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Profiling individual physicians using administrative data from a single insurer: variance components, reliability,

Frank Eijkenaar1, René C J A van Vliet

  • 1Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands. eijkenaar@bmg.eur.nl

Medical Care
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PubMed
Summary

Measuring individual physician performance with single-insurer data is unreliable due to small sample sizes. Most performance measures lack sufficient reliability for profiling, highlighting challenges in comparative assessments.

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Area of Science:

  • Health Services Research
  • Medical Informatics
  • Quality Improvement

Background:

  • Physician performance assessments are increasingly common.
  • Single-insurer data presents challenges for reliable individual physician profiling due to small sample sizes.

Purpose of the Study:

  • To examine variation in general practitioners' performance using administrative data.
  • To assess the reliability of performance measures for individual physicians.

Main Methods:

  • Utilized administrative data from a Dutch insurer (2006-2008).
  • Analyzed performance on expenses, hospital care utilization, and clinical quality for diabetes and COPD.
  • Employed multilevel models to calculate intraclass correlation coefficients (ICCs) and reliability.

Main Results:

  • Average ICCs varied significantly across measures, from 0.07% to 8.34%.
  • Risk adjustment often reduced ICCs and reliability, which generally decreased over time.
  • Only 8 measures exceeded 0.70 reliability; 3 exceeded 0.90. Hospital care utilization measures had low reliability (<0.60).
  • While most GPs had adequate patients for 0.70 reliability, none met sample size requirements for 0.90 reliability.

Conclusions:

  • Reliable individual physician performance measurement using single-purchaser data is difficult.
  • Most measures demonstrated insufficient reliability for high-stakes or any profiling applications.
  • Further research is needed to improve the reliability of physician performance profiles.