Most doctors slow to integrate quality data into their practices
■ Physicians in larger groups might have more financial flexibility to implement quality improvement methods.
By Damon Adams — Posted June 6, 2005
Many physicians are not actively working to improve the quality of care in their practices, and smaller practices are less likely than larger ones to use data to boost quality care, according to a new study.
A survey of 1,837 physicians by the Commonwealth Fund showed that only one in three doctors has access to data about the quality of their clinical performances and one in three is involved in redesigning their systems to improve care.
Researchers said physicians are slow to adopt measures to boost quality and doctors are reluctant to publicly share information about the quality of care they provide.
"It's fine to have [quality] data but you have to integrate it in your daily routine," said Anne-Marie Audet, MD, vice president of the quality improvement program at the Commonwealth Fund and lead author of the study, which appeared in the May/June Health Affairs.
The study was intended to gauge physicians' involvement in quality improvement methods and used data from a national survey of physicians conducted in 2003.
Researchers said their findings show most physicians do not incorporate such quality methods into their practices. Doctors do not routinely use data for assessing their performance and they infrequently take part in quality redesign activities, according to the study.
Less than half of the doctors could easily generate a list of patients by certain age groups. About four in five doctors found it difficult or were unable to generate lists of their patients by lab results, making it more difficult to follow up with high-risk patients, the study said.
Physicians in larger practices were more likely than doctors in smaller practices to receive quality-of-care data. About one in three doctors received any data, such as outcomes and patient surveys, concerning the quality of care they provide. Insurance companies and health plans were the most common sources of quality data for physicians.
Participation in quality improvement activities was lacking. The smaller the doctor's practice, the less likely a doctor was to take part in revamping the practice to embrace quality improvement. Doctors in larger practices might have more financial flexibility and access to funds, putting them in a better position to implement measurements and other quality improvement methods.
"The most surprising finding to me was the huge chasm that separates physicians in solo and small groups from physicians in large groups," Dr. Audet said.
When it comes to sharing performance data, 71% of doctors said it was OK to share such information with medical leadership. About half agreed that performance data should be shared with patients. But two in three doctors opposed giving such information to the general public.
"Physicians equate giving information to the public with having their name on the front page of the newspaper," said Dr. Audet, explaining that some physicians believe the public might misinterpret quality data to mean a doctor provides poor care.
Improving quality of care
The study's authors said physician involvement in quality efforts should be increased through incentives and policies. They said performance-based payment programs should be explored, and they added that medical school curricula and other training should include quality improvements.
Some medical leaders agreed with the study's findings. But they said the results are not because physicians are unwilling to engage in quality improvement practices.
"I see the problem as a global health care problem, not one of pure physician resistance," said John Whittington, MD, a patient safety scholar with the Institute for Healthcare Improvement.
Quality care experts said many physicians did not receive training in medical school on how to implement quality improvements.
"Doctors want to do a good job. They're not doing [quality improvements] because it was not how they were taught to practice medicine," said Janet Sullivan, MD, a board member of the National Quality Forum and chief medical officer of Hudson Health Plan in New York.
But experts said medical organizations and other groups are taking steps to integrate quality improvement into physicians' everyday lives.
The AMA-led Physician Consortium for Performance Improvement has developed performance measure sets that primary care physicians can use.
"The goal has been to improve the quality of clinical care through these measures," said AMA Trustee Cyril M. Hetsko, MD. "There is a lot of activity going on in this arena that the AMA is supporting."
The American College of Physicians last year issued a position paper saying that physician performance measures should be evidence-based and clinically relevant. The college also supports demonstration projects to evaluate the use of financial incentives to reward physicians who meet or exceed performance standards, the paper said.
"The goal is to foster continuous quality improvements. They should be pertinent to the physicians," said Michael S. Barr, MD, the ACP's vice president of patient advocacy and improvement.
Bruce Bagley, MD