MEASURING THE EFFICENCY OF HEALTH CARE PROVIDERS

有证据表明，美国各地区较高的医疗保健支出与较低的质量和没有任何好处相关 在健康方面的结果表明，有大量机会来提高美国医疗保健的效率。实现 然而，由于缺乏可操作的措施以及质量和资源，改进将是困难的。 使用--而且对效率的决定因素缺乏了解--在医生、医生组、 以及医院层面。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、医生 团体和医院。我们将利用常规收集的数据来开发和实现特定于提供商的数据 临床表现测评。因为小样本量严重限制了能够 我们将应用统计过滤和经验贝叶斯技术来改善 我们测量的精确度。 目的2.探索个人医生水平上的效率决定因素。我们已经达成了协议 从美国内科委员会和美国委员会获得委员会认证考试分数 家庭医学部。我们会将个别医生的考试成绩与临床表现指标挂钩。 在目标1下制定，并采用具有他们培训和培训环境特征的措施 他们现在在那里练习。这些数据将被用来解决这个问题：是什么造就了一个好医生？ 目的3.探索医生群体和医院效率的决定因素。我们将利用 在目标1和目标2下制定了广泛的措施--并通过我们建议的全国调查 医生-确定与提高效率相关的两个组织层面的因素：医院 本身和“扩展医务人员”(在特定医院内工作或其 这些医院收治病人)。 该项目的目标是在个别医生、医生 团体和医院应该被证明在努力提高美国医疗保健效率方面是有用的 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.