MEASURING THE EFFICENCY OF HEALTH CARE PROVIDERS

有证据表明，美国各地区的医疗保健支出增加与质量下降和没有收益有关 健康结果表明，改善美国医疗保健效率的机会很大。实现 然而，由于缺乏可操作的措施以及质量和资源， 使用-以及对效率决定因素的知识不足-在医生，医生群体， 医院水平。该项目将实现以下具体目标： 目标1.制定和实施可用于评估医生效率的措施， 团体和医院。我们将利用定期收集的数据，制定和实施针对供应商的 临床性能指标。因为小样本量严重限制了提供者的数量， 可靠的测量，我们将应用统计过滤与经验贝叶斯技术，以改善 我们的措施的精确性。 目标二。探索个体医生水平上效率的决定因素。我们有协议 从美国内科医学委员会和美国委员会获得委员会认证考试成绩 家庭医学。我们将把个别医生的考试成绩与临床表现指标联系起来 根据目标1制定的标准，以及体现其培训环境特点的措施， 他们现在练习的地方。这些数据将被用来解决这个问题：是什么让一个好医生？ 目标3.探讨医师团体和医院效率的决定因素。我们将利用 根据目标1和2制定了广泛的措施，并通过我们提议的全国调查， 医生-确定与两个组织层面的效率提高相关的因素：医院 “扩展医务人员”（在特定医院工作的医生或 病人被送往这些医院）。 该项目的目标是在个体医生、医生、 这些组织和医院应该在提高美国医疗保健效率的努力中发挥作用 系统

Evidence that higher health care spending across US regions is associated with lower quality and no gains in health outcomes suggest substantial opportunities to improve the efficiency of U.S. health care. Achieving improvements, however, will be difficult due to the lack of actionable measures and of quality and resource use - and insufficient knowledge about the determinants of efficiency - at the physician, physician group, and hospital levels. This project will address the following specific aims: Aim 1. Develop and implement measures that can be used to assess the efficiency of physicians, physician groups, and hospitals. We will draw on routinely collected data to develop and implement provider-specific clinical performance measures. Because small sample sizes seriously limit the number of providers who can be reliably measured, we will apply statistical filtering with empirical Bayes techniques to improve the precision of our measures. Aim 2. Explore the determinants of efficiency at the individual physician level. We have agreements in place to obtain board certification exam scores from the American Board of Internal Medicine and American Board of Family Medicine. We will link individual physicians' exam scores to the clinical performance measures developed under Aim 1 as well as with measures that characterize the settings where they trained and where they now practice. These data will be used to address the question: what makes a good doctor? Aim 3. Explore the determinants of efficiency for physician groups and hospitals. We will draw on the extensive measures developed under Aims 1 and 2 - and through our proposed national survey of physicians - to identify factors associated with improved efficiency at two organizational levels: the hospital itself and the "extended medical staff' (physicians who either work within a specific hospital or whose patients are admitted to these hospitals). The goal of this project is to provide measures and insights at the levels of individual physicians, physician groups, and hospitals that should prove useful in efforts to improve the efficiency of the US health care system.