Public Reporting III: Improving the Value of Public Physician Quality Information
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- data collection
- electronic health records
- practice guideline
- quality assurance, health care
- work performance
Patients, communities, colleagues, hospital systems, and regulators are entitled to information about the quality of medical performance by physicians. The regular flow of this information provides the basis for practice improvement and enhanced patient safety. However, as reviewed previously, the processes used today to gather, collate, analyze, verify, and distribute this information are deficient. Data are managed and distributed by many sources, with variable definitions, standards, and quality oversight; adequate adjustment for variations in patient and practice characteristics is challenging, if not impossible; end points receiving the most attention may not be the best indicators of physician performance (eg, mortality after myocardial infarction); the risk of citation as an underperformer can lead to provider behaviors that are not in the best interests of patients, including risk avoidance; and the complex statistics of data interpretation are poorly understood by most consumers of this information.1,2 Despite these issues, performance data, most of it public, are used routinely to advise people seeking care, alert practices and hospitals of potential outliers, define clinical practice guidelines, and inform regulatory and payer policies. The momentum toward ever greater public transparency is tremendous.
An infrastructure is now in place to collect a lot of information about physicians and the patients under their care. Paradoxically, this may be part of the problem: the demands of data reporting (and addressing the reports generated from these data) increase physician work requirements, contributing to workplace dissatisfaction and physician burnout. A recent Health Affairs survey of cardiology, orthopedic, primary care, and multispecialty practices found that, on average, physicians and their staff members spend >15 hours per week managing external quality measures.3 This hints at data collection inefficiencies. A 2013 industry report identified 1367 quality …