Using profiling for cost and quality management in the emergency department.

Area of Science:

• Health Services Research
• Clinical Epidemiology
• Healthcare Management

Background:

• Inappropriate utilization of healthcare resources (overuse or underuse) can lead to poor patient outcomes and increased morbidity.
• Monitoring clinical resource use is essential for identifying physicians with suboptimal cost/quality performance.
• Wide variations in practice patterns are common in emergency departments due to the episodic nature of patient care.

Purpose of the Study:

• To introduce physician profiling as an analytical tool for monitoring resource utilization and care efficiency.
• To establish standards of care and implement information systems for effective profiling.
• To reduce practice variations and improve patient throughput, especially in emergency settings.

Main Methods:

• Employing epidemiological methods to analyze cost, service use, and quality across diverse physician practice patterns.
• Developing and implementing a physician profiling program.
• Establishing clear standards of care and robust information systems for data collection.

Main Results:

• Physician profiling enables the identification of practice variations and potential quality or utilization issues.
• The program facilitates comparisons of cost, service use, and quality among physicians.
• Implementing profiling can lead to significant reductions in practice variations.

Conclusions:

• Physician profiling is a valuable tool for monitoring and improving healthcare resource utilization and quality.
• Standardized care and effective information systems are crucial for successful profiling programs.
• Reducing practice variations through profiling can enhance efficiency and patient flow, particularly in emergency departments.