Chapter 6. Comparing Your Results

2012 User Comparative Database Report: Medical Office Survey on Patient Safety Culture

To compare your medical office's survey results with the results from the database, you need to calculate your medical office's percent positive response on the survey's 10 composites and other survey items, including patient safety and quality issues, information exchange with other settings, and ratings on quality and patient safety. The Notes section at the end of this report describes how to calculate these percent positive scores. You can then compare your medical office's results with the database averages and examine the percentile scores to place your medical office's results relative to the distribution of database medical offices.

When comparing your medical office's results with results from the database, keep in mind that the database only provides relative comparisons. Even though your medical office's survey results may be better than the database statistics, you may still believe there is room for improvement in a particular area within your medical office in an absolute sense.

As you will notice from the database results, there are some patient safety composites that even the highest scoring medical offices could improve on. Therefore, the comparative data provided in this report should be used to supplement your medical office's own efforts toward identifying areas of strength and areas on which to focus patient safety culture improvement efforts.
 

Highlights

  • There was considerable variability in the range of medical office scores (lowest to highest) across the 10 patient safety culture composites.
  • Overall Rating on Patient Safety showed a wide range of response as well. At one medical office, none of the respondents (0 percent) rated their office as "Excellent," and in another medical office, 88 percent did.

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Description of Comparative Statistics

In addition to the average percent positive scores presented in Chapter 5, a number of other statistics are provided to facilitate comparisons with the database medical offices. A description of each statistic shown in this chapter is provided next.

Average Percent Positive

The comparative results tables in this chapter present the average percent positive scores for each of the 10 patient safety culture composites and for the 51 survey items. In addition, a percent positive score is calculated for the Average Overall Rating on Quality and Patient Safety, which is the average percent positive scores across all five Overall Ratings on Quality and the Overall Rating on Patient Safety.

These average percent positive scores were calculated by averaging composite-level percent positive scores across all medical offices in the database, as well as averaging item-level percent positive scores across medical offices. Since the percent positive is displayed as an overall average, scores from each medical office are weighted equally in their contribution to the calculation of the average.i

Standard Deviation

The standard deviation (s.d.), a measure of the spread or variability of medical office scores around the average, is also displayed. The standard deviation tells you the extent to which medical offices' scores differ from the average:

  • If scores from all medical offices were exactly the same, then the average would represent all their scores perfectly and the standard deviation would be zero.
  • If scores from all medical offices were very close to the average, then the standard deviation would be small and close to zero.
  • If scores from many medical offices were very different from the average, then the standard deviation would be a large number.

When the distribution of medical office scores follows a normal bell-shaped curve (where most of the scores fall in the middle of the distribution, with fewer scores at the lower and higher ends of the distribution), the average, plus or minus the standard deviation, will include about 68 percent of all medical office scores. For example, if an average percent positive score across the database medical office was 70 percent with a standard deviation of 10 percent (and scores were normally distributed), then about 68 percent of all the database medical offices would have scores between 60 and 80 percent.

"Significant" differences between scores. You may be interested in determining the statistical significance of differences between your scores and the averages in the database, or between scores in various breakout categories (numbers of providers and staff, implementation status of electronic tools, etc). Statistical significance is greatly influenced by sample size; as the number of observations in comparison groups increases, small differences in scores become statistically significant. While a 1 percentage point difference between percent positive scores might be "statistically" significant (that is, not due to chance), the difference is not likely to be meaningful or "practically" significant.

Keep in mind that statistically significant differences are not always important, and nonsignificant differences are not always trivial. We provide the average, standard deviation, range, and percentile information so that you can compare your data with the database in different ways.

Minimum and Maximum Scores

The minimum (lowest) and maximum (highest) percent positive scores are presented for each composite and item. These scores provide information about the range of percent positive scores obtained by medical offices in the database and are actual scores from the lowest and highest scoring medical offices. When comparing with the minimum and maximum scores, keep in mind that these scores may represent medical offices that are extreme outliers (indicated by large differences between the minimum score and the 10th percentile score, or between the 90th percentile score and the maximum score).

Percentiles

The 10th, 25th, 50th (or median), 75th, and 90th percentile scores are displayed for the survey composites and items. Percentiles provide information about the distribution of medical office scores. To calculate percentile scores, we ranked all medical office percent positive scores in order from low to high. A specific percentile score shows the percentage of medical offices that scored at or below a particular score. For example, the 50th percentile, or median, is the percent positive score where 50 percent of the medical offices scored the same or lower and 50 percent of the medical offices scored higher.

 

When the distribution of medical office scores follows a normal bell-shaped curve (where most of the scores fall in the middle of the distribution with fewer scores at the lower and higher ends of the distribution), the 50th percentile, or median, will be very similar to the average score. Interpret the percentile scores as shown in Table 6-1.

To compare with the database percentiles, compare your medical office's percent positive scores with the percentile scores for each composite and item. Look for the highest percentile where your medical office's score is higher than that percentile.

 

For example: On survey item 1 in Table 6-2, the 75th percentile score is 49 percent positive, and the 90th percentile score is 62 percent positive.

