Profiling care provided by different groups of physicians: Effects of patient case-mix (bias) and physician-level clustering on quality assessment results
Profiling care provided by different groups of physicians: Effects of patient case-mix (bias) and physician-level clustering on quality assessment results
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DOI：
10.7326/0003-4819-136-2-200201150-00008
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发表时间：
2002-01-15
影响因子：
39.2
通讯作者：
Griffith, JL
中科院分区：
文献类型：
--
作者：
Greenfield, S;Kaplan, SH;Griffith, JL
背景资料：患者特征（病例组合偏倚）和医生水平变异（聚类）往往被忽视，在剖析由不同的医生群体，如specialties.Objective提供的护理质量：研究的影响，病例组合偏见和医生水平的聚类之间的差异，在专业组糖尿病护理参与美国糖尿病协会的供应商认可Program.Design：对1年内的过程和结局指标进行回顾性记录审查，并进行横断面患者调查。该样本包括29个独奏和小组实践地点在不同地区的美国。在29个站点中，15个是内分泌学站点，14个是初级保健站点。患者：1750名成年糖尿病患者。测量：过程测量包括血红蛋白A、血脂和尿蛋白检测的频率;血压测量;以及足部和眼部检查。结果指标包括A、C水平、血压、血脂水平和患者满意度。患者的病例组合变量包括年龄，性别，健康状况，教育水平，少数民族的地位，和持续时间的diabetes.Results：未调整的内分泌学家和通才之间的差异有统计学意义的过程和结果的措施。纳入患者病例组合变量降低了某些质量指标的专业差异的统计学意义。占大量的医生水平的聚类后，观察到的专业之间的差异不再有统计学意义的任何质量measurements except patient satisfactions.Conclusions：研究结果强调：设计医生分析研究的重要性，有足够的权力来解释医生水平的变化（聚类）以及患者的病例组合。研究的设计没有考虑足够数量的医生和每位医生的患者，可能会扭曲医生组之间的护理质量差异。
Background: Patient characteristics (case-mix bias) and physician-level variation (clustering) are often overlooked in profiling the quality of care provided by different groups of physicians, such as specialties.Objective: To examine the effect of case-mix bias and physician-level clustering on differences in quality of diabetes care between specialty groups participating in the American Diabetes Association's Provider Recognition Program.Design: Retrospective record review of both process and outcome measures over 1 year and a cross-sectional patient survey. The sample included 29 solo and group practice sites in diverse regions of the United States. Of the 29 sites, 15 were, endocrinology sites and 14 were primary care sites.Patients: 1750 adults with diabetes.Measurements: Process measures included frequency of hemoglobin A,, lipid, and urine protein testing; blood pressure measurement; and foot and eye examinations. Outcome measures included A,c level, blood pressure, lipid levels, and patient satisfaction. Patient case-mix variables included age, sex, health status, level of education, ethnic minority status, and duration of diabetes.Results: Unadjusted differences between endocrinologists and generalists were statistically significant for most process and outcome measures. Inclusion of patient case-mix variables reduced the statistical significance of specialty differences for some quality measures. After accounting for the substantial physician-level clustering, observed differences between specialties were no longer statistically significant for any of the quality measures except patient satisfaction.Conclusions: The findings underscore the: importance of designing physician profiling studies with sufficient power to account for physician-level variation (clustering) as well as patient case-mix. Studies that are not designed with both sufficient numbers of physicians and patients per physician may distort differences in quality of care between physician groups.