Private Performance Feedback Reporting for Physicians
Appendix A: Ambulatory Quality Alliance Principles for Reporting to Clinicians and Hospitals
The Ambulatory Quality Alliance (AQA) recognizes that reporting information to clinicians on their respective performance is critical for improving quality and patient safety, as well as for promoting accountability. The following principles are designed to guide the reporting of such information to clinicians and hospitals. These principles reflect the importance of ensuring that clinicians receive valid, reliable, and useful information so they can most effectively assess and improve their performance and meet or exceed agreed-upon targets. They also emphasize the need for physician and other clinician engagement in report design.
Recognizing that consumers, purchasers, and other stakeholders also need better information to enable them to make informed decisions about treatment, coverage, and other matters related to their health care, a separate set of principles has been developed to guide public reports.1 The principles set forth in this document should be considered in conjunction with these other principles, as well as principles for performance measurement1 and data sharing and aggregation1 that the AQA has already endorsed.
Content of Reports
- Reports should focus on areas that have the greatest opportunities to improve quality by making care safe, timely, effective, efficient, equitable, and patient centered.
- Reports should rely on standard performance and patient experience measures that meet the AQA Principles for Performance Measurement (e.g., measures should be evidence based, relevant to patient outcomes, and statistically valid and reliable).
- Reports should include overall composite assessments of individual clinician or group performance, as well as assessments of the individual measures used for the overall composite assessment (e.g., quality or cost of care).
- Performance data should, when available, reflect trend data over time rather than periodic snapshots to optimize data use for quality improvement. Measures used for trending should be stable (e.g., the data definitions or collection methodology do not change between intervals) unless there is compelling evidence or a justifiable reason not to be.
- Data specifications for reported performance data, such as sample size and methods of data collection and analysis, should be explicit and disclosed to physicians and other clinicians and hospitals.
- Clinicians whose performance is reported should be able to review and comment on the methodology for data collection and analysis (including risk adjustment). Clinicians and hospitals should be notified in writing in a timely manner of any changes in program requirements and evaluation methods.
- Report sponsors should also make the performance results available to clinicians for review prior to any public release. To improve the accuracy of reports, mechanisms need to be in place to verify and correct reported data.
- To the extent possible, results should accurately reflect all services that are accountable in whole or in part for the performance measured. Attribution should be explicit and transparent.
Portrayal of Performance Differences
- Results of individual clinician or group performance should be displayed relative to peers. Any reported differences between individual providers or groups should include the clinical relevancy of the findings.
Report Design and Testing for Usability
- Practicing physicians and other clinicians should be actively involved in the design of performance reports.
- Report formats should be designed to be user friendly and easily understood and should be pilot tested before implementation.
- Data displays in reports should highlight meaningful and actionable differences in performance.
- Reports should be continually improved so that they are increasingly effective and evaluated for potential unintended consequences.
- Clinicians and hospitals should collaborate to share pertinent information in a timely manner that promotes patient safety and quality improvement.
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