In this modern era of healthcare where value trumps volume, assessing a physician’s performance is more important than ever. However, according to a new analysis published in JAMA Network Open, obtaining accurate assessments can still be difficult.
The authors compared two techniques commonly used by physicians to track their ABCS performance scores: medical record abstraction (MRA) and extracting data from electronic health records (EHRs). The study included data from a random sample of 621 patients taken from the Healthy Hearts for Oklahoma Project. All patients were treated by one of 21 primary care practices in 2018.
The ABCS performance scores focus on three areas: aspirin, blood pressure and smoking. Overall, the observed performance scores related to aspirin were 76% when using MRA data and 74.9% when using EHR data. Similar differences were also noted in the other categories. The observed performance scores related to blood pressure were 80.6% when using MRA data and 75.1% when using EHR data; the scores related to smoking were 85.7% when using MRA data and 75.4% when using EHR data.
“These results raise significant concerns about the comparability and validity of different methods used to determine performance scores, which has important implications for quality improvement activities and implementation of value-based payment models,” wrote lead author Juell Homco, PhD, MPH, University of Oklahoma Health Sciences Center in Tulsa, and colleagues. “Despite being imperfect, our study illustrates that MRA and EHR data do a relatively good job of determining performance scores, given that there are no alternatives. However, using imperfect performance measures in practice can have significant implications when payment to clinicians depends on the achievement of target performance levels.”
Going forward, the authors concluded, this is an area that requires much more research.
“Given the importance of performance measurement to quality improvement efforts and value-based payment models, more extensive study is required to better understand the source of these differences so that improvements in care quality can be measured with confidence,” they wrote.
The full study from JAMA Network Open is available here.