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Study calls for better data for physician profiling

Research Activities, June 2009, No. 346

An ever-increasing number of health insurance plans are using physician performance data to improve quality and market share. More than one-third of health maintenance organizations (HMOs) now reward physicians based on quality measures, such as colorectal cancer screening for eligible patients or use of appropriate medications for patients with asthma. However, questions regarding the reliability and validity of these measures remain. The authors of a new study recommend greater efforts to improve the quality and quantity of data available for physician profiling. They found that most physicians did not have adequate numbers of quality events (patients that qualified for a specific screening or treatment) to support reliable quality measurement.

The researchers evaluated data obtained from 9 health plans covering more than 11 million members. They used 27 quality measures to determine the effectiveness of care delivered, and calculated the number of quality events. The authors point out that using administrative data to measure and compare physician performance on a reliable basis is challenging. This is particularly true when data are limited to patients in a single health plan. With this limitation, the researchers found that only a small number of physicians could be profiled in a reliable way on common quality measures.

Most measures required at least 50 quality events per physician to get a reliable estimate of a physician's performance. The largest proportions of physicians that were reliably evaluated on a single quality measure were 8 percent for colorectal cancer screening and 2 percent for diabetic kidney disease screening. When the researchers used composite measures of preventive, chronic, acute, and overall care, more physicians were able to be evaluated reliably. However, the majority of physicians in this large database could not be evaluated reliably by either method. The study was supported in part by the Agency for Healthcare Research and Quality (HS16277).

See "Benchmarking physician performance: Reliability of individual and composite measures," by Sarah Hudson Scholle, M.P.H., Dr.P.H., Joachim Roski, Ph.D., M.P.H., John L. Adams, Ph.D., and others, in the December 2008 American Journal of Managed Care 14(12), pp. 829-839.

Current as of June 2009
Internet Citation: Study calls for better data for physician profiling: Research Activities, June 2009, No. 346. June 2009. Agency for Healthcare Research and Quality, Rockville, MD.