Innovations in the Science of Public Reporting of Provider Performance

描述(由申请人提供)：在公共和私人医疗保健购买者中，对比较提供者业绩的公开报告很普遍。这些报告工作的一个关键目标是为消费者提供比较信息，帮助他们选择高价值的供应商(即高质量、低成本)。然而，迄今为止的证据表明，消费者在使用这些报告方面遇到了挑战，反映了其设计中的问题，包括基本的分析方法、信息的内容和显示，以及在作出卫生保健决定时向消费者传播。虽然由于努力增加消费者的成本分担和选择高价值的服务和供应商，人们对供应商的不同“价值”非常感兴趣，也有必要将其传达给消费者，但在制定结合成本和质量信息的价值衡量标准方面进展甚微。在成本和质量指标之间存在弱关联的情况下，在组合措施以创建一种价值衡量标准方面存在挑战。目前展示“价值”的尝试主要集中在成本和质量指标的并列展示上。此外，随着测量进一步深入到每个提供者的事件数量较低的领域，在获得关于提供者真实表现的强烈信号方面出现了问题。我们建议开发一个创新的框架，将医疗保健价值概念化为一个二维结构。我们的方法将评估整个成本-质量连续体的最佳提供商性能，允许在公共报告中更充分地考虑成本-质量权衡。该项目的目标1是提高卫生保健提供者质量公共报告中提供给消费者的信息的精确度和实质性相关性。我们将通过以下方式做到这一点：(A)评估将医生错误分类到绩效等级的风险，并将医生档案的可靠性与错误分类风险和 (B)审查为具体报告目标量身定做的业绩摘要(例如，排名、确定业绩百分位数或业绩等级)是否会产生比使用特定于供应商的方法的标准办法更准确和准确的关于小型供应商业绩的公开报告。目标2是开发一个严格的成本-质量建模框架，以向公众报告卫生保健提供者的价值。我们将使用双变量分层建模来获得提供商分层结构的每个级别上的成本-质量权衡的度量。项目的公共卫生相关性：我们的发现将帮助公共报告的发起人将提供者绩效错误分类的频率和严重程度降至最低。我们项目的最终好处将是加强公共报告的可信度，导致消费者更多地使用报告，最终提高美国提供的医疗保健的价值。 公共卫生相关性：该项目旨在提高卫生保健提供者质量和成本的公共报告中向消费者提供的信息的准确性和实质性相关性。项目的公共卫生相关性：我们的发现将帮助公共报告的发起人将提供者绩效错误分类的频率和严重程度降至最低。我们项目的最终好处将是加强公共报告的可信度，导致消费者更多地使用报告，最终提高美国提供的医疗保健的价值。

DESCRIPTION (provided by applicant): The public reporting of comparative provider performance is widespread among public and private purchasers of health care. A key goal of these reporting efforts is to provide consumers with comparative information that can help them choose high-value providers (i.e., high-quality, low-cost). However, the evidence to date shows challenges in consumer use of these reports, reflecting problems in their design, including the underlying analytic methods, the content and display of information, and dissemination to consumers at the point when health care decisions occur. While there is great interest in and need to communicate the differential "value" of providers to consumers given efforts to increase consumer cost sharing and selection of high value services and providers, there has been little progress in developing a value metric that combines cost and quality information. Challenges exist in combining measures to create a measure of value where cost and quality measures have weak associations. Current attempts at showing "value" have focused on side-by-side displays of cost and quality measures. Moreover, as measurement pushes further into areas where the number of events per provider is low, problems arise in obtaining a strong signal on a provider's true performance. We propose to develop an innovative framework that conceptualizes health care value as a two-dimensional construct. Our approach will estimate optimal provider performance across the cost-quality continuum, allowing for fuller consideration of cost-quality tradeoffs in public reports. Aim 1 of the project is to improve the precision and substantive relevance of the information provided to consumers in public reports of health care provider quality. We will do this by (a) assessing the risk of misclassifying physicians into performance tiers and associate reliabilities of physician profiles with misclassification risk and (b) examining whether performance summaries that are tailored to specific reporting goals (e.g., ranking, establishing percentiles or tiers of performance) result in more accurate and precise public reports of small providers' performance as compared to the standard approach of using provider-specific means. Aim 2 is to develop a rigorous cost-quality modeling framework to inform the public reporting of health care provider value. We will employ bivariate hierarchical modeling to obtain measures of the cost-quality tradeoff at each level of the provider hierarchy. Public Health Relevance of the Project: Our findings will help the sponsors of public reports minimize the frequency and severity of provider performance misclassification. The ultimate benefit from our project will be to strengthen the credibility of public reports, leading to increaed use by consumers, ultimately improving the value of health care delivered in the U.S. PUBLIC HEALTH RELEVANCE: This project aims to improve the precision and substantive relevance of the information provided to consumers in public reports of health care provider quality and cost. Public Health Relevance of the Project: Our findings will help the sponsors of public reports minimize the frequency and severity of provider performance misclassification. The ultimate benefit from our project will be to strengthen the credibility of public reports, leadng to increased use by consumers, ultimately improving the value of health care delivered in the U.S.