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Setting a Fair Performance Standard for Physicians’ Quality of Patient Care
- Source :
- Journal of General Internal Medicine. 26:467-473
- Publication Year :
- 2010
- Publisher :
- Springer Science and Business Media LLC, 2010.
-
Abstract
- Assessing physicians' clinical performance using statistically sound, evidence-based measures is challenging. Little research has focused on methodological approaches to setting performance standards to which physicians are being held accountable.Determine if a rigorous approach for setting an objective, credible standard of minimally-acceptable performance could be used for practicing physicians caring for diabetic patients.Retrospective cohort study.Nine hundred and fifty-seven physicians from the United States with time-limited certification in internal medicine or a subspecialty.The ABIM Diabetes Practice Improvement Module was used to collect data on ten clinical and two patient experience measures. A panel of eight internists/subspecialists representing essential perspectives of clinical practice applied an adaptation of the Angoff method to judge how physicians who provide minimally-acceptable care would perform on individual measures to establish performance thresholds. Panelists then rated each measure's relative importance and the Dunn-Rankin method was applied to establish scoring weights for the composite measure. Physician characteristics were used to support the standard-setting outcome.Physicians abstracted 20,131 patient charts and 18,974 patient surveys were completed. The panel established reasonable performance thresholds and importance weights, yielding a standard of 48.51 (out of 100 possible points) on the composite measure with high classification accuracy (0.98). The 38 (4%) outlier physicians who did not meet the standard had lower ratings of overall clinical competence and professional behavior/attitude from former residency program directors (p = 0.01 and p = 0.006, respectively), lower Internal Medicine certification and maintenance of certification examination scores (p = 0.005 and p0.001, respectively), and primarily worked as solo practitioners (p = 0.02).The standard-setting method yielded a credible, defensible performance standard for diabetes care based on informed judgment that resulted in a reasonable, reproducible outcome. Our method represents one approach to identifying outlier physicians for intervention to protect patients.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
media_common.quotation_subject
MEDLINE
Patient care
Cohort Studies
Young Adult
Nursing
Physicians
Diabetes Mellitus
Internal Medicine
Humans
Medicine
Quality (business)
Prospective Studies
Aged
Quality of Health Care
Retrospective Studies
media_common
business.industry
Public health
Editorials
Clinical performance
Retrospective cohort study
Middle Aged
Employee Performance Appraisal
Female
Clinical Competence
Patient Care
business
Cohort study
Subjects
Details
- ISSN :
- 15251497 and 08848734
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Journal of General Internal Medicine
- Accession number :
- edsair.doi.dedup.....a649e2f5de36e813e5aa8869324a0a27