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Patient experience is a critical measure for ambulatory primary care, although it is unclear how to best improve patient experience scores. This study aimed to determine whether use of a real-time feedback (RTF) device improved patient experience scores in a cluster-randomized trial. The primary outcomes were change from baseline in 9 Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CG-CAHPS) question and domain scores most closely related to the RTF questions asked in a linear mixed effects model. There were no observed statistically significant intervention-related differences in CG-CAHPS scores in any of the 9 CG-CAHPS questions or domains ( P = .12-.99). In intervention clinics, there were no statistically significant correlation between CG-CAHPS top box scores and RTF device scores ( P = .23-.98). Clinics in an urban primary care network randomized to receive RTF devices did not significantly improve related CG-CAHPS question or domain scores nor were those scores correlated with RTF device scores. More research is needed to identify effective interventions to improve ambulatory primary care patient experience.

Background . The use of computer interpretations of electrocardiograms (ECGs) as an aid to physician interpretations is widespread. Computer misinterpretations are common and negatively affect physician interpretations. Objective . To measure the effect of computer ECG misinterpretations on clinical decision making. Design . Quasi-randomized trial. Setting . Resident teaching conferences. Participants . Included 105 internal and emergency medicine residents. Intervention . After a brief case presentation, residents were asked to interpret an ECG and choose appropriate management. Residents chose from a concealed stack of handouts; some contained an erroneous computer interpretation of the ECG (citing acute ischemia), and some contained no computer interpretation. Measurements . ECG interpretations and management decisions by residents whose ECG did or did not include an erroneous computer interpretation were compared using chi-square tests. Results . The presence or absence of erroneous computer interpretations of ischemia did not significantly affect residents' ECG interpretations (P= 0.62). However, the residents whose ECGs included erroneous computer interpretations were more likely to recommend revascularization than the residents without (30% v. 10%, P= 0.01). Of those residents who read the ECG as diagnostic of ischemia, those with the erroneous computer interpretation were more likely to recommend revascularization than those without (54% v. 25%, P= 0.048). Limitations . A single ECG was used. Conclusions . Erroneous computer interpretations of ECGs affected residents' clinical decision making in the absence of an effect on the actual interpretation of the ECG. Measuring the impact of computer misinterpretations by examining only physician interpretations will underestimate the effect of computer misinterpretations on clinical decision making.