|Study: Physician Performance Can Be Tiered Using Measure Composites
The performance of physician practices can be reliably
measured by using a composite of quality measures, according to
research led by Sherrie Kaplan, PhD, MPH of the University of
California at Irvine and co-authored by National Committee for Quality
Assurance Executive Vice President Dr. Greg Pawlson.
Published in Medical Care, the findings – that
used data from NCQA-recognized physicians – suggest that
physician practices can be distributed into three levels of relative
quality (high, average, low) when a cluster of measures, rather than a
single measure, is used to differentiate performance.
Researchers used data submitted by physicians who were
recognized in the NCQA Diabetes Physician Recognition Program (DPRP).
Using a sample of 35 patients from each practice, the research team
analyzed data from 11 diabetes measures. They found that combining
performance on five to nine measures could reliably separate practices
into three levels of quality.
"This research suggests that evaluating physician
practices for pay-for-performance or similar programs can be a sound
process when based on selected measure composites," said Pawlson. "As
we move further into the widespread use of evaluation at the physician
practice level, careful testing and evaluation of the evaluation
methodology is critical for ensuring that the information is accurate
and draws fair conclusions. Composite measures appear to offer a
substantial advantage over individual or unrelated measures in this
Evaluation programs need to use a carefully selected set
of measures to be meaningful. "Our study underscores the importance of
setting thresholds for the measures that reflect the degree of
physician influence or impact on the measures," said Kaplan.
"Identifying thresholds that reflect physician impact in contrast to
the influence of the other factors, like patient characteristics, is of
critical importance for fair and reliable performance assessment."
Address; National Committee for Quality Assurance, 1100 13th Street NW, Suite 1000, Washington DC 20005; (202) 955-3500, www.ncqa.org.