The unreliability of individual Physician "report cards" for assessing the costs and quality of care of a chronic disease.
Context Physician profiling is widely used by many health care systems, but little is known about the reliability of commonly used profiling systems.
Objectives To determine the reliability of a set of physician performance measures for diabetes care, one of the most common conditions in medical practice, and to examine whether physicians could substantially improve their profiles by preferential patient selection.
Design and Setting Cohort study performed from 1990 to 1993 at 3 geographically and organizationally diverse sites, including a large staff-model health maintenance organization, an urban university teaching clinic, and a group of private-practice physicians in an urban area.
Participants A total of 3642 patients with type 2 diabetes cared for by 232 different physicians.
Main Outcome Measures Physician profiles for their patients'hospitalization and clinic visit rates, total laboratory resource utilization rate and level of glycemic control by average hemoglobin A1c level with and without detailed case-mix adjustment.
Results For profiles based on hospitalization rates, visit rates, laboratory utilization rates, and glycemic control, 4% or less of the overall variance was attributable to differences in physician practice and the reliability of the median physician's case-mixadjusted profile was never better than 0.40. (...)
Mots-clés Pascal : Maladie, Chronique, Homme, Qualité service, Soin santé primaire, Diabète, Etude cohorte, Relation médecin malade, Etats Unis, Amérique du Nord, Amérique, Dossier médical, Coût, Classification par stade, Endocrinopathie
Mots-clés Pascal anglais : Disease, Chronic, Human, Service quality, Primary health care, Diabetes mellitus, Cohort study, Physician patient relation, United States, North America, America, Medical record, Costs, Stage classification, Endocrinopathy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0345357
Code Inist : 002B30A05. Création : 14/12/1999.