Innovations in the Science of Public Reporting of Provider Performance

描述（由申请人提供）：公共报告的比较提供者的表现是广泛的公共和私人购买者的医疗保健。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，消费者使用这些报告存在挑战，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，以及在医疗保健决策发生时向消费者传播。鉴于努力增加消费者分担费用和选择高价值服务和供应商，人们对向消费者传达供应商的不同“价值”很感兴趣，也很有必要，但在制定一个将成本和质量信息结合起来的价值衡量标准方面进展甚微。在成本和质量衡量标准关联性较弱的情况下，将各种衡量标准结合起来，以创造一种价值衡量标准，这方面存在挑战。目前显示“价值”的尝试集中在并排显示成本和质量措施。此外，随着测量进一步推进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的结构。我们的方法将估计整个成本质量连续体的最佳供应商性能，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是提高医疗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）评估将医生错误分类为绩效等级的风险，并将医生档案的可靠性与错误分类风险相关联， (b)检查是否为特定报告目标定制的绩效摘要（例如，与使用提供商特有手段的标准方法相比，使用这种手段（排名、确定业绩等级或层级）可以更准确、更精确地公开报告小型提供商的业绩。目标2是开发一个严格的成本质量建模框架，以告知公共报告的医疗保健提供者的价值。我们将采用双变量层次模型，以获得在供应商层次结构的每一级的成本质量权衡的措施。

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.