Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2010 Dec;45(6 Pt 2):1912-33.
doi: 10.1111/j.1475-6773.2010.01160.x. Epub 2010 Sep 1.

The comprehensive care project: measuring physician performance in ambulatory practice

Eric S Holmboe  1 , Weifeng Weng, Gerald K Arnold, Sherrie H Kaplan, Sharon-Lise Normand, Sheldon Greenfield, Sarah Hood, Rebecca S Lipner
Affiliations

The comprehensive care project: measuring physician performance in ambulatory practice

Eric S Holmboe et al. Health Serv Res. 2010 Dec.

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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Distribution of Physician Performance Composite Scores
See this image and copyright information in PMC

References

    1. Agency for Healthcare Quality and Research (AHRQ) 2005. “National Healthcare Quality Report” [accessed on January 4, 2010]. Available at http://www.ahrq.gov/qual/nhqr05/nhqr05.htm.
    1. American College of Physicians (ACP) 2007. “Joint Principles of the Patient-Centered Medical Home” [accessed on January 4, 2010]. Available at http://www.acponline.org/advocacy/where_we_stand/medical_home/approve_jp....
    1. Asch SM, McGlynn EA, Hogan MM, Hayward RA, Shekelle P, Rubenstein L, Keesey J, Adams J, Kerr EA. Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample. Annals of Internal Medicine. 2004;141:938–45. - PubMed
    1. Bodenheimer T. Coordinating Care—A Perilous Journey through the Health Care System. New England Journal of Medicine. 2008;358:1064–71. - PubMed
    1. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical Practice Guidelines and Quality of Care for Older Patients with Multiple Comorbid Diseases: Implications for Pay for Performance. Journal of American Medical Association. 2005;294:716–24. - PubMed

Publication types

MeSH terms

LinkOut - more resources