Assessment of physician performance for diabetes: a bias-corrected data envelopment analysis model

In most national health systems, especially when universal coverage is provided, family physicians act as gatekeepers, because most healthcare services are only delivered if there is a formal prescription provided by a primary care physician. Although the consumption of healthcare resources is initiated by prescriptions coming from family physicians, studies that evaluate their performance, especially those using a consolidated methodology (e.g.quality and efficiency) are limited in the literature. The specific aim of this paper is to propose a method for assessing primary care performance.

The novelty of the proposed model is twofold. First, physician performance is assessed following a clinical pathway that focuses on homogeneous groups of patients, in this case, diabetes patients. Second, we argue that performance should not be limited to efficiency, but should encompass clinical effectiveness. Performance assessment is not based on the physician practice as a whole, but on a single disease, in this paper, diabetes. Data were collected from a sample of family physician practices in Italy, and Data Envelopment Analysis (DEA) is used to evaluate their efficiency performance.

We found that 35 of 96 practices were efficient based on the standard DEA model. The number of efficient practices decreased based on three restricted models that explored various behavioural preferences of physicians in relation to patient visits, medication administration and referrals to hospitals.

The efficiency assessment is completed by a post-hoc evaluation of effectiveness, which in this study is defined as patient care adherence to the prescribed guideline. This study identified best practices both in terms of efficiency and effectiveness. The methods used in this paper are generalisable and could be applied to many other chronic conditions, which may constitute the prevalent activities within the primary care.