Systems Learning from Physician Performance Data.

CONTEXT Data collected in 1998 on primary physician performance, including Health Plan Employer Data and Information Set (HEDIS) measures, were the basis of reports distributed quarterly to 194 primary care physicians at 25 medical centers in Group Health Cooperative. Here, we summarize results of research designed to assess reliability of measures of physician performance and to identify practice components which influence patient outcome. Various aspects of these results are published in Medical Care, The Journal of General Internal Medicine, and Family Medicine. DESIGN Summary of results from studies that used retrospective analysis of administrative data on physician performance measures and practice structures. MAIN OUTCOME MEASURES Twenty-three HEDIS measures of physician performance, both individual and grouped into aggregate measures: cancer screening, diabetic management, patient satisfaction, and ambulatory costs. ANALYSIS Bivariate and sequential sets of multiple regression models controlled for selected patient panel and physician characteristics. RESULTS Although individual HEDIS measures were reliable when used to assess physician performance, aggregated measures were more reliable. Physician continuity was not associated with patient outcome, but practice coordination (measured by shared practice, years of team tenure, and medical clinic size) was significantly associated with improvement in cancer screening, diabetic management, and patient satisfaction. Performance assessment of physicians with reduced appointment hours or part-time status was associated with improved cancer screening and diabetic management. CONCLUSIONS Assessing physician performance data on individuals yielded useful collective clinical practice information. Analyzing physician performance data collectively can identify effective primary care practice structures and processes and benefit patient care.