Обзор американских кардиологических журналов за неделю (ссылки)

[Chevychelov]

Title: Associations Between Physician Characteristics and Quality of Care
Date Posted: September 15, 2010
Authors: Reid RO, Friedberg MW, Adams JL, McGlynn EA, Mehrotra A.
Citation: Arch Intern Med 2010;170:1442-1449.

Study Question:
Patients are encouraged to select physicians on the basis of characteristics such as education, board certification, and malpractice history. In a large sample of Massachusetts physicians, what is the relationship between physician characteristics and performance on a broad range of quality measures?
Methods:
Overall performance scores were calculated on 124 quality measures from RAND’s Quality Assessment Tools for each of 10,408 Massachusetts physicians using claims generated by 1.13 million adult patients. The patients were continuously enrolled in one of four Massachusetts commercial health plans from 2004 to 2005. Physician characteristics were obtained from the Massachusetts Board of Registration in Medicine. Associations between physician characteristics and overall performance scores were assessed using multivariate linear regression.
Results:
The mean overall performance score was 62.5% (5th to 95th percentile range, 48.2%-74.9%). Three physician characteristics were independently associated with significantly higher overall performance: female sex (1.6 percentage points higher than male sex; p < 0.001), board certification (3.3 percentage points higher than noncertified; p < 0.001), and graduation from a domestic medical school (1.0 percentage point higher than international; p < 0.001). There was no significant association between performance and malpractice claims (p = 0.26). The available physician characteristics explained only 2.8% of overall variation in physician performance.
Conclusions:
Few characteristics of individual physicians were associated with higher performance on measures of quality, and observed associations were small in magnitude. Publicly available characteristics of individual physicians are poor proxies for performance on clinical quality measures.
Perspective:
The data, as presented above in the summary of results, were derived from the entire cohort regardless of specialty. When considered by specialty, the 877 OB/GYN practitioners had higher scores (better care) if they had one or more malpractice claims or attended lower-ranked or unranked medical school compared to a top 10 school, and not significantly better if board certified. There was no relationship between quality measures and years in practice for any specialty. The authors concluded that ‘public reporting of individual physician quality data may provide the consumer with more valuable guidance when seeking providers of high-quality health care.’ I doubt that will be any better than claims-based data. The task of evaluating individual physicians and health care systems will improve with a national health care registry, but only if carefully risk adjusted with criteria established by a national representative group of primary care physicians and specialty groups.