Assessing Performance in Health Care Using International Surveys: Are Patient and Clinician Perspectives Complementary or Substitutive

BACKGROUND: Over the last decade, international surveys of patients and clinicians have been used to compare health care across countries. Findings from these surveys have been extensively used to create aggregate scores and rankings. OBJECTIVE: To assess the concordance of survey responses provided by patients and clinicians. METHODS: Analysis of 16 pairs of questions that focused on coordination, organizational factors, and patient-centered competencies from the Commonwealth Fund International Health Policy Survey of older adults (2014) and of primary care physicians (2015). Concordance was assessed by comparing absolute rates and relative rankings. RESULTS: In absolute terms, patients and clinicians gave differing responses for questions about coordination of care (patients were more positive) and provision of after-hours care (patients were less positive). In relative terms, country rankings were positively correlated for 5 of 16 question pairs (Spearman ρ > .6 and P < .05). CONCLUSION: Patterns of concordance between patient and clinician perspectives provides information to guide the use of survey data in performance assessment. However, this study highlights the need to assess the complementarity and substitutive nature of patients’ and clinicians’ perspectives before combining them to create aggregate assessments of performance.