Post on 16-Dec-2015
transcript
Benchmarking Clinicians
Farrokh Alemi, Ph.D.
Why should it be done?
Hiring, promotion, and management decisions
Help clinicians improve
Intrusion in clinician’s practice?
Managers understand patient outcomes Practice profiles are constructed after the
fact, when the patient is gone. Both the patient and managers can use
benchmarked data Poor clinicians are bad for the patient as well as
for the organization
How should the analysis be done?
Compare clinician to average peerCompare clinician to average peer taking
care of same kinds of patientsCompare clinician to expectations on
admissionCompare clinician and peers on patients
matched on certain features
In benchmarking, a clinician's performanceis compared to an expected value.
Compare Clinician to Average Peer
Calculate peer providers and the clinician’s average and standard deviation
Compare using test of hypothesis with unequal means
Problem: Maybe misleading as providers see different
kinds of patients and the clinician with more severely ill patients will naturally have worst outcomes
Example Data
123 internal medicine residents at the New York-Presbyterian Hospital in New York City.
The outcomes examined included following outcomes: Patients' satisfaction measured by telephone interviews of at least 10
patients Disease-management profiles for average of 7 diabetes and 11
hypertensive patients. Patient's condition Frequency of use of various medications
Faculty-evaluations on seven dimensions: History taking Physical examination Differential diagnosis Diagnostic and/or treatment plan Health care maintenance Act compassionately Team player
Sample Report
Compare Clinician to Average Peer Caring for Same Kinds of Patients
Example Data
Comparing Clinicians to Expected Prognosis at Admission
Assess patients severityPredict prognosisCalculate pair-wise student-t comparison
of observed and expected values
Example Data
Comparing Clinicians When Patient's Severity of Illness Is Not Known
Example Data
Event Tree for Clinician’s Patients Is Kept, Outcomes Change
Is it reasonable to benchmark clinicians?
Measurement distorts goalsMeasurement leads to defensive behaviorNo adequate measure of severity maybe
availableToo much time spent on measurement
and too little on improvement
How Should Benchmarked Data Be Presented?
Before the meeting Schedule a feedback time and date as soon as
possible. Check your data to make sure there are no errors. Add text, charts or graphics. Supplement numeric data
with anecdotal information and the customer's voice (e.g. a short audio from a patient).
Distribute handouts ahead of meeting to participants
How Should Benchmarked Data Be Presented?
At the meeting Make it clear that the evaluation is confidential Make a brief introduction of the purpose of the session Acknowledge the limitation of the practice profiling
method Present the data and not the conclusions Explicitly ask for clinician's evaluation of the data after
each section of the report is presented DO NOT defend the practice profiling method, the
benchmarking effort or any aspect of your work Thank the clinicians for their time and describe next
steps
How Should Benchmarked Data Be Presented?
After the meeting Summarize the comments and append it to the report. Describe resources available. Send a written report to each clinician. Ask the clinicians to comment on:
What worked well and what needs improvement? Do they plan to change their practice and in what way? Was it worthwhile?
Set the time of next benchmarking report. .
Take Home Lesson
Expected Outcomes Can Be Benchmarked Using Severity of
Patients’ Illness