What Do We Want Out of Physician Performance Measures? Developing a Conceptual Frame
- What Do We Want Out of Physician Performance Measures? Developing a Conceptual Frame.
- Prevalence of Financial Targets for Quality Improvement.
- The Evolving Doctor-Patient Relationship.
- Patient Engagement.
- Patient Engagement History.
- The Conflict.
- Possible Repercussions.
AHRQ National Advisory Council
November 4, 2011
Bonuses Tied to Medicare's Star System Reward Insurers
"For the first time, a government-backed quality rating will have a financial meaning to health insurance companies looking to attract millions of older Americans to privately run Medicare coverage next."
Bruce Japsen, New York Times (10/12/11)
- This era is ending, being replaced with consumerism and the movement toward shared decisionmaking:
- Teutsch, C. Patient doctor communication. The Medical Clinics of North America 2003;87:11-15-45.
- Previous research has demonstrated a strong relationship between patient-centered patterns of communication and higher levels of satisfaction and trust:
- Jackson JL. Communication about symptoms in primary care: impact on patient outcomes. The Journal of Alternative and Complementary Medicine 2005;11(Supplement 1):S-51 S-56.
- There is a 19 percent higher risk of non-adherence among patients whose physician communicates poorly than among patients whose physician communicates well:
- Haskard Zolnierek KB, DiMatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Medical Care 2009 August;47(8):826-34.
"The core point at which health care costs explode is the point at which the doctor and the patient sit down together to make a decision about what they should do. We have not concentrated enough, in our thinking about reform, on that moment."
January 4, 2010
Image: Photograph of a doctor dressed for the operating-room.
Image: A timeline shows the following key steps in patient engagement history:
- 1999: To Err is Human: Building A Safer Health System.
- 2000: Doing What Counts for Patient Safety: Federal Actions to Reduce Medical Errors.
- 2001: AHRQ initiates 5-year, $150 million in patient safety funding.
- 2002: Harvard/Kaiser surveys find 42% of public and 35% of physicians report experiencing errors.
- 2005: AHRQ/Ad Council exploratory research finds patients worry about errors, but don't feel empowered to take action.
- 2007: Questions are the Answer Campaign. First TV ads feature singing/dancing health care professionals.
- 2009: Campaign update encourages patients to prioritize their questions.
- 2011: Campaign Refresh Adds Clinicians to the Target Audience.
Image: A cartoon shows two cars in a head-on collision. One car is labeled "Patient Engagement" and the other is labeled "Quality Improvement."
- Minimization or inhibition of nascent empowerment/activation initiatives.
- Physicians may fire or discourage "noncompliant" patients from their practices.
- Pushback by providers to Quality Improvement (QI) initiatives.
- Quality targets less than 100 percent.
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