A 10-itemquality of care summarymeasurewas adapted fromitems
in the Community Tracking Study Physician Survey, a nationally
representative telephone survey by the Center for Studying Health
System Change (The Community Tracking Study (CTS) Physician Survey,
n.d.) (scored from 10 to 50, with higher scores representing positive
views on quality of care delivery). We added two items to reflect cost
concerns in providing care and an itemmeasuring communication with
third party payers. The items reflect providers' perceptions about
abilities to make clinical decisions that meet their patient's needs, level
of communication with other providers and third party payers,
balancing cost concerns with patient advocacy, and time spent with
patients. Construct validity was assessed using exploratory factor
analysis. Two factors accounted for 49% of the variance in the scale
score. The first factor, consisting of 5-items, measured quality patient
carewith loadings ranging from0.59 to 0.72. The second factor consisted
of 5-itemsmeasuring communicationwith others and cost issues. Factor
loadings for this subscale ranged from 0.46 to 0.80. The item “canmake
clinical decisions in the best interest of my patients without pressure to
keep the cost down” also loaded moderately on the quality of patient
care factor (loading = 0.47). Cronbach's alpha showed an internal
consistency of 0.81 for the total scale and acceptable reliabilities for the
subscales (0.74 for the patient care subscale and 0.70 for the
communication/cost subscale respectively).