Private Performance Feedback Reporting for Physicians
A growing number of Chartered Value Exchanges (CVEs) and other multistakeholder community quality collaboratives are now producing some type of private performance feedback report to physicians or other health care providers in parallel to their public report for consumers. In contrast to public reports, private performance feedback reports for physicians are designed to serve the measurement and improvement goals of clinicians and other health professionals, as well as health care organization leaders. Private reports focus on key performance indicators such as clinical process, clinical outcome, patient experience, and resource use measures.
Although the data sources and performance measures included in private feedback reports are often the same as those used in public reports, private reports to physicians contain a much greater level of data detail and search capabilities. Often these reports have data at the level of individual patients. This level of detail facilitates care management and followup in the context of ongoing quality improvement programs.
Community quality collaboratives face a range of considerations as they develop or redesign private performance feedback reports for physicians, including overall strategic issues and more specific elements related to report content, design, and dissemination. This guide offers 13 specific recommendations intended primarily for CVEs and other collaboratives engaged in private feedback reporting. Based on a review of the limited literature on private reports, an examination of selected examples of community quality collaborative feedback reports, and an indepth case study of one CVE's experience with private reporting, the recommendations are:
- Understand the goals and information needs of your target audience: The starting point for an effective report, whether public or private, is to engage with the target audience you intend to reach. Involving physicians and other end users in this process can yield important insights and lead to greater ownership and use of the report.
- Identify your value-added reporting niche: Once specific goals and needs are established, sponsors can determine which needed information they are in a unique market position to supply. A key contribution that CVEs can bring to private feedback reporting is their unique ability to provide community-level benchmarks that no single care system or heath plan can create on its own.
- Select performance measures that are perceived as relevant and are actionable: These include measures that reflect important processes of care related to patient outcomes and that signal clear steps that a clinician can take to improve performance. Measures that align with those included in public reports can help reinforce their relevance, since physicians will have strong incentives to improve on those measures that are publicly reported.
- Include benchmarks for comparison to peers and normative standards: Peer comparisons are important in private feedback reports if the goal is to change physician behavior, since physicians are motivated by comparative information. Comparisons to normative standards also are important, but it is helpful to make them achievable so that they cannot easily be perceived as unreasonable or unattainable and therefore be ignored.
- Use displays to highlight the most important patterns: Many of the design principles for private feedback reporting are the same as for public reporting, namely, to use graphic displays and text that tell a clear story about performance that is understood and seen as useful by the target audience.
- Provide access to patient-level data: An important feature of private feedback reports for physicians is the ability to view the underlying patient-level data that go into the reported performance measures. This way, the clinician can identify specific patients who have not followed management goals or are overdue for specific services.
- Enable physicians to correct patient-level data: In addition to providing access to patient-level data, it is important to allow physicians to review and identify data that appear to be in error. Such a feature not only provides a feedback loop for improving data quality, but also may enhance physician trust in the report.
- Use sound methods and make them transparent: Physicians' perceptions of the accuracy and completeness of the data are critical if they are to have sufficient credibility for physicians to rely on them as indicators of their need for quality improvement.
- Update data at least quarterly: Timeliness of data is critical for management of patient care, as well as for tracking performance and monitoring progress toward improvement goals. While monthly reports are considered ideal, most clinicians and managers concur that private feedback reports should be updated at least quarterly.
- Build in capacity to view performance trends: The ability to update reports on a monthly or quarterly basis also supports the ability to view performance measures over time through such tools as run charts and other monitoring tools.
- Distribute reports through multiple channels: The most successful approach to report distribution is likely to combine multiple strategies such as email, faxed reports, mailed hard copy reports, and posting of comparative reports onsite. In addition, presentations and discussions of reports can take place as part of quality committee meetings, improvement collaborative sessions, and individual performance appraisal reviews.
- Embed feedback reporting as an integral part of quality improvement: Private feedback reports are most likely to promote clinician behavior change if they are used strategically within a quality improvement program. The most successful interventions for changing practitioner behavior appear to involve interactive approaches allowing clinicians to meet and discuss improvement opportunities and challenges with their peers.
- Evaluate private feedback reports against reporting goals: Like all reporting tools, private feedback reports can be enhanced through a periodic evaluation of their utility to users and their impact in helping to achieve their intended goals. Methods include focus groups, key informant interviews, user surveys, and online tracking tools for Web-based reports.
Finally, as suggested by the Cincinnati CVE case study, CVEs and other community quality collaboratives may be able to augment their private feedback reporting tool or system by developing supportive resources or services that can assist report users in applying the information to achieve their goals.