Innovations in the Science of Public Reporting of Provider Performance

提供者绩效公开报告的科学创新

• 批准号: 8449450
• 负责人: SUSAN M. PADDOCK
• 金额: $ 29.34万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8449450
• 关键词: Innovations; Science; Public; Reporting; Provider

DESCRIPTION (provided by applicant): The public reporting of comparative provider performance is widespread among public and private purchasers of health care. A key goal of these reporting efforts is to provide consumers with comparative information that can help them choose high-value providers (i.e., high-quality, low-cost). However, the evidence to date shows challenges in consumer use of these reports, reflecting problems in their design, including the underlying analytic methods, the content and display of information, and dissemination to consumers at the point when health care decisions occur. While there is great interest in and need to communicate the differential "value" of providers to consumers given efforts to increase consumer cost sharing and selection of high value services and providers, there has been little progress in developing a value metric that combines cost and quality information. Challenges exist in combining measures to create a measure of value where cost and quality measures have weak associations. Current attempts at showing "value" have focused on side-by-side displays of cost and quality measures. Moreover, as measurement pushes further into areas where the number of events per provider is low, problems arise in obtaining a strong signal on a provider's true performance. We propose to develop an innovative framework that conceptualizes health care value as a two-dimensional construct. Our approach will estimate optimal provider performance across the cost-quality continuum, allowing for fuller consideration of cost-quality tradeoffs in public reports. Aim 1 of the project is to improve the precision and substantive relevance of the information provided to consumers in public reports of health care provider quality. We will do this by (a) assessing the risk of misclassifying physicians into performance tiers and associate reliabilities of physician profiles with misclassification risk and (b) examining whether performance summaries that are tailored to specific reporting goals (e.g., ranking, establishing percentiles or tiers of performance) result in more accurate and precise public reports of small providers' performance as compared to the standard approach of using provider-specific means. Aim 2 is to develop a rigorous cost-quality modeling framework to inform the public reporting of health care provider value. We will employ bivariate hierarchical modeling to obtain measures of the cost-quality tradeoff at each level of the provider hierarchy. Public Health Relevance of the Project: Our findings will help the sponsors of public reports minimize the frequency and severity of provider performance misclassification. The ultimate benefit from our project will be to strengthen the credibility of public reports, leading to increaed use by consumers, ultimately improving the value of health care delivered in the U.S. PUBLIC HEALTH RELEVANCE: This project aims to improve the precision and substantive relevance of the information provided to consumers in public reports of health care provider quality and cost. Public Health Relevance of the Project: Our findings will help the sponsors of public reports minimize the frequency and severity of provider performance misclassification. The ultimate benefit from our project will be to strengthen the credibility of public reports, leadng to increased use by consumers, ultimately improving the value of health care delivered in the U.S.

描述（由申请人提供）：比较提供者绩效的公开报告在医疗保健的公共和私人购买者中普遍存在。这些报告工作的一个关键目标是为消费者提供比较信息，以帮助他们选择高价值提供者（即高质量，低成本）。但是，迄今为止的证据表明，消费者使用这些报告的挑战，反映了其设计中的问题，包括基本的分析方法，信息的内容和显示以及在发生医疗保健决策时向消费者传播。尽管人们对提供商的差异“价值”与消费者的差异“价值”传达给消费者的成本分配和选择高价值服务和提供商的选择，但在开发结合成本和质量信息的价值度量方面几乎没有进展。在结合措施以创建成本和质量衡量标准较弱的关联的情况下，存在挑战。当前展示“价值”的尝试集中在并排的成本和质量措施上。此外，随着测量进一步推向每个提供商的事件数量较低的领域，出现了在提供者的真实绩效上获得强烈信号的问题。我们建议开发一个创新的框架，将医疗保健价值视为二维结构。我们的方法将估计整个成本质量连续体的最佳提供商绩效，从而在公共报告中更加考虑成本质量的权衡。该项目的目标1是提高向消费者提供医疗保健提供者质量报告中提供的信息的精确和实质性相关性。我们将通过（a）评估将医生分类为绩效层的风险，并使医师概况的可靠性与错误分类的风险和 （b）检查针对特定报告目标（例如，排名，建立百分位数或绩效层的绩效摘要）是否会导致与使用特定于提供者特定方式的标准方法相比，小型提供者的绩效的更准确和精确的公共报告。目标2是开发一个严格的成本质量建模框架，以告知医疗保健提供者价值的公开报告。我们将采用双变量层次建模来获得提供商层次结构级别的成本质量权衡的衡量标准。该项目的公共卫生相关性：我们的发现将有助于公开报告的赞助商最大程度地减少提供者绩效错误分类的频率和严重性。我们项目的最终好处将是增强公众报告的信誉，从而导致消费者的逐步使用，最终提高美国提供的医疗保健价值 公共卫生相关性：该项目旨在提高提供给消费者的信息的精确和实质性相关性，这些信息在医疗保健提供者质量和成本的公共报告中。该项目的公共卫生相关性：我们的发现将有助于公开报告的赞助商最大程度地减少提供者绩效错误分类的频率和严重性。我们项目的最终好处是增强公众报告的信誉，导致消费者使用的使用增加，最终提高美国提供的医疗保健价值