AIM: Public info on docs may not help patients yield better care

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Publicly available information about board certification, education and malpractice claims does not appear to equip consumers with enough information about the quality of care provided by individual physicians, according to a report in the Sept. 13 issue of Archives of Internal Medicine.

“To improve the quality of care received by their beneficiaries, some health plans use physician report cards and tiered physician networks to steer their members toward physicians who provide high quality care. However, most patients do not have access to physician quality measures,” wrote Rachel O. Reid, BA, from the University of Pittsburgh School of Medicine, and colleagues.

“Patients are therefore encouraged to use publicly available proxies for clinical performance when choosing a physician. The Agency for Healthcare Research and Quality advises patients to consult state medical boards and to seek information on board certification and training as a way to assess the quality of care physicians provide.”

The researchers used claims data from 1.13 million adults from 2004 to 2005 to calculate overall performance scores on 124 quality measures for each of 10,408 Massachusetts physicians. The patients were continuously enrolled in one of four Massachusetts commercial health plans from 2004 to 2005. Physician characteristics were obtained from the Massachusetts Board of Registration in Medicine while associations between physician characteristics and overall performance scores were assessed using multivariate linear regression.

The mean overall performance score was 62.5 percent, the authors found. Three physician characteristics were independently associated with significantly higher overall performance: female sex (1.6 percentage points higher than male sex), board certification (3.3 percentage points higher than noncertified) and graduation from a domestic medical school (1 percentage point higher than international).

There was no significant association between performance and malpractice claims, Reid and colleagues added.

“If one looks just at the three physician characteristics that had an association with quality, the difference in overall composite performance between the average physician with the best combination of these characteristics (female, board-certified, domestically trained) and the average physician with the worst combination (male, non-certified, internationally trained physician) is only 5.9 percent,” the authors wrote.

“This is the average difference,” they continued. “Among physicians with the best combination there is a wide range of performance (48.8 percent to 75.3 percent, fifth to 95th percentile); this range is quite similar to the range of all physicians (48.2 percent to 74.9 percent). Thus, there is little evidence to suggest that a patient will consistently receive higher quality care by switching to a physician with these characteristics.”

The lack of association between malpractice claims or disciplinary actions and quality suggests that malpractice claims may reflect more about physician communication style and other attributes than they do about negligent care, the authors noted.

“Publicly available characteristics of individual physicians are poor proxies for performance on clinical quality measures,” the authors concluded. “Public reporting of individual physician quality data may provide the consumer with more valuable guidance when seeking providers of high-quality healthcare.”