Consistency in Performance Among Primary Care Practitioners

OBJECTIVES: The authors studied the consistency of performance of individual physicians to evaluate the identification of outlier practitioners as a strategy for improving patient care. METHODS: The authors used a data base containing information on 430 practitioners caring for 6,090 patients in 16 group practices. The authors analyzed inter- and intraphysician differences in performance on the basis of review criteria for 8 patient care guidelines. These criteria allowed for a variety of acceptable clinical strategies, incorporated decision tree logic, and included input from participating practitioners. The authors took steps to maximize validity and controlled for potentially confounding characteristics of patients and practitioners. The authors identified outliers, evaluated the significance of differences between outliers and nonoutliers, and studied variations in performance across cases and guidelines in conformance with guidelines. RESULTS: The authors identified a few statistically significant outliers. Correlations for performance across cases seen by a given physician were low. The highest positive correlation for performance between any pair of guidelines was 0.32. CONCLUSIONS: The performance of a given practitioner is highly variable from patient to patient and from guideline to guideline. Thus, strategies focusing solely on substandard outliers will miss opportunities to improve performance

Confounding · Consistency (knowledge bases) · Family medicine · Guideline · Identification (biology) · MEDLINE · Outlier · Primary care · Artificial Intelligence · Computer Science · Health Policy Implementation Science · Innovations in Medical Education · Medicine · Primary Care and Health Outcomes

• Quantifying the Physician Contribution to Managed Care Pharmacy Expenses

  Mark E Cowen, Robert L Strawderman•Medical Care•2002

  Añadir item

• Assessing the Comparability of Various Measures of the Quality of Ambulatory Care

  Tejal K Gandhi, Francis E Cook et al.•Medical Care•2002

  Añadir item

• Developing a Reliable, Valid, and Feasible Plan for Quality-of-Care Measurement for Cancer

  Katherine L Kahn, Jennifer L Malin et al.•Medical Care•2002

  Añadir item

• Improving the Reliability of Physician “Report Cards”

  Kimberly Smith, Kimberly A Smith et al.•Medical Care•2013

  Añadir item

• Quality Improvement Among Primary Care Practitioners

  R Heather Palmer, J Lee Hargraves•Medical Care•1996

  Añadir item

• Issues of Variability and Bias Affecting Multisite Measurement of Quality of Care

  Endel John Orav, ELIZABETH A WRIGHT et al.•Medical Care•1996

  Añadir item

• Physician management in primary care

  Barbara S Hulka, Lawrence L Kupper et al.•American Journal of Public Health•1976

  Añadir item

• Comparisons between OEO neighborhood health centers and other health care providers of ratings of the quality of health care

  Mildred A Morehead, Rose Donaldson et al.•American Journal of Public Health•1971

  Añadir item

• Measuring Clinical Performance of Individual Internists in Office and Hospital Practice

  Paul J Sanazaro, ROBERT M WORTH•Medical Care•1985

  Añadir item

• The Relationships of Pediatric Resident Recording Behavior Across Medical Conditions

  Vivian F Erviti, Bryce Templeton et al.•Medical Care•1980

  Añadir item

• Quality of Clinical Management of Disease in Comprehensive Neighborhood Health Centers

  Mildred A Morehead, Rose Donaldson•Medical Care•1974

  Añadir item

• The Ambulatory Care Medical Audit Demonstration Project

  R Heather Palmer, J Lee Hargraves•Medical Care•1996

  Añadir item

• Quality Assurance in Eight Adult Medicine Group Practices

  R Heather Palmer, Rose Strain et al.•Medical Care•1984

  Añadir item

• Evaluating Quality of Medical Care in the Neighborhood Health Center Program of the Office of Economic Opportunity

  Mildred A Morehead•Medical Care•1970

  Añadir item

• Interdiagnosis Relationships of Physician Recording in Ambulatory Child Health Care

  Charles E Osborne•Medical Care•1977

  Añadir item

• A Randomized Controlled Trial of Quality Assurance in Sixteen Ambulatory Care Practices

  R Heather Palmer, Thomas A Louis et al.•Medical Care•1985

  Añadir item

• Interdiagnosis Relationships of Physician Performance Measures

  Thomas F Lyons, Beverly C Payne•Medical Care•1974

  Añadir item

• Performance Quality, Gender, and Professional Role

  Judith A Hall, R Heather Palmer et al.•Medical Care•1990

  Añadir item

• Issues of Variability and Bias Affecting Multisite Measurement of Quality of Care

  Endel John Orav, ELIZABETH A WRIGHT et al.•Medical Care•1996

  Añadir item

• Measurement of Physician Performance by Standardized Patients

  Christel A Woodward, Gayle A McConvey et al.•Medical Care•1985

  Añadir item

• Individual and Institutional Variables Which May Serve as Indicators of Quality of Medical Care

  R Heather Palmer, Margaret Connorton Reilly•Medical Care•1979

  Añadir item