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Physician Performance Rankings Tied to Patient Traits

Rankings lower when patient panels have more underinsured, non-English-speaking patients

TUESDAY, Sept. 7 (HealthDay News) -- Primary care physicians with greater proportions of patients who are underinsured, a minority, and non-English-speaking are more likely to have lower quality clinical performance rankings, according to research published in the Sept. 8 issue of the Journal of the American Medical Association.

Clemens S. Hong, M.D., of the Massachusetts General Hospital in Boston, and colleagues evaluated data from 125,303 adult patients who had visited a primary care physician in one large academic primary care network between Jan. 1, 2003, and Dec. 31, 2005. Their objective was to determine the relationship between patient panel characteristics and physicians' relative clinical performance rankings.

The investigators found that bottom tertile (for quality performance) primary care physicians had more minority patients compared with top tertile physicians (25.6 versus 13.7 percent). In addition, bottom tertile primary care physicians had more non-English speaking patients (10.2 versus 3.2 percent) and patients with Medicaid coverage or without insurance coverage (17.2 versus 9.6 percent). Adjusting for patient panel factors resulted in a relative mean change in physician rankings of 7.6 percentiles per primary care physician after accounting for practice site and visit frequency differences, with 36 percent of primary care physicians reclassified into different quality tertiles.

"Efforts to improve quality of care must address both fairness of physician clinical performance assessment and the design of incentive schemes to both provide equitable distribution of resources and reduce disparities in care for vulnerable patients," the authors write.

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