  • If your medical office's score is 55 percent positive, it falls above the 75th percentile (but below the 90th), meaning that your medical office scored higher than at least 75 percent of the medical offices in the database.
  • If your medical office's score is 65 percent positive, it falls above the 90th percentile, meaning your medical office scored higher than at least 90 percent of the medical offices in the database.

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Composite and Item-Level Comparative Tables

 

The comparative results in Tables 6-3 and 6-4 show considerable variability in the range of medical office scores (lowest to highest) across the 10 patient safety culture composites. The standard deviation around the average percent positive scores ranged from 12 percent to 20 percent on the composites and ranged from 12 percent to 26 percent on the composite items.

 

Tables 6-5, 6-6, 6-7, 6-8, and 6-9 all show substantial variability, with responses ranging from 0 percent to a high score of 100 percent.

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Appendixes A and B: Overall Results by Medical Office and Respondent Characteristics

In addition to the overall results on the database medical offices presented, Part II of the report presents data tables showing average percent positive scores on the survey composites and items across database medical offices, broken down by the following medical office and respondent characteristics:

Appendix A: Results by Medical Office Characteristics:

  • Number of Providers.
  • Single vs. Multi-Specialty.
  • Specialty (Cardiology, Hematology, OB/GYN, Pediatrics, Primary Care).
  • Ownership.
  • Region.

Appendix B: Results by Respondent Characteristics:

  • Staff Position.

The breakout tables are included as appendixes because there are a large number of them. Highlights of the findings from the breakout tables in these appendixes are provided on the following pages. The appendixes are available on the following Web site: http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/2012/index.html.

Number of Providers (Tables A-1, A-3, A-5)

  • Medical offices with one or two providers had the highest average percent positive on all 10 patient safety culture composites.
  • Percent positive scores (those responding "Excellent" or "Very good") for all five Overall Ratings on Quality were higher for medical offices with fewer providers.
  • Medical offices with two providers had the highest (74 percent) percentage of respondents who gave their medical office an Average Overall Rating on Quality and Patient Safety of "Excellent" or "Very good"; medical offices with 14 to 19 providers had the lowest (57 percent).

Single vs. Multi-Specialty(Tables A-6, A-8, A-10)

  • Single specialty medical offices had a higher average percent positive response than Multi-Specialty medical offices on all 10 patient safety culture composites.
  • Single specialty medical offices had higher percent positive scores (those responding "Excellent" or "Very good") for all five Overall Ratings on Quality.
  • Single specialty medical offices had a higher percentage of respondents who gave their medical office an Average Overall Rating on Quality and Patient Safety of "Excellent" or "Very good" (68 percent) than Multi-Specialty medical offices (59 percent).

Specialtyii (Tables A-11, A-13, A-15)

  • No clear patterns emerged across specialties (Cardiology, Hematology, OB/GYN, Pediatrics, Primary Care) on the patient safety culture composites or the five Overall Ratings on Quality.
  • Medical offices that only specialized in Pediatrics had the highest Average Overall Rating on Quality and Patient Safety (those responding "Excellent" or "Very good") (69 percent); OB/GYN had the lowest (66 percent).

Ownership (Tables A-16, A-18, A-20)

  • Community health center and Provider and/or Physician owned medical offices had the highest average percent positive response across the composites (72 percent).
  • Federal, State, or local government medical offices had the lowest percent positive scores (those responding "Excellent" or "Very good") for all five Overall Ratings on Quality.
  • Federal, State, or local government medical offices had the lowest Average Overall Rating on Quality and Patient Safety (those responding "Excellent" or "Very good") (51 percent).

Region (Tables A-21, A-23, A-25)

  • South Atlantic medical offices had the highest average percent positive response on all 10 patient safety culture composites.
  • South Atlantic medical offices had higher percent positive scores (those responding "Excellent" or "Very good") for all five Overall Ratings on Quality.
  • South Atlantic medical offices had the highest percentage of respondents who gave their medical office an Average Overall Rating on Quality and Patient Safety of "Excellent" or "Very good" (70 percent).

Staff Position (Tables B-1, B-3, B-5)

  • Management had the highest average percent positive response across the composites (80 percent).
  • Management had the highest percent positive scores (those selecting "Excellent" or "Very Good") for three of the five Overall Ratings on Quality; Physicians had the highest percent positive scores for the other two ratings.
  • Management had the highest percentage who gave their medical office an Average Overall Rating on Quality and Patient Safety of "Excellent" or "Very good" (73 percent); Administrative/Clerical had the lowest (60%).

i. As described in the Notes section, an alternative method would be to report a straight percentage of positive response across all respondents, but this method would give greater weight to respondents from larger medical offices since they account for more responses than smaller medical offices.
ii. Primary Care includes internal medicine, family practice, general preventive medicine, and general practice.


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Current as of May 2012
Internet Citation: Chapter 6. Comparing Your Results: 2012 User Comparative Database Report: Medical Office Survey on Patient Safety Culture. May 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/2012/mosurv12chap6.html