How we judged a primary care physician? 美國版，分數和你所吸引到的病人群相關…
美國認為pay for performance很重要…不過好的病人群才是拿高分的原因之一
有好原料才能燒好菜
不過衡量primary care physician的HEDIS指標，比起我們健保局的各項品質指標
實在是差太多了，健保局真是青出於藍勝於藍啊!!
但是，控制到了什麼呢? 指標是真相嗎? 拿慢箋開立率好了，為了達成這個目標，常常一拿三個月藥，multiple co-morbidities的病人哪有那麼易與的? 地區醫院還好住院容易，常常要幫醫學中心的病人cover倒是真的……嚴重妨害醫療品質，真是蛋頭指標，省錢指標…
How can you judge a man by these stupid fiugures? 管理的目的不在此，蛋頭啊!!
Clinical Performance Rankings of Primary Care Physicians
Rankings are influenced by socioeconomic characteristics of patient panels.
Physician quality measures are used increasingly for pay-for-performance and other clinical incentive programs. To assess how patient socioeconomic characteristics influence physician rankings, researchers reviewed records for 125,000 patients of 162 primary care physicians in a Massachusetts academic primary care network. Physicians were initially ranked in tertiles without adjustment, based on nine HEDIS (Health Effectiveness Data and Information Set) criteria, including screening for breast, cervical, and colon cancers, and risk factor reduction in diabetes and coronary artery disease.
Top-ranked physicians, compared with bottom-ranked physicians, had patients who were significantly older, more likely to have comorbidities, and more likely to make frequent visits and who were less likely to be of minority descent, non–English-speaking, insured by Medicaid, or uninsured. After adjustments for practice characteristics and visit frequency, physician rankings changed by an average of about 15 percentiles. After further adjustment for patient characteristics, physician rankings changed again by an average of nearly 8 percentiles, with 59 physicians (36%) moving into different tertiles, either higher or lower.
Comment: Because their model is not fully adjusted, the authors do not present it as a tool for making actual performance ratings or pay-for-performance decisions; rather, these results demonstrate that performance ratings are influenced by factors that are not under the primary care physician's control — particularly by patient socioeconomic characteristics.
— Thomas L. Schwenk, MD
Published in Journal Watch General Medicine September 21, 2010
Citation(s):
Hong CS et al. Relationship between patient panel characteristics and primary care physician clinical performance rankings. JAMA 2010 Sep 8; 304:1107. (http://dx.doi.org/10.1001/jama.2010.1287)
* Original article (Subscription may be required)
* Medline abstract (Free)
HEDIS 指標如下…和本國健保局的指標相比，太容易達成了
還是一句話，有什麼原料燒什麼菜，指標燒到極限，哪裏還有醫護人員佛心要收人球???
9 HEDIS measures including
(1) mammography in the previous
2 years for eligible women aged
42 to 69 years; (2) Papanicolaou cervical
screening in the previous 3 years
for eligible women aged 21 to 64 years;
(3) colonoscopy within 10 years, sigmoidoscopy
or double-contrast barium
enema within 5 years, or home fecal occult
blood testing within 1 year for eligible
patients aged 52 to 69 years; (4)
hemoglobin A1c testing in the prior year
and proportion with levels of 7.0% or
less in patients with diabetes; (5) lowdensity
lipoprotein cholesterol testing
in the previous year and proportion
with levels of 100 mg/dL or less (to convert
to mmol/L, multiply by 0.0259) for
patients with diabetes and coronary artery
disease.
https://docs.google.com/fileview?id=0B278nGJMQBk7YmE4ODQzOGQtZDU3Ni00MWYxLTk2MzgtNjZiODc1MTUzZTNh&hl=zh_TW
有好原料才能燒好菜
不過衡量primary care physician的HEDIS指標，比起我們健保局的各項品質指標
實在是差太多了，健保局真是青出於藍勝於藍啊!!
但是，控制到了什麼呢? 指標是真相嗎? 拿慢箋開立率好了，為了達成這個目標，常常一拿三個月藥，multiple co-morbidities的病人哪有那麼易與的? 地區醫院還好住院容易，常常要幫醫學中心的病人cover倒是真的……嚴重妨害醫療品質，真是蛋頭指標，省錢指標…
How can you judge a man by these stupid fiugures? 管理的目的不在此，蛋頭啊!!
Clinical Performance Rankings of Primary Care Physicians
Rankings are influenced by socioeconomic characteristics of patient panels.
Physician quality measures are used increasingly for pay-for-performance and other clinical incentive programs. To assess how patient socioeconomic characteristics influence physician rankings, researchers reviewed records for 125,000 patients of 162 primary care physicians in a Massachusetts academic primary care network. Physicians were initially ranked in tertiles without adjustment, based on nine HEDIS (Health Effectiveness Data and Information Set) criteria, including screening for breast, cervical, and colon cancers, and risk factor reduction in diabetes and coronary artery disease.
Top-ranked physicians, compared with bottom-ranked physicians, had patients who were significantly older, more likely to have comorbidities, and more likely to make frequent visits and who were less likely to be of minority descent, non–English-speaking, insured by Medicaid, or uninsured. After adjustments for practice characteristics and visit frequency, physician rankings changed by an average of about 15 percentiles. After further adjustment for patient characteristics, physician rankings changed again by an average of nearly 8 percentiles, with 59 physicians (36%) moving into different tertiles, either higher or lower.
Comment: Because their model is not fully adjusted, the authors do not present it as a tool for making actual performance ratings or pay-for-performance decisions; rather, these results demonstrate that performance ratings are influenced by factors that are not under the primary care physician's control — particularly by patient socioeconomic characteristics.
— Thomas L. Schwenk, MD
Published in Journal Watch General Medicine September 21, 2010
Citation(s):
Hong CS et al. Relationship between patient panel characteristics and primary care physician clinical performance rankings. JAMA 2010 Sep 8; 304:1107. (http://dx.doi.org/10.1001/jama.2010.1287)
* Original article (Subscription may be required)
* Medline abstract (Free)
HEDIS 指標如下…和本國健保局的指標相比，太容易達成了
還是一句話，有什麼原料燒什麼菜，指標燒到極限，哪裏還有醫護人員佛心要收人球???
9 HEDIS measures including
(1) mammography in the previous
2 years for eligible women aged
42 to 69 years; (2) Papanicolaou cervical
screening in the previous 3 years
for eligible women aged 21 to 64 years;
(3) colonoscopy within 10 years, sigmoidoscopy
or double-contrast barium
enema within 5 years, or home fecal occult
blood testing within 1 year for eligible
patients aged 52 to 69 years; (4)
hemoglobin A1c testing in the prior year
and proportion with levels of 7.0% or
less in patients with diabetes; (5) lowdensity
lipoprotein cholesterol testing
in the previous year and proportion
with levels of 100 mg/dL or less (to convert
to mmol/L, multiply by 0.0259) for
patients with diabetes and coronary artery
disease.
https://docs.google.com/fileview?id=0B278nGJMQBk7YmE4ODQzOGQtZDU3Ni00MWYxLTk2MzgtNjZiODc1MTUzZTNh&hl=zh_TW
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