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，公开报告比较提供者绩效的做法很普遍。这些报告工作的一个关键目标是为消费者提供可帮助他们选择高价值供应商（即高质量、低成本）的比较信息。然而，迄今为止的证据表明，消费者在使用这些报告时遇到了挑战，反映出这些报告的设计存在问题，包括基本的分析方法、信息的内容和显示，以及在做出保健决定时向消费者传播这些问题。由于努力增加消费者分担费用和选择高价值的服务和提供者，人们对向消费者传达提供者的不同“价值”很感兴趣，也很有必要，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。挑战存在于结合度量来创建价值度量的过程中，其中成本和质量度量之间的关联很弱。目前显示“价值”的尝试主要集中在成本和质量指标的并列显示上。此外，随着度量进一步推进到每个提供者的事件数量较低的领域，在获取提供者真实性能的强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。我们的方法将在成本-质量连续体中评估最佳供应商绩效，允许在公开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开报告中向消费者提供的信息的准确性和实质性相关性。我们将通过(a)评估误诊医生的风险，并将医生档案的可靠性与误诊风险和误诊风险联系起来

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.