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Consistency in performance evaluation reports and medical records
Mingshan Lu1, Ching-to Albert Ma
1Department of Economics, University of Calgary, 2500 University Drive, NW, Calgary, AB, Canada, T2N 1N4. lu@ucalgary.ca
The Journal of Mental Health Policy and Economics
|October 28, 2003
Summary
Clinician reports on alcohol use frequency showed inconsistencies between administrative and clinical records. These reporting variations may stem from self-interest or altruistic motives, impacting performance-based contracts.
Area of Science:
- Health Services Research
- Healthcare Management
- Addiction Treatment
Background:
- Managed care organizations rely on accurate clinician data for service delivery, referrals, and claims processing.
- Clinician reporting practices in response to managed care solicitations are influenced by factors like gaming, sincerity, nudging, and rule-dodging.
Purpose of the Study:
- To assess the consistency of clinician reports on clients across administrative data and clinical records.
- To identify patterns and potential motives behind reporting inconsistencies in alcohol abuse treatment.
Main Methods:
- Compared clinician reports from administrative data (Maine Addiction Treatment System) with medical record abstracts for approximately 1,000 alcohol abuse treatment episodes.
- Analyzed inconsistencies in five categories: admission/discharge alcohol use frequency, termination status, and admission/discharge employment status.
- Utilized chi-square tests, Kappa statistics, sensitivity/specificity tests, and multiple imputation methods for analysis.
Main Results:
- Found strong evidence of inconsistencies in reported alcohol use frequency at admission and discharge.
- Observed strong consistency in reported employment status but mixed evidence for termination status.
- Inconsistency patterns suggest potential influence from both altruistic and self-interest motives.
Conclusions:
- Performance-based payment contracts may be undermined by provider mis-reporting, necessitating further analysis of clinician gaming.
- Understanding physician reporting behavior is crucial for increasing accountability in healthcare policy.
- Strategic reporting in alcohol addiction treatment is statistically significant, warranting further research into underlying motives and incentives.