Dorothea M. G. Wild, M.D., M.P.H., Dr. med.; Nancy Kwon; Suparna Dutta, M.D., M.P.H.; Baylah Tessier-Sherman, M.P.H.; Navitha Woddor, M.D.; Heather L. Sipsma, Ph.D.; Tara Rizzo, M.P.H.; Elizabeth H. Bradley, Ph.D. G ood physician communication is a vital precondition for patient-centered and safe care. 1 Although there are many instruments to measure the patient-centeredness of physician communication, 2 the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey—also known as the CAHPS ® Hospital Survey or Hospital CAHPS—is commonly used to assess physician communication in the hos- pital setting. 3 Among other items, HCAHPS measures patient satisfaction with physician communication by asking how often physicians treated patients with courtesy and respect, listened carefully to patients, and explained things in a way patients can understand. The HCAHPS survey has been extensively vali- dated to reflect patients’ perceptions. 3-5 For public reporting, HCAHPS physician reports are summarized into the percentage of patients of any given hospital who answered “always.” 6 The HCAHPS provides patient ratings of physician communication in general (henceforth called the “overall score”), potentially obscuring differences among the various physicians involved in a patient’s care. Hospitalized patients in- teract with multiple types of physicians, such as emergency medicine (EM) physicians, hospitalists, and specialists. There- fore, physicians and administrators struggle with how to inter- pret their communication scores. To implement effective efforts to improve patient experiences of physician communication, it is important for hospitals to understand how ratings may be influenced by patient experiences with various physician types. Accordingly, we examined the strength of the association be- tween HCAHPS physician communication scores for different physician types—EM physicians, hospitalists, specialists—and the overall physician communication score. We also asked pa- tients what factors influenced their scores. This study’s findings can help hospitals design efforts to improve physician commu- nication as perceived by hospitalized patients. Performance Measures Who’s Behind an HCAHPS Score? Article-at-a-Glance Background: The Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey asks patients how frequently their physicians treated them with courtesy and respect, listened carefully, and explained things in a way they could understand. Such summary reports may obscure differences among the types of physicians involved. A study was conducted to examine the association between ratings for different physician types and the overall HCAHPS rating of physicians. Methods: A mixed-methods study included closed-ended surveys and in-depth interviews of patients on a hospitalist teaching service. The three HCAHPS physician communi- cation items were used to interview patients about their communication experiences with emergency medicine (EM) physicians, hospitalists, and specialists. The association be- tween the overall score and the scores of each physician type was examined using Spearman correlation coefficients and linear regression. Qualitative data from additional in-depth interviews were analyzed using the constant comparative method to identify recurrent themes. Results: Ninety-six patients were recruited for the survey, and additional in-depth interviews were conducted with the first 30 patients. Hospitalist and specialist scores were sig- nificantly associated (p values < .05) with overall scores. Re- current themes regarding determinants of patients’ ratings were categorized in three broad domains: individual physi- cian behavior, team communication, and system issues. The influence of each domain differed across physician types. Discussion: Physician communication scores may be most strongly influenced by patient experiences with hospitalists and specialists rather than with EM physicians. Several team communication and system issues represent opportunities for improving physician communication. The Joint Commission Journal on Quality and Patient Safety October 2011 Volume 37 Number 10 461 Copyright 2011 © The Joint Commission