ArticleBMJ quality & safety2012
Should measures of patient experience in primary care be adjusted for case mix? Evidence from the English General Practice Patient Survey.
Article in BMJ quality & safety, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 63 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
63 citing papers in PubMed, 1 synthesis or guideline pooled it.
- A systematic review of the validity and reliability of patient-reported experience measures.Health services research · 2019Pooled it
- Evaluation of the Prevention and Reactivation Care Program (PreCaP) for the hospitalized elderly: a prospective nonrandomized controlled trial.Clinical interventions in aging · 2015Trial
- Case-mix adjustments of patient reported experience measures in general practice: variations between Norwegian municipalities.Scandinavian journal of primary health care · 2026Article
- Case-mix adjustment through inverse probability weighting to compare health indicators across territories or providers - an application in the agency for health protection of Milan.BMC health services research · 2025Article
- Case-mix Adjustment of Patient Reported Experience Measures (PREMs): a rapid review to inform benchmarking practices across inpatient health centers in Switzerland.Journal of patient-reported outcomes · 2025Review
- Variation in the use of primary care-led investigations prior to a cancer diagnosis: analysis of the National Cancer Diagnosis Audit.BMJ quality & safety · 2025Article
- Developing quality indicators for cancer hospitals in China: a national modified Delphi process.BMJ open · 2024Review
- Case-mix adjustments for patient reported experience and outcome measures in primary care: an empirical approach to identify patient characteristics as case-mix adjusters based on a secondary analysis of an international survey among patients and their general practitioners in 34 countries.Journal of patient-reported outcomes · 2023Article
- Case-mix adjustment of patient-reported experience measures in National Regional Center for Pediatric.Pediatric research · 2023Article
- Patient healthcare experiences of cancer hospitals in China: A multilevel modeling analysis based on a national survey.Frontiers in public health · 2023Article
- The hospital care experiences of older patients compared to younger patients.Journal of the American Geriatrics Society · 2022Article
- Comparing healthcare quality: A common framework for both ordinal and cardinal data with an application to primary care variation in England.Health economics · 2022Article
- Article
- Adjusting for Patient Characteristics to Compare Quality of Care Provided by Serious Illness Programs.Journal of palliative medicine · 2022Article
- Understanding disparities in primary care patient experience.Canadian family physician Medecin de famille canadien · 2021Article
- Impact of primary care funding on patient satisfaction: a retrospective longitudinal study of English general practice, 2013-2016.The British journal of general practice : the journal of the Royal College of General Practitioners · 2021Article
- Changes in patient experience associated with growth and collaboration in general practice: observational study using data from the UK GP Patient Survey.The British journal of general practice : the journal of the Royal College of General Practitioners · 2020Observational
- Evaluating quality in clinical care.Surgery (Oxford, Oxfordshire) · 2020Review
- Do collaboRATE Scores Reflect Differences in Perceived Shared Decision-Making Across Diverse Patient Populations? Evidence From a Large-Scale Patient Experience Survey in the United States.Journal of patient experience · 2020Article
- Measuring Patient-Reported Shared Decision-Making to Promote Performance Transparency and Value-Based Payment: Assessment of collaboRATE's Group-Level Reliability.Journal of patient experience · 2020Article
3 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
objectivesUncertainties exist about when and how best to adjust performance measures for case mix. Our aims are to quantify the impact of case-mix adjustment on practice-level scores in a national survey of patient experience, to identify why and when it may be useful to adjust for case mix, and to discuss unresolved policy issues regarding the use of case-mix adjustment in performance measurement in health care. DESIGN/
settingSecondary analysis of the 2009 English General Practice Patient Survey. Responses from 2 163 456 patients registered with 8267 primary care practices. Linear mixed effects models were used with practice included as a random effect and five case-mix variables (gender, age, race/ethnicity, deprivation, and self-reported health) as fixed effects.
main outcome measuresPrimary outcome was the impact of case-mix adjustment on practice-level means (adjusted minus unadjusted) and changes in practice percentile ranks for questions measuring patient experience in three domains of primary care: access; interpersonal care; anticipatory care planning, and overall satisfaction with primary care services.
resultsDepending on the survey measure selected, case-mix adjustment changed the rank of between 0.4% and 29.8% of practices by more than 10 percentile points. Adjusting for case-mix resulted in large increases in score for a small number of practices and small decreases in score for a larger number of practices. Practices with younger patients, more ethnic minority patients and patients living in more socio-economically deprived areas were more likely to gain from case-mix adjustment. Age and race/ethnicity were the most influential adjustors.
conclusionsWhile its effect is modest for most practices, case-mix adjustment corrects significant underestimation of scores for a small proportion of practices serving vulnerable patients and may reduce the risk that providers would 'cream-skim' by not enrolling patients from vulnerable socio-demographic groups.
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