The comprehensive care project: measuring physician performance in ambulatory practice

Abstract

Objective: To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice.

Data sources/study setting: Ambulatory-based general internists in 13 states participated in the assessment.

Study design: We assessed physician-level performance, adjusted for patient factors, on 46 individual measures, an overall composite measure, and composite measures for chronic, acute, and preventive care. Between- versus within-physician variation was quantified by intraclass correlation coefficients (ICC). External validity was assessed by correlating performance on a certification exam.

Data collection/extraction methods: Medical records for 236 physicians were audited for seven chronic and four acute care conditions, and six age- and gender-appropriate preventive services.

Principal findings: Performance on the individual and composite measures varied substantially within (range 5-86 percent compliance on 46 measures) and between physicians (ICC range 0.12-0.88). Reliabilities for the composite measures were robust: 0.88 for chronic care and 0.87 for preventive services. Higher certification exam scores were associated with better performance on the overall (r = 0.19; p<.01), chronic care (r = 0.14, p = .04), and preventive services composites (r = 0.17, p = .01).

Conclusions: Our results suggest that reliable and valid comprehensive assessment of the quality of chronic and preventive care can be achieved by creating composite measures and by sampling feasible numbers of patients for each condition.

Figure 1

Distribution of Physician Performance Composite Scores