Consistency in performance evaluation reports and medical records.
Consistency in performance evaluation reports and medical records.
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发表时间：
2002-12
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通讯作者：
M. Lu;C. Ma
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作者：
M. Lu;C. Ma
背景技术在医疗保健市场中，管理式医疗已经成为服务提供的最新创新。为了有效实施，管理式医疗组织依赖于准确的信息。因此，在批准转诊、授权治疗或处理保险索赔之前，临床医生经常被要求报告患者的情况。临床医生对管理式医疗组织的信息征集有何反应？现有的健康文献已经指出了提供商游戏、诚实报告、助推和规避规则的重要性。研究目的 我们评估临床医生对客户的管理数据和临床记录报告的一致性。方法 对于大约 1,000 次酒精滥用治疗事件，我们比较了两个数据集的临床医生报告。第一个是缅因州成瘾治疗系统 (MATS)，是一个管理数据集；州政府用它来监测和评估项目绩效。第二个是一组医疗记录摘要，直接取自治疗事件的临床记录。如果 MATS 中报告的信息与病历中报告的信息在统计上显着不同，则临床医生的报告实践会表现出不一致。我们在五个类别中寻找不一致的证据：入院饮酒频率、出院饮酒频率、终止状态、入院就业状况和出院就业状况。卡方检验、Kappa 统计以及敏感性和特异性检验用于假设检验。采用多种插补方法来解决记录摘要数据集中的缺失值问题。结果 对于入院和出院时的饮酒频率测量，我们分别发现了强有力的支持性证据来证明不一致。我们发现同样强有力的证据表明入院和出院就业状况报告的一致性，以及关于终止状态报告一致性的混合证据。不一致的模式可能是由于利他动机和自利动机造成的。讨论和限制 基于绩效的付款合同可能会受到提供商错误报告的影响，这可能会严重损害其目的。然而，需要进一步分析来确定观察到的不一致有多少是临床医生在报告中博弈的结果。对卫生政策的影响 加强系统问责制对于卫生保健政策制定者来说变得越来越重要。这项研究的结果将有助于更好地理解医生的报告行为。对未来研究的影响 我们在本文中关于数据集的工作证实了酒精成瘾治疗中战略报告的统计意义。确认我们在其他数据集中的发现将会很有趣。我们正在进行的研究将对战略报告背后的动机进行建模。我们将假设利他动机和经济动机都存在。我们的实证识别策略将使用缅因州基于绩效的合同系统和客户保险来源来测试这些激励措施如何影响临床医生战略报告的方向。
BACKGROUND In the health care market managed care has become the latest innovation for the delivery of services. For efficient implementation, the managed care organization relies on accurate information. So clinicians are often asked to report on patients before referrals are approved, treatments authorized, or insurance claims processed. What are clinicians responses to solicitation for information by managed care organizations? The existing health literature has already pointed out the importance of provider gaming, sincere reporting, nudging, and dodging the rules. AIMS OF THE STUDY We assess the consistency of clinicians reports on clients across administrative data and clinical records. METHODS For about 1,000 alcohol abuse treatment episodes, we compare clinicians reports across two data sets. The first one, the Maine Addiction Treatment System (MATS), was an administrative data set; the state government used it for program performance monitoring and evaluation. The second was a set of medical record abstracts, taken directly from the clinical records of treatment episodes. A clinician s reporting practice exhibits an inconsistency if the information reported in MATS differs from the information reported in the medical record in a statistically significant way. We look for evidence of inconsistencies in five categories: admission alcohol use frequency, discharge alcohol use frequency, termination status, admission employment status, and discharge employment status. Chi-square tests, Kappa statistics, and sensitivity and specificity tests are used for hypothesis testing. Multiple imputation methods are employed to address the problem of missing values in the record abstract data set. RESULTS For admission and discharge alcohol use frequency measures, we find, respectively, strong and supporting evidence for inconsistencies. We find equally strong evidence for consistency in reports of admission and discharge employment status, and mixed evidence on report consistency on termination status. Patterns of inconsistency may be due to both altruistic and self-interest motives. DISCUSSION AND LIMITATIONS Payment contracts based on performance may be subject to provider mis-reporting, which could seriously undermine its purpose. However, further analysis is needed to determine how much of the inconsistencies observed are results of clinician gaming in reporting. IMPLICATIONS FOR HEALTH POLICY Increasing system accountability is becoming more and more important for health care policy makers. Results of this study will lead to a better understanding of physician reporting behavior. IMPLICATIONS FOR FUTURE RESEARCH Our work in this paper on the data sets confirms the statistical significance of strategic reporting in alcohol addiction treatment. It will be of interest to confirm our finding in other data sets. Our on-going research will model the motives behind strategic reporting. We will hypothesize that both altruistic and financial incentives are present. Our empirical identification strategy will use Maine s Performance-Based Contracting system and client insurance sources to test how these incentives affect the direction of clinician s strategic reporting.