Associations Between Physician Characteristics and Quality of Care

School of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA.
Archives of internal medicine (Impact Factor: 17.33). 09/2010; 170(16):1442-9. DOI: 10.1001/archinternmed.2010.307
Source: PubMed


Information on physicians' performance on measures of clinical quality is rarely available to patients. Instead, patients are encouraged to select physicians on the basis of characteristics such as education, board certification, and malpractice history. In a large sample of Massachusetts physicians, we examined the relationship between physician characteristics and performance on a broad range of quality measures.
We calculated overall performance scores on 124 quality measures from RAND's Quality Assessment Tools for each of 10,408 Massachusetts physicians using claims generated by 1.13 million adult patients. The patients were continuously enrolled in 1 of 4 Massachusetts commercial health plans from 2004 to 2005. Physician characteristics were obtained from the Massachusetts Board of Registration in Medicine. Associations between physician characteristics and overall performance scores were assessed using multivariate linear regression.
The mean overall performance score was 62.5% (5th to 95th percentile range, 48.2%-74.9%). Three physician characteristics were independently associated with significantly higher overall performance: female sex (1.6 percentage points higher than male sex; P < .001), board certification (3.3 percentage points higher than noncertified; P < .001), and graduation from a domestic medical school (1.0 percentage points higher than international; P < .001). There was no significant association between performance and malpractice claims (P = .26).
Few characteristics of individual physicians were associated with higher performance on measures of quality, and observed associations were small in magnitude. Publicly available characteristics of individual physicians are poor proxies for performance on clinical quality measures.

1 Follower
18 Reads
  • Source
    • "Consumer groups applauded this effort, but the release of raw mortality rates without risk adjustment was quickly shown to be misleading [1]. In the years that followed, process and outcomes measures have been increasingly used to describe the quality of care received by patients in United States Hospitals [2]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Hospitals are increasingly compared based on clinical outcomes adjusted for severity of illness. Multiple methods exist to adjust for differences between patients. The challenge for consumers of this information, both the public and healthcare providers, is interpreting differences in risk adjustment models particularly when models differ in their use of administrative and physiologic data. We set to examine how administrative and physiologic models compare to each when applied to critically ill patients. We prospectively abstracted variables for a physiologic and administrative model of mortality from two intensive care units in the United States. Predicted mortality was compared through the Pearsons Product coefficient and Bland-Altman analysis. A subgroup of patients admitted directly from the emergency department was analyzed to remove potential confounding changes in condition prior to ICU admission. We included 556 patients from two academic medical centers in this analysis. The administrative model and physiologic models predicted mortalities for the combined cohort were 15.3% (95% CI 13.7%, 16.8%) and 24.6% (95% CI 22.7%, 26.5%) (t-test p-value<0.001). The r(2) for these models was 0.297. The Bland-Atlman plot suggests that at low predicted mortality there was good agreement; however, as mortality increased the models diverged. Similar results were found when analyzing a subgroup of patients admitted directly from the emergency department. When comparing the two hospitals, there was a statistical difference when using the administrative model but not the physiologic model. Unexplained mortality, defined as those patients who died who had a predicted mortality less than 10%, was a rare event by either model. In conclusion, while it has been shown that administrative models provide estimates of mortality that are similar to physiologic models in non-critically ill patients with pneumonia, our results suggest this finding can not be applied globally to patients admitted to intensive care units. As patients and providers increasingly use publicly reported information in making health care decisions and referrals, it is critical that the provided information be understood. Our results suggest that severity of illness may influence the mortality index in administrative models. We suggest that when interpreting "report cards" or metrics, health care providers determine how the risk adjustment was made and compares to other risk adjustment models.
    PLoS ONE 02/2012; 7(2):e32286. DOI:10.1371/journal.pone.0032286 · 3.23 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In an attempt to improve quality and control costs, health plans are creating tiered products that encourage enrollees to seek care from "high-value" physicians. However, tiered products may limit access to care because patients may have to travel unreasonable distances to visit the nearest high-value physician. To assess geographic access to high-value physicians, particularly for disadvantaged populations. Cross-sectional observational study. Physicians and adult patients in Massachusetts. Travel time from census block centroid to nearest physician address under two scenarios: patients can see (1) any physician or (2) only high-value physicians. Among the physicians, 768 (20.9%) primary care physicians (PCPs), 225 (26.6%) obstetricians/gynecologists, 69 (10.3%) cardiologists, and 31 (6.0%) general surgeons met the definition of high-value. Statewide mean travel times to the nearest PCP, obstetrician/gynecologist, cardiologist, or general surgeon under the two scenarios (any physician vs. only high-value physicians) were 2.8 vs. 4.8, 6.0 vs. 7.2, 7.0 vs. 12.4, and 6.6 vs. 14.8 minutes, respectively. Across the four specialties, between 89.4%-99.4% of the population lived within 30 minutes of the nearest high-value physician. Rural populations had considerably longer travel times to see high-value physicians, but other disadvantaged populations generally had shorter travel times than comparison groups. Most patients in Massachusetts are likely to have reasonable geographic access to high-value physicians in tiered health plans. However, local demographics, especially rural residence, should be taken into consideration when applying tiered health plans broadly. Future work should investigate whether patients can and will switch to receive care from high-value physicians.
    Journal of General Internal Medicine 12/2010; 26(4):440-5. DOI:10.1007/s11606-010-1607-3 · 3.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A study was undertaken to examine factors that hinder primary care physicians' and specialist physicians' ability to provide high-quality care. The study used data collected by the Center for Studying Health System Change's 2008 Health Tracking Physician Survey. The 2008 Health Tracking Physician data set consisted of 4720 physicians belonging to the American Medical Association. Both primary care physicians and specialists rated care decisions rejected by insurance (49%, 51%), followed by patient being unable to pay for needed care (45%, 43%), and patient noncompliance with treatment recommendation (43%, 37%) as the top major problem areas in providing quality care to patients. In addition, 36% of primary care physicians and 27% of specialists reported that inadequate time with patients during visit was a major problem in providing quality care to patients. Primary care physicians reported significantly more problems associated with having adequate time with patients during office visits, ability of patients to pay for needed care, availability of qualified specialists in the area, receiving timely reports from other doctors, and patient noncompliance with treatment recommendations. On the other hand, primary care physicians reported significantly lower communication difficulties with patients due to language or cultural barriers. Care decisions rejected by insurance, patient being unable to pay for care, and patient noncompliance with treatment recommendation were the top 3 hindrances in providing quality care to patients for both physician types. For 6 of the 8 hindrance factors, there were significant differences in the level of problems identified by primary care physicians and specialist physicians.
    The health care manager 04/2011; 30(2):172-8. DOI:10.1097/HCM.0b013e318216fa81
Show more


18 Reads
Available from