Benchmarking Physician Performance: Current Practice & Research Needs

全国各地的健康计划、雇主和医生组织的地方联盟正在参与通过收集和传播有关医生和医生组织的绩效信息来提高医疗保健质量的项目。这些努力可以集中在质量改进计划，为医生提供信息，以基准他们的表现对他人，为消费者提供可靠和有效的护理质量信息选择提供者，允许付款人或购买者奖励上级性能。在这些组织中，用于实施这些措施的措施和方法存在很大差异，这给医生造成了困惑，并限制了比较的机会。通过英联邦基金的一笔赠款，国家质量保证委员会正在与一个全国医生基准组织小组合作，制定和测试一套完整的医生一级有效性和资源消耗措施的执行方法，以便能够在全国范围内标准化业绩计量收集和基准制定。研究文献中提到了一些关于方法问题的关切，如计量可靠性、风险调整和博弈的可能性。目前还不清楚从事医生基准的组织是否意识到这些问题，并在现有的方法中解决了这些问题。迫切需要确保与使用医生基准数据的组织和利益相关者共享可以改善当前医生测量工作的研究知识。NCQA将于2006年1月召开一次会议，召集医生基准制定组织和研究人员，讨论在实际一级衡量和基准制定有效性和资源利用绩效的共识标准草案。其目标是：1）建议医生基准组织制定一套医生基准工作的措施实施规则草案，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。本次会议直接解决AHRQ的努力，以增加有关提高所有美国人的医疗保健质量的知识转移的机会，并为AHRQ提供了一个关键的机会，以刺激知识转移给用户，并鼓励努力，将改变医疗保健系统。

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.