Year: 2018
Type: editorial
Abstract: atients, communities, colleagues, hospital systems, and regulators are entitled to information about the quality of medical performance by physicians.The regular flow of this information provides the basis for practice improvement and enhanced patient safety.However, as reviewed previously, the processes used today to gather, collate, analyze, verify, and distribute this information are deficient.Data are managed and distributed by many sources, with variable definitions, standards, and quality oversight; adequate adjustment for variations in patient and practice characteristics is challenging, if not impossible; end points receiving the most attention may not be the best indicators of physician performance (eg, mortality after myocardial infarction); the risk of citation as an underperformer can lead to provider behaviors that are not in the best interests of patients, including risk avoidance; and the complex statistics of data interpretation are poorly understood by most consumers of this information.1,2 Despite these issues, performance data, most of it public, are used routinely to advise people seeking care, alert practices and hospitals of potential outliers, define clinical practice guidelines, and inform regulatory and payer policies.The momentum toward ever greater public transparency is tremendous.An infrastructure is now in place to collect a lot of information about physicians and the patients under their care.Paradoxically, this may be part of the problem: the demands of data reporting (and addressing the reports generated from these data) increase physician work requirements, contributing to workplace dissatisfaction and physician burnout.A recent Health Affairs survey of cardiology, orthopedic, primary care, and multispecialty practices found that, on average, physicians and their staff members spend >15 hours per week managing external quality measures.3 This hints at data collection inefficiencies.A 2013 industry report identified 1367 quality measures followed by state or regional agencies, and noted that only about one-fifth of these measures were used by >1 agency.4 In addition, federal agencies track >1700 measures.Electronic health records and computerassisted physician order entry systems have not lessened the perceived burden.3 What can be done to improve the value of reporting physician performance data to the public?We offer 3 achievable changes that are highly likely to make a positive difference:1. Improve efficiencies by reducing the number of quality measures, standardizing definitions across collection entities, and using structured data collection systems.A goal of reducing the physician reporting load by two-thirds should be sought, and measures to achieve this goal should be supported by federal agencies devoted to improving health care.Metrics collected currently for quality management that do not have great utility must be retired.New metrics should be added only when they offer unambiguous value.The Center for Medicare and Medicaid Services, the National Quality Forum, the Institute
Source: Circulation
Authors: Kirk N. Garratt, William S. Weintraub
Language: English
Subfield: Health Information Management
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2807199343