Evaluating Profiling Program and New Quality Indicators for Diabetes Care
Clinical report cards, rankings, and pay-for-performance programs are designed to improve quality of care by providing clinical feedback and competition to healthcare providers, but physicians have numerous concerns about these programs. For example, profiling programs do not account for differences in patient panel characteristics, and another concern is whether or not observed quality differences are due to chance or actual underlying differences in care. This study evaluated the addition of new quality indicators to an ongoing clinician feedback initiative that profiles diabetes care. Investigators focused on diabetes mellitus because it is common among Veterans and has established indicators with clinical significance. Veterans (n=11,031) included in this study received care at 13 VA clinics, within one VA network, during 2004 and 2005. Clinic performance was assessed by analyzing patient data on several quality measures, including A1c, LDL, blood pressure, urine protein, as well as nephropathy and retinopathy exams.
Results show that monitoring for A1c, LDL, and urine protein; A1c and LDL control; and appropriate treatment for LDL and nephropathy ranged from 83% to 97% network-wide. Findings also revealed the presence of low network attainment for some benchmarks. For retinopathy monitoring, blood pressure control, and hypertension treatment, network adherence was found to be 59.5%, 66.6%, and 46.7%, respectively. In addition, there was noticeable variation at the clinic level that was statistically, and often clinically significant. This study suggests that rather than relying on benchmarks with high and consistent attainment, profiling programs may want to target indicators that demonstrate low and variant performance to better differentiate care across sites.
Ta S, Goldzweig C, Juzba M, Lee M, Wenger N, Yano E, and Asch S. Addressing physician concerns about performance profiling: Experience with a local Veterans Affairs quality evaluation program. American Journal of Medical Quality March-April 2009;24(2):123-131.
This study was partly funded by HSR&D. Drs. Goldzweig, Lee, Yano, and Asch are part of HSR&D's Center for the Study of Healthcare Provider Behavior in Sepulveda, CA.