Physician performance assessment: Prevention of cardiovascular disease
Lipner RS, Weng W, Hess BJ. — American Board of Internal Medicine
Presented: American Educational Research Association Annual Meeting, April 2012
Background: Given the rising burden of health care costs, both patients and health care purchasers are interested in discerning which physicians deliver quality care.
Objective: We propose a methodology to assess physician clinical performance in preventive cardiology care, determine a benchmark for performance, and evaluate measurement properties of the approach.
Design: Retrospective cohort study.
Participants: 811 physicians from the United States with time-limited certification in internal medicine or a subspecialty.
Main Measures: The American Board of Internal Medicine’s Preventive Cardiology Practice Improvement Module was used to collect data on eight clinical measures and form an overall composite score for preventive cardiology. An expert panel of nine internists/cardiologists skilled in preventive care for cardiovascular disease used an adaptation of the Angoff standard-setting method and the Dunn-Rankin method to create a composite score for preventive cardiology and establish a benchmark for minimally acceptable performance. Physician characteristics were used to examine the validity of the inferences made from the composite scores.
Key Results: The mean number of medical charts abstracted per physician was 25.5 (SD = 1.8); overall, physicians abstracted 20,656 charts. The mean composite score was 73.88% (SD = 11.88). Reliability of the composite was 0.87. Specialized cardiologists had significantly lower composite scores (P = 0.04), while physicians who reported spending more time in primary, longitudinal, and preventive consultative care had significantly higher scores (P = 0.01), providing some evidence of score validity. The panel established a standard of 47.38 (out of 100 possible points) on the composite measure with high classification accuracy (0.98). Only 2.7% of the physicians performed below the standard for minimally acceptable preventive cardiovascular disease care. Of those, 64% (N=14), were not general cardiologists.
Conclusions: We found a psychometrically defensible methodology for assessing physician performance in preventive cardiology while also providing relative feedback with the hope of heightening physician awareness about deficits and improving patient care.
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