What Do We Want Out of Physician Performance Measures? Developing a Conceptual Frame

National Advisory Council, November 4, 2011

On November 4, 2011, Carolyn Clancy and Lisa Latts made this presentation at the meeting of the National Advisory Council.

Slides

  1. What Do We Want Out of Physician Performance Measures? Developing a Conceptual Frame.
  2. Prevalence of Financial Targets for Quality Improvement.
  3. The Evolving Doctor-Patient Relationship.
  4. Patient Engagement.
  5. Patient Engagement History.
  6. The Conflict.
  7. Possible Repercussions.
  8. Feedback.

Slide 1. What Do We Want Out of Physician Performance Measures? Developing a Conceptual Frame

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Carolyn Clancy
Lisa Latts
AHRQ National Advisory Council
November 4, 2011

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Slide 2. Prevalence of Financial Targets for Quality Improvement

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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)

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Slide 3. The Evolving Doctor-Patient Relationship

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  • 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.

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Slide 4. Patient Engagement

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"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."

Atul Gawande
Time magazine
January 4, 2010

Image: Photograph of a doctor dressed for the operating-room.

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Slide 5. Patient Engagement History

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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.

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Slide 6. The Conflict

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Image: A cartoon shows two cars in a head-on collision. One car is labeled "Patient Engagement" and the other is labeled "Quality Improvement."

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Slide 7. Possible Repercussions

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  • 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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Slide 8. Feedback

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We need your ideas!

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Page last reviewed November 2011
Internet Citation: What Do We Want Out of Physician Performance Measures? Developing a Conceptual Frame: National Advisory Council, November 4, 2011. November 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/nac/2011-11-nac/clancy_latts/clancy_latts.html