician
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
15
Specialist
42
43
Chart IV-7. Receipt of Timely
Referral Information
Percent who say they receive timely information about the results of a referral
Sometimes
28%
34%
Often
54%
Rarely
6%
Always
11%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
44
Chart IV-8. Receipt of Timely
Referral Information
Percent who say they “always/often” receive timely information
about the results of a referral
100
75
67
71
66
55
62
58
50
25
0
1
2–9
10–49
50+
Primary
Physician
Physicians
Physicians
Physicians
Care
Specialist
Physician
Practice Size
Physician Type
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart IV-9. Availability of Quality-of-Care Data
When Making Referrals
Percent indicating how often they have any data about a physician’s
quality of care when making referrals
Sometimes
16%
Rarely
32%
64%
Often
14%
Always
5%
Never
32%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
45
Chart IV-10. Availability of Quality-of-Care Data
When Making Referrals
Percent indicating they “always/often” have data about a physician’s
quality of care when making a referral
100
75
50
25
24
22
15
17
18
2–9
10–49
50+
10 Years or
11–15
Physicians
Physicians
Physicians
Less
Years
17
11
0
1 Physician
Practice Size
16+ Years
Years in Practice
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
46
47
Chart IV-11. Relative Importance of
Quality-of-Care Data
Percent indicating
following information is
MORE important than
quality-of-care data*
Physician’s reputation among peers
42%
Physician’s technical qualifications (e.g., training, education, board certification)
25%
Experiences with the physician
64%
Physician’s bedside manner, as reported by patients
25%
* Indicates physicians who responded that the above information was more important than quality-of-care data.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
48
Chapter V
Strategies to Improve
Quality of Care
Chart V-1. Physicians’ Opinions on Strategies
to Improve Quality of Care
Percent of physicians who indicate the following
are “very effective” in improving quality of care
52%
Having more time to spend with patients
41%
Better patient access to preventive care
35%
Improved teamwork and communication
More use of computer technology
Better information on best specialized
physicians/centers
Better treatment guidelines for common conditions
25%
23%
21%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
49
Chart V-2. Physicians’ Opinion on Team Care
Percent indicating
they “agree” or
“strongly agree” that*
The give and take among team members results in
better decisions regarding patient care
73%
The team process makes care more cumbersome
32%
The involvement of multiple team members increases
the likelihood of medical errors
24%
* Indicates physicians who, based on their experience working in teams,
said that they agree or disagree with the above.
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
50
Chart V-3. Physicians’ Opinion on Team Care,
by Practice Size
51
Percent who agree/strongly agree
100
1 Physician
65
73
2–9 Physicians
10–49 Physicians
50+ Physicians
80 81
50
37
33
28 27
32
23
19 17
0
The give and take among team
The team process makes care
The involvement of multiple
members results in better
more cumbersome
team members increases the
decisions regarding patient
likelihood of medical errors
care
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart V-4. Physicians’ Opinions on Team Care,
by Physician Type
Percent who say improved teamwork would be
“very effective” in improving quality of care
100
75
50
41
45
33
32
Specialist
Male
25
0
Primary Care
Female
Physician
Physician Type
Gender
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
52
53
Chapter VI
Incentives and Disincentives
to Providing Quality Care
and Physicians’ Satisfaction
with Current Practice
54
Chart VI-1. Factors Affecting
Physicians’ Compensation
Percent indicating the following as factors
in determining compensation or income
Major Factor
Minor Factor
Not a Factor
58%
Productivity/ Billing
14%
72%
Board Re-Certification Status
11%
28%
60%
39%
Measures of Clinical Care
8%
19%
72%
27%
Patient Surveys/ Experience
Quality Bonus/Incentive Payments from
Insurance Plans
8%
19%
27%
4% 15%
72%
80%
19%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
27%
55
Chart VI-2. Financial Consequences of Providing
High Quality of Care, by Practice Size
Percent indicating that providing high quality of care
“often/sometimes” means less income
100
51
58
52
50
41
46
0
Total
1 Physician
2–9
10–49
50+
Physicians
Physicians
Physicians
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
Chart VI-3. Physicians’ Satisfaction with
Current Medical Practice
Somewhat dissatisfied
17%
Somewhat satisfied
45%
Very dissatisfied
5%
Very satisfied
33%
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
56
Chart VI-4. Physicians’ Dissatisfaction with
Current Practice, by Practice Size
Percent “very or somewhat” dissatisfied with current practice
50
27
25
21
19
21
14
0
Total
1 Physician
2–9
10–49
50+
Physicians
Physicians
Physicians
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
57
58
Appendix
Profile of
Physician Respondents
Chart A-1. Characteristics of Small and Large
Group Physician Practices
Practice Characteristics
Total
Percent Distribution
1
Physician
2–9
Physicians
10–49
Physicians
50+
Physicians
27%
41%
17%
12%
100%
100%
100%
100%
Practice Setting
Hospital or public clinic
14
5
15
20
23
Single or multi-specialty group
52
—
78
69
55
Solo
25
93
—
—
—
9
2
6
11
22
41
16
43
53
72
Full owner
36
90
20
13
7
Part owner
28
2
45
35
24
Not an owner
35
8
34
52
68
Primary care
29
26
29
37
28
Specialist
71
74
71
63
72
8
10
6
7
8
21–40 hours
30
32
16
35
34
More than 40 hours
62
58
68
58
57
Other
Salary Status
Salaried (yes)
Ownership of Practice
Physician Type
Hours in Direct Care
20 hours or fewer
Source: The Commonwealth Fund National Survey of Physicians and Quality of Care.
59