Physician Cost Profiling -- Reliability and Risk of Misclassification.
Physician Cost Profiling -- Reliability and Risk of Misclassification.
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DOI：
10.1056/nejmsa0906323
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发表时间：
2010-03-18
影响因子：
158.5
通讯作者：
McGlynn, Elizabeth A.
中科院分区：
文献类型：
--
作者：
Adams, John L.;Mehrotra, Ateev;McGlynn, Elizabeth A.
背景：鼓励患者根据成本分析工具选择提供低成本护理的医生的保险产品越来越普遍。然而，尚未进行严格的评估来确定这些工具是否能够准确区分费用较高的医生和费用较低的医生。 方法：我们汇总了马萨诸塞州四个健康计划 2004 年和 2005 年的索赔数据。我们使用商业软件构建临床同质的护理事件（例如，糖尿病、心脏病或尿路感染的治疗），将每个事件分配给医生，并根据所有分配的事件为每个医生创建资源使用（即成本）的摘要概况。我们以 0 到 1 的范围来估计每个医生的成本概况评分的可靠性（信噪比），其中 0 表示医生成本概况的所有差异都是由于测量缺乏精确性（噪声）而 1 表示所有差异都是由于服务成本的实际变化（信号）造成的。我们使用可靠性结果来估计每个专业的医生在两级保险产品中其成本绩效被不准确分类的比例，其中成本概况处于最低四分位数的医生被标记为“较低成本”。结果：中位可靠性范围从血管外科的 0.05 到胃肠病学和耳鼻喉科的 0.79。总体而言，59% 的医生的成本概况评分的可靠性低于 0.70，这是次优可靠性的常用标志。使用我们的可靠性结果，我们估计 22% 的医生会被错误分类在两级系统中。结论：当前根据服务成本对医生进行分析的方法可能会产生误导性结果。N Engl J Med 2010；362：1014-21。
Background: Insurance products with incentives for patients to choose physicians classified as offering lower-cost care on the basis of cost-profiling tools are increasingly common. However, no rigorous evaluation has been undertaken to determine whether these tools can accurately distinguish higher-cost physicians from lower-cost physicians.Methods: We aggregated claims data for the years 2004 and 2005 from four health plans in Massachusetts. We used commercial software to construct clinically homogeneous episodes of care (e.g., treatment of diabetes, heart attack, or urinary tract infection), assigned each episode to a physician, and created a summary profile of resource use (i.e., cost) for each physician on the basis of all assigned episodes. We estimated the reliability (signal-to-noise ratio) of each physician's cost-profile score on a scale of 0 to 1, with 0 indicating that all differences in physicians' cost profiles are due to a lack of precision in the measure (noise) and 1 indicating that all differences are due to real variation in costs of services (signal). We used the reliability results to estimate the proportion of physicians in each specialty whose cost performance would be classified inaccurately in a two-tiered insurance product in which the physicians with cost profiles in the lowest quartile were labeled as ``lower cost.''Results: Median reliabilities ranged from 0.05 for vascular surgery to 0.79 for gastroenterology and otolaryngology. Overall, 59% of physicians had cost-profile scores with reliabilities of less than 0.70, a commonly used marker of suboptimal reliability. Using our reliability results, we estimated that 22% of physicians would be misclassified in a two-tiered system.Conclusions: Current methods for profiling physicians with respect to costs of services may produce misleading results.N Engl J Med 2010;362:1014-21.