slide1 n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
AcademyHealth, June 9, 2008 Washington, DC Weifeng Weng, Gerald K. Arnold, PowerPoint Presentation
Download Presentation
AcademyHealth, June 9, 2008 Washington, DC Weifeng Weng, Gerald K. Arnold,

Loading in 2 Seconds...

play fullscreen
1 / 16

AcademyHealth, June 9, 2008 Washington, DC Weifeng Weng, Gerald K. Arnold, - PowerPoint PPT Presentation


  • 102 Views
  • Uploaded on

Comparison of Physician Rankings on Performance Quality Composites in the Care of Hypertensive Patients. AcademyHealth, June 9, 2008 Washington, DC Weifeng Weng, Gerald K. Arnold, Eric S. Holmboe, Rebecca S. Lipner. ABIM and Maintenance of Certification (MOC).

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'AcademyHealth, June 9, 2008 Washington, DC Weifeng Weng, Gerald K. Arnold,' - ewa


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1

Comparison of Physician Rankings on Performance Quality Composites in the Care of Hypertensive Patients

AcademyHealth, June 9, 2008

Washington, DC

Weifeng Weng, Gerald K. Arnold,

Eric S. Holmboe, Rebecca S. Lipner

abim and maintenance of certification moc
ABIM and Maintenance of Certification (MOC)
  • ABIM certifies physicians in internal medicine and its subspecialties
  • Certification is time-limited: 10 year duration
  • Renew certificates through MOC program
  • MOC requires demonstration of
    • Professionalism
    • Lifelong Learning
    • Cognitive Expertise
    • Practice performance
practice improvement module pim tm
Practice Improvement Module (PIMTM)

Evidence-based guidelines

Based on Picker patient and CAHPS surveys

Based on Wagner’s Chronic Care Model & IHI’s Idealized Office Design

Patient survey

Practice survey

Chart audit

Performance Report

Improvement

plan

do

act

Impact

study

research question
Research Question
  • In P4P programs
    • Clinical measures dominate
    • Patient survey and Practice system survey measures used less frequently
    • Typically, rewards awarded by relative ranking
    • Typically not all three data streams used
  • Do physician performance rankings (and rewards) vary considerably when different combinations of the three data streams are used?
methods
Methods
  • Physician database with patient-level data
  • Standardized composite scores for the three data streams

(1) Chart audit

(2) Patient survey

(3) Practice systems

  • Super-composite scores: Combine composites
  • Examine changes in physician rankings
physician and patient samples
Physician and Patient Samples
  • 659 Physicians
    • Mean Age: 44 (SD = 6.4), 26% female
    • 61% general internists, 39% subspecialists (largely nephrologists and cardiologists)
    • 29% in solo practice
  • Patients
    • Chart audit: 13,096 patients, age 18-75, 51% male
    • Patient survey: 14,913 patients, age 18-75, 53% male
chart audit individual measures
Chart Audit Individual Measures

Outcome variables are risk adjusted for co-morbidity conditions:

BP control <130/80 for pts with dm or stroke co-morbidities, <140/90 for rest.

LDL control <100 for pts with major risks, <130 for pts with other risks, <160 for the rest.

practice system individual measures
Practice System Individual Measures

Practice system survey of 89 questions

distribution of physician performance composite scores
Distribution of Physician Performance Composite Scores

6

4

2

0

-2

-4

-6

-8

C+S

Chart (C)

Patient (P)

System (S)

C+P

C+P+S

percent who change rankings by more than one quartile
Percent who change rankings by more than one quartile*

Baseline: Chart

Ranks better than chart

Ranks worse than chart

* One quartile counts for 164 rank positions

percent who change rankings by more than two quartiles
Percent who change rankings by more than two quartiles*

Baseline: Chart

Ranks better than chart

Ranks worse than chart

* Two quartile counts for 329 rank positions

examples of extreme discordance of performance more than three quartiles ranks and z scores
Examples of Extreme Discordance of Performance – more than three quartilesRanks and (z scores)

Rank 1 = Best; Rank 659 = Worst

conclusions
Conclusions
  • Measuring multiple dimensions in the quality of patient care is complex
    • Very moderate correlations among three data streams
    • Rankings change considerably depending on combinations
  • A profile that incorporates more than one aspect of patient care tells a different story than any one of them alone
limitations and future research
Limitations and Future Research
  • Self-report data for chart and system data
  • Participants are volunteers
  • Need more robust risk adjusters
  • Investigate other analytic approaches for combining individual measures into composites
  • Investigate stability of pass/fail decisions