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PubMed · 10788033

Alternative explanations for poor report card performance.

R Sorokin
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Abstract

CONTEXT: Many managed care organizations grade physician groups with "report cards" developed from administrative data sets and chart reviews. OBJECTIVE: To investigate the accuracy of five report cards on a single group practice. DESIGN: Determination of report card accuracy by using the practice capitation list and a review of the patients' medical records. SETTING: Academic practice in Philadelphia, Pennsylvania (19 physicians), evaluated with five report cards by two capitated health plans between 1994 and 1997. RESULTS: Four major problems were uncovered. First, four of the five report cards included patients who were enrolled in our practice for only a portion of the reporting year (for the four report cards, the proportion of partial-year enrollees was 8%, 15%, 23%, and 100%). Second, there was a considerable number of false-positive diagnoses in the administrative algorithms. Eight of the 61 patients labeled with hypertension did not have this condition (error rate, 14%). Other error rates were 44% for coronary artery disease, 50% for congestive heart failure, 33% for atrial fibrillation, and 0% for diabetes. Third, the administrative data often failed to capture laboratory data. Laboratory performance measures for patients with diabetes (hemoglobin A1c and cholesterol measurement and screening for microalbuminuria) were 3 to 10 times higher when assessed by chart review. Finally, the uniformly small sample sizes used in the report cards make the estimates of performance imprecise. No report card reported 95% CIs. CONCLUSION: Five report cards on a group practice contained methodologic problems that led to systematic underestimation of the practice's performance. Larger surveys are needed to determine the accuracy of report cards in current use.

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AdultAgedAged, 80 and overFemaleGroup PracticeHumansMaleManaged Care ProgramsMedical AuditMiddle AgedOrganizational Case StudiesPhiladelphiaPrimary Health CareReproducibility of ResultsJournal Article

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R Sorokin. Alternative explanations for poor report card performance.. https://pubmed.ncbi.nlm.nih.gov/10788033/

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