Dialysis patient ratings of the quality of medical care.

Dialysis patients receive medical care from a variety of physicians. Little is known about how dialysis patients assess the quality of this care. We sought to determine (1) who dialysis patients receive medical care from, (2) how they rate the quality of such care, and (3) how ratings differ for care provided by generalists, nephrologists, and other specialists. We performed a cross-sectional interview study of 148 patients from four chronic hemodialysis units. Using a structured questionnaire, we asked subjects about each condition for which they received care in the preceding 12 months. For each condition, subjects mentioned the type of physician who provided care and then rated their overall satisfaction with care as well as six components of quality of care (availability of doctor, technical skill, personal manner, explanations provided, amount of time spent, and how much patient was helped). We found that generalists, nephrologists, and other specialists provided care for 14%, 48%, and 38% of conditions for which patients received care. Sixty-nine percent of overall satisfaction ratings were very good or better. Of the six components of quality of care, explanations and amount of time received the lowest ratings. On multivariate analysis, increased patient age, black race, and care for acute illnesses were associated with lower ratings of quality of care. There was no difference in ratings of care provided by generalists, nephrologists, and other specialists. In conclusion, dialysis patients receive most of their medical care from nephrologists and other specialists. Although they generally rate this care highly, we recommend that providers pay special attention to explanations provided, time spent with patients, and care for acute illness.