Practice Characteristics and HMO Enrollee Satisfaction with Specialty Care: An Analysis of Patients with Glaucoma and Diabetic Retinopathy

Authors

  • José J. Escarce,

    1. Address correspondence to: José J. Escarce, M.D., Ph.D., RAND Health Program, 1700 Main St., PO Box 2138, Santa Monica, CA 90407-2138.Dr. Escarce and Carol M. Mangione, M.D., M.S.P.H. (who is also with RAND Health Program), are with the Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, as well. Kanika Kapur, Ph.D., Matthew D. Solomon, M.A., M. Phil., Paul P. Lee, M.D., J.D., John L. Adams, Ph.D., and Elaine S. Quiter, M.S., are with RAND Health Program in Santa Monica. In addition, Dr. Lee is with the Department of Ophthalmology, Duke Eye Center, Durham NC., Steven L. Wickstrom, M.S., is with the Center for Health Care Policy and Evaluation, United Health Care, Minneapolis, MN.
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  • 1,2 Kanika Kapur,

    1. Address correspondence to: José J. Escarce, M.D., Ph.D., RAND Health Program, 1700 Main St., PO Box 2138, Santa Monica, CA 90407-2138.Dr. Escarce and Carol M. Mangione, M.D., M.S.P.H. (who is also with RAND Health Program), are with the Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, as well. Kanika Kapur, Ph.D., Matthew D. Solomon, M.A., M. Phil., Paul P. Lee, M.D., J.D., John L. Adams, Ph.D., and Elaine S. Quiter, M.S., are with RAND Health Program in Santa Monica. In addition, Dr. Lee is with the Department of Ophthalmology, Duke Eye Center, Durham NC., Steven L. Wickstrom, M.S., is with the Center for Health Care Policy and Evaluation, United Health Care, Minneapolis, MN.
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  • 3 Matthew D. Solomon,

    1. Address correspondence to: José J. Escarce, M.D., Ph.D., RAND Health Program, 1700 Main St., PO Box 2138, Santa Monica, CA 90407-2138.Dr. Escarce and Carol M. Mangione, M.D., M.S.P.H. (who is also with RAND Health Program), are with the Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, as well. Kanika Kapur, Ph.D., Matthew D. Solomon, M.A., M. Phil., Paul P. Lee, M.D., J.D., John L. Adams, Ph.D., and Elaine S. Quiter, M.S., are with RAND Health Program in Santa Monica. In addition, Dr. Lee is with the Department of Ophthalmology, Duke Eye Center, Durham NC., Steven L. Wickstrom, M.S., is with the Center for Health Care Policy and Evaluation, United Health Care, Minneapolis, MN.
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  • 3 Carol M. Mangione,

    1. Address correspondence to: José J. Escarce, M.D., Ph.D., RAND Health Program, 1700 Main St., PO Box 2138, Santa Monica, CA 90407-2138.Dr. Escarce and Carol M. Mangione, M.D., M.S.P.H. (who is also with RAND Health Program), are with the Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, as well. Kanika Kapur, Ph.D., Matthew D. Solomon, M.A., M. Phil., Paul P. Lee, M.D., J.D., John L. Adams, Ph.D., and Elaine S. Quiter, M.S., are with RAND Health Program in Santa Monica. In addition, Dr. Lee is with the Department of Ophthalmology, Duke Eye Center, Durham NC., Steven L. Wickstrom, M.S., is with the Center for Health Care Policy and Evaluation, United Health Care, Minneapolis, MN.
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  • 2 Paul P. Lee,

    1. Address correspondence to: José J. Escarce, M.D., Ph.D., RAND Health Program, 1700 Main St., PO Box 2138, Santa Monica, CA 90407-2138.Dr. Escarce and Carol M. Mangione, M.D., M.S.P.H. (who is also with RAND Health Program), are with the Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, as well. Kanika Kapur, Ph.D., Matthew D. Solomon, M.A., M. Phil., Paul P. Lee, M.D., J.D., John L. Adams, Ph.D., and Elaine S. Quiter, M.S., are with RAND Health Program in Santa Monica. In addition, Dr. Lee is with the Department of Ophthalmology, Duke Eye Center, Durham NC., Steven L. Wickstrom, M.S., is with the Center for Health Care Policy and Evaluation, United Health Care, Minneapolis, MN.
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  • 3 John L. Adams,

