The Unreliability of Individual Physician “Report Cards” for Assessing the Costs and Quality of Care of a Chronic Disease

Hofer, Timothy P.; Hayward, Rodney A.; Greenfield, Sheldon; Wagner, Edward H.; Kaplan, Sherrie H.; Manning, Willard G.

doi:10.1097/00132586-200006000-00055

Cited by 113 publications

(163 citation statements)

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“…34 Initial enthusiasm about physician-level quality measures has been tempered by several concerns, including the reliability of these measures and their stability over time. 35,36 For many quality measures, provider variation is low, with intraclass correlation coefficients of <0.10. 35,37 This in turn leads to low reliability of provider performance estimates, unless the number of patients per provider is larger than is feasible for most measures.…”

Section: Discussionmentioning

confidence: 99%

“…35,36 For many quality measures, provider variation is low, with intraclass correlation coefficients of <0.10. 35,37 This in turn leads to low reliability of provider performance estimates, unless the number of patients per provider is larger than is feasible for most measures. However, the high physician variability in early imaging for acute low back pain allows for generation of estimates with reliability of >0.80 for physicians with at least 20 such patients.…”

Section: Discussionmentioning

confidence: 99%

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Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain

2015

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BACKGROUND: Diagnostic imaging is not recommended in the evaluation and management of non-specific acute low back pain. OBJECTIVE: To estimate the variation among primary care providers (PCPs) in the use of diagnostic imaging for older patients with non-specific acute low back pain. DESIGN AND PARTICIPANTS: Retrospective cohort study using 100 % Texas Medicare claims data. We identified 145,320 patients aged 66 years and older with nonspecific acute low back pain during the period January 1, 2007, through November 30, 2011, cared for by 3297 PCPs. MAIN MEASURES: We tracked whether each patient received lumbar imaging (radiography, computed tomography [CT], or magnetic resonance imaging [MRI]) within 4 weeks of the initial visit. Multilevel logistic regression models were used to estimate physician-level variation in imaging use. KEY RESULTS: Among patients, 27.2 % received radiography and 11.1 % received CT or MRI within 4 weeks of the initial visit for low back pain. PCPs varied substantially in the use of imaging. The average rate of radiography within 4 weeks was 53.9 % for PCPs in the highest decile, compared to 6.1 % for PCPs in the lowest decile. The average rates of CT/MRI within 4 weeks were 18.5 % vs. 3.2 % for PCPs in the highest and lowest deciles, respectively. The specific physician seen by a patient accounted for 25 % of the variability in whether imaging was performed, while only 0.44 % of the variance was due to measured patient characteristics and 1.4 % to known physician characteristics. Use of imaging by individual physicians was stable over time. CONCLUSIONS: PCPs vary substantially in the use of imaging for non-specific acute low back pain. Providerlevel measures can be employed to provide feedback to physicians in an effort to modify imaging use.KEY WORDS: back pain; care management; practice variation; primary care; quality assessment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain

2015

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“…These process-of-care measures do not penalize physicians or systems that care for sicker or less adherent patients (42). Hofer and colleagues (43) showed that high outlier physicians could dramatically improve profiles on the basis of levels of control alone, simply by avoiding caring for some patients with elevated risk factor levels.…”

Section: Discussionmentioning

confidence: 99%

Therapy Modifications in Response to Poorly Controlled Hypertension, Dyslipidemia, and Diabetes Mellitus

et al. 2006

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“…Such physicians are likely to have a reasonably large and homogeneous sample of patients from which to draw inferences about their quality as compared with primary care physicians, who see patients with a wide range of diseases and within disease a wide range of severity (e.g., varying combinations of comorbidities). In the case of primary care physicians treating diabetic patients, even drawing inferences about cost, something presumably one can measure with less error than quality, is problematic because of the small number of diabetics in any primary care physician practice-and diabetes is a relatively common disease (Hofer et al, 1999). Furthermore, in the case of procedures it is less problematic to attribute outcomes to a given physician than in the case of managing a patient with a medical problem who may have seen several physicians.…”

Section: Other Competitive Factors and Physician Payoffmentioning

confidence: 99%

Using performance measures to motivate ‘report-averse’ and ‘report-loving’ agents

Glazer

McGuire

Newhouse³

2007

Journal of Health Economics

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In designing a quality report, a health plan needs to account for the report's effect on the doctor, hospital or other provider. This paper proposes a simple model of how quality reporting affects a health care provider, using the example of a doctor subject to reporting with a "cut point" that designates the doctor as above or below some standard. Choice of cut point affects the doctor's welfare through the doctor's preferences about income and by affecting market demand for the doctor's services. These factors lead doctors to be "reportaverse" or "report-loving," a determination that affects a health plan's cost to enlist a doctor in a contract with reporting and that guides choice of a cut point to maximize the doctors' effort to improve her quality.

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The Unreliability of Individual Physician “Report Cards” for Assessing the Costs and Quality of Care of a Chronic Disease

Cited by 113 publications

References 0 publications

Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain

Variation among Primary Care Physicians in the Use of Imaging for Older Patients with Acute Low Back Pain

Therapy Modifications in Response to Poorly Controlled Hypertension, Dyslipidemia, and Diabetes Mellitus

Using performance measures to motivate ‘report-averse’ and ‘report-loving’ agents

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