Available physician characteristics may not help patients find high-quality care

(Press-News.org) Publicly available information about board certification, education and malpractice claims appear to provide consumers with little information about the quality of care individual physicians provide, according to a report in the September 13 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

"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," the authors write as background information in the article. "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."

Rachel O. Reid, B.A., of the University of Pittsburgh, and colleagues 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. They then obtained information about the same physicians from the Massachusetts Board of Registration in Medicine.

The average overall performance score for the physicians was 62.5 percent. Of the publicly available individual physician characteristics, three were associated with higher overall performance: female sex, board certification and graduation from a domestic medical school. However, the differences were small in magnitude. There was no significant association between malpractice claims and performance.

"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 write.

"Also, this is the average difference. 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 suggest that malpractice claims may reflect more about physician communication style and other attributes than they do about negligent care, the authors note.

'In conclusion, we found that individual physician characteristics are poor proxies for performance on clinical quality measures and are not well suited for use as such by patients," they conclude. "Public reporting of individual physician quality data may provide the consumer with more valuable guidance when seeking providers of high-quality health care."

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(Arch Intern Med. 2010;170[16]:1442-1449. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This research was supported by a contract from the U.S. Department of Labor and a grant from the Commonwealth Fund. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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