    1. Address correspondence to: José J. Escarce, M.D., Ph.D., RAND Health Program, 1700 Main St., PO Box 2138, Santa Monica, CA 90407-2138.Dr. Escarce and Carol M. Mangione, M.D., M.S.P.H. (who is also with RAND Health Program), are with the Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, as well. Kanika Kapur, Ph.D., Matthew D. Solomon, M.A., M. Phil., Paul P. Lee, M.D., J.D., John L. Adams, Ph.D., and Elaine S. Quiter, M.S., are with RAND Health Program in Santa Monica. In addition, Dr. Lee is with the Department of Ophthalmology, Duke Eye Center, Durham NC., Steven L. Wickstrom, M.S., is with the Center for Health Care Policy and Evaluation, United Health Care, Minneapolis, MN.
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  • 3 Steven L. Wickstrom,

    1. Address correspondence to: José J. Escarce, M.D., Ph.D., RAND Health Program, 1700 Main St., PO Box 2138, Santa Monica, CA 90407-2138.Dr. Escarce and Carol M. Mangione, M.D., M.S.P.H. (who is also with RAND Health Program), are with the Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, as well. Kanika Kapur, Ph.D., Matthew D. Solomon, M.A., M. Phil., Paul P. Lee, M.D., J.D., John L. Adams, Ph.D., and Elaine S. Quiter, M.S., are with RAND Health Program in Santa Monica. In addition, Dr. Lee is with the Department of Ophthalmology, Duke Eye Center, Durham NC., Steven L. Wickstrom, M.S., is with the Center for Health Care Policy and Evaluation, United Health Care, Minneapolis, MN.
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  • and 4 Elaine S. Quiter 3

    1. Address correspondence to: José J. Escarce, M.D., Ph.D., RAND Health Program, 1700 Main St., PO Box 2138, Santa Monica, CA 90407-2138.Dr. Escarce and Carol M. Mangione, M.D., M.S.P.H. (who is also with RAND Health Program), are with the Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, as well. Kanika Kapur, Ph.D., Matthew D. Solomon, M.A., M. Phil., Paul P. Lee, M.D., J.D., John L. Adams, Ph.D., and Elaine S. Quiter, M.S., are with RAND Health Program in Santa Monica. In addition, Dr. Lee is with the Department of Ophthalmology, Duke Eye Center, Durham NC., Steven L. Wickstrom, M.S., is with the Center for Health Care Policy and Evaluation, United Health Care, Minneapolis, MN.
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  • Supported by Cooperative Agreement U01-HS-09942 from the Agency for Healthcare Research and Quality and the American Association of Health Plans Foundation.

Abstract

Background. The specialist's role in caring for managed care patients is likely to grow. Thus, assessing the correlates of patient satisfaction with specialty care is essential.

Objective. To examine the association between characteristics of eye care practices and satisfaction with eye care among working age patients with open-angle glaucoma (OAG) or diabetic retinopathy (DR).

Subjects/Study Setting. A total of 913 working age patients with OAG or DR enrolled in six commercial managed care health plans. The patients were treated in 144 different eye care practices.

Study Design. We used a patient survey to obtain information on patient characteristics and satisfaction with eye care, measured by scores on satisfaction subscales of the 18-item Patient Satisfaction Questionnaire. We used a survey of eye care practices to obtain information on practice characteristics, including provider specialties, practice organization, financial features, and utilization and quality management systems. We estimated logistic regression models to assess the association of patient and practice characteristics with high levels of patient satisfaction.

Principal Findings. Treatment in a practice with a glaucoma specialist (for OAG patients) or a retina specialist (for DR patients) was associated with higher satisfaction, whereas treatment in a practice that obtained a high proportion of its revenues from capitation payments or in a group practice where providers obtained a high proportion of their incomes from bonuses was associated with lower satisfaction.

Conclusions. Many eye care patients prefer to be treated by specialists with expertise in their conditions. Financial arrangement features of eye care practices also are associated with patient satisfaction with care. The most likely mechanisms underlying these associations are effects on provider behavior and satisfaction, which in turn influence patient satisfaction. Managed care plans and provider groups should aim to minimize the negative impact of managed care features on patient satisfaction.

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