Healthc (Amst) - Reliability of utilization measures for primary care physician profiling.

Tópicos

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Resumo

CKGROUND: Given rising health care costs, there has been a renewed interest in using utilization measures to profile physicians. Despite the measures' common use, few studies have examined their reliability and whether they capture true differences among physicians.METHODS: A local health improvement organization in New York State used 2008-2010 claims data to create 11 utilization measures for feedback to primary care physicians (PCP). The sample consists of 2938 PCPs in 1546 practices who serve 853,187 patients. We used these data to measure reliability of these utilization measures using two methods (hierarchical model versus test-retest). For each PCP and each practice, we estimate each utilization measure's reliability, ranging from 0 to 1, with 0 indicating that all differences in utilization are due to random noise and 1 indicating that all differences are due to real variation among physicians.RESULTS: Reliability varies significantly across the measures. For 4 utilization measures (PCP visits, specialty visits, PCP lab tests (blood and urine), and PCP radiology and other tests), reliability was high (mean>0.85) at both the physician and the practice level. For the other 7 measures (professional therapeutic visits, emergency room visits, hospital admissions, readmissions, skilled nursing facility days, skilled home care visits, and custodial home care services), there was lower reliability indicating more substantial measurement error.CONCLUSIONS: The results illustrate that some utilization measures are suitable for PCP and practice profiling while caution should be used when using other utilization measures for efforts such as public reporting or pay-for-performance incentives.

Resumo Limpo

ckground given rise health care cost renew interest use util measur profil physician despit measur common use studi examin reliabl whether captur true differ among physiciansmethod local health improv organ new york state use claim data creat util measur feedback primari care physician pcp sampl consist pcps practic serv patient use data measur reliabl util measur use two method hierarch model versus testretest pcp practic estim util measur reliabl rang indic differ util due random nois indic differ due real variat among physiciansresult reliabl vari signific across measur util measur pcp visit specialti visit pcp lab test blood urin pcp radiolog test reliabl high mean physician practic level measur profession therapeut visit emerg room visit hospit admiss readmiss skill nurs facil day skill home care visit custodi home care servic lower reliabl indic substanti measur errorconclus result illustr util measur suitabl pcp practic profil caution use use util measur effort public report payforperform incent

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