Comparisons of patients’ satisfaction should take expectations into account

Patients’ experiences have become increasingly important in the assessment of quality of care1,2. For example, the Centers for Medicare & Medicaid Services (CMS) uses Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys to measure patient experience, and reward providers for providing high quality care through Value-Based Purchasing initiatives3. There is concern, however, that patients’ reports may be related to typically unmeasured characteristics, such as their expectations for care4,5 or frame of mind at the start of a visit6. We report the results of a survey of skin cancer patients’ experiences with care, and how adjustment for expectation fulfillment may affect comparisons of quality between two practice settings. This article is protected by copyright. All rights reserved.