Benchmarking Physician Performance: Current Practice & Research Needs

全国各地的保健计划、雇主和医生组织的地方联盟正在参与通过收集和传播关于医生和医生组织的绩效信息来提高保健质量的项目。这些努力可以集中在质量改进举措上，为医生提供信息以对照他人的表现，为消费者选择提供者提供可靠和有效的护理质量信息，允许付款人或购买者奖励卓越的表现。这些组织在实施这些措施的措施和方法上有很大的差异，给医生造成了困惑，限制了比较的机会。在联邦基金的资助下，国家质量保证委员会（NCQA）正在与一个由医生基准组织组成的国家小组合作，开发和测试一套完整的实施方法，用于医生水平的有效性和资源消耗测量，以实现全国标准化的绩效测量收集和基准测试。在研究文献中已经注意到许多关于方法论问题的关注，如测量可靠性，风险调整和游戏的潜力。目前尚不清楚参与医生基准测试的组织是否意识到这些问题，并在现有方法中解决了这些问题。迫切需要确保能够改善当前医生测量工作的研究知识与使用医生基准数据的组织和利益相关者共享。NCQA将于2006年1月召开一次会议，召集医生基准组织和研究人员，讨论在物理水平上对有效性和资源利用的衡量和基准绩效的共识标准草案。目标是：1)为医生基准组织提供一套医生基准工作措施实施规则草案的建议；2)起草一份研究议程，为未来医生水平测量方法的改进提供信息。本次会议直接讨论了AHRQ的工作，即增加与提高全体美国人保健质量相关的知识转移机会，并为AHRQ提供了一个重要的机会，以刺激向用户的知识转移，并鼓励将改变卫生保健系统的努力。

Local coalitions of health plans, employers, and physician organizations across the country are engaging in projects to improve health care quality by collecting and disseminating performance information about physicians and physician organizations. These efforts can focus on quality improvement initiatives, provide physicians information to benchmark their performance against others, offer consumers reliable and valid quality of care information for selecting providers, allow payers or purchasers to reward superior performance. There is substantial variation across these organizations in the measures and methods used to implement these measures, creating confusion for physicians and limiting opportunities for comparisons. Through a grant from the Commonwealth Fund, the National Committee for Quality Assurance (NCQA) is working with a national panel of physician benchmarking organizations to develop and test a complete set of implementation methods for physician-level measures of effectiveness and resource consumption to enable nationally standardized performance measure collection and benchmarking. A number of concerns have been noted in the research literature about methodological issues such as measurement reliability, risk adjustment and the potential for gaming. It is unclear whether organizations engaged in physician benchmarking are aware of these concerns and have addressed them in existing methods. There is a critical need to ensure that research knowledge that could improve current physician measurement efforts is shared with organizations and stakeholders that use physicians benchmarking data. NCQA will convene a conference in January 2006 to bring together physician benchmarking organizations and researchers to discuss draft consensus standards for measuring and benchmarking performance on effectiveness and resource utilization at the physical level. The goals are 1) To advise physician benchmarking organizations on a set of draft measure implementation rules for physician benchmarking efforts and 2) To draft a research agenda that will inform the improvement of methods for physician level measurement in the future. This conference directly addresses AHRQ's efforts to increase opportunities for knowledge transfer related to improving quality of care health for all Americans and offers a critical opportunity for AHRQ to stimulate knowledge transfer to users and to encourage efforts that will transform the health care system.