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Related Experiment Videos

Using collectively-derived standards to evaluate individual performance: a cautionary note on clinical practice

M J Long1, M Lescoe-Long

  • 1Department of Public Health Sciences, Withita State University, Kansas 67260-0043, USA. Img@chp.twsu.edu

Health Services Management Research
|October 28, 1999
PubMed
Summary

Evaluating individual physician performance against group-based practice guidelines is problematic. Physician performance can justifiably vary based on patient factors, and reducing practice variation doesn't always lower costs.

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Area of Science:

  • Health Services Research
  • Medical Quality Improvement
  • Physician Performance Measurement

Background:

  • Practice guidelines are often derived from group consensus or central tendency measures.
  • Evaluating individual physician performance against macro-level criteria presents challenges.
  • The relationship between practice variation and healthcare costs is complex.

Purpose of the Study:

  • To highlight the difficulties in assessing individual physician performance using aggregate practice guidelines.
  • To argue for the justification of physician performance variation due to patient characteristics and care processes.
  • To investigate the impact of reducing practice variation on healthcare costs.

Main Methods:

  • Analysis of physician performance data relative to established practice guidelines.

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  • Examination of cost data in relation to practice variation.
  • Exploration of potential 'spillover effects' from performance monitoring.

    • Main Results:

    • Cost reductions were observed in areas not directly targeted by guidelines, suggesting a 'spillover effect'.
    • Some evidence indicated increased healthcare costs following a reduction in practice variation.
    • Individual physician performance may legitimately differ from aggregate guidelines.

    Conclusions:

    • Caution is advised when evaluating individual physicians against aggregate-level guidelines.
    • Individual physician performance should be assessed within the natural distribution of practice.
    • Understanding the implicit distribution of performance is crucial for accurate evaluation.