Influence of patient education on profiles of physician practices

Background: Few data are available about the effect of patient socioeconomic status on profiles of physician practices. Objective: To determine the ways in which adjustment for patients' level of education las a measure of socioeconomic status) changes profiles of physician practices. Design: Cross-sectional survey of patients in physician practices. Setting: Managed care organization in western New York State. Participants: A random sample of 100 primary care physicians and 50 consecutive patients seen by each physician. Measurements: Ranks of physicians for patient physical and mental health (Short Form 12-item Health Survey) and satisfaction (Patient Satisfaction Questionnaire), adjusted for patient age, sex, morbidity, and education. Results: Physicians whose patients had a lower mean level of education had significantly better ranks for patient physical and mental health status after adjustment for patients' level of education level than they did before adjustment (P < 0.001); this result was not seen for patient satisfaction. After adjustment for patients' level of education, each 1-year decrease in mean educational level was associated with a rank that improved by 8.1 (95% CI, 6.6 to 9.6) for patient physical health status and by 4.9 (CI, 3.9 to 5.9) for patient mental health status. Adjustment for education had similar effects for practices with more educated patients and those with less educated patients. Conclusions: Profiles of physician practices that base ratings of physician performance on patients' physical and mental health status a re substantially affected by patients' level of education. However, these results do not suggest that physicians who care for less educated patients provide worse care. Physician profiling should account for differences in patients' level of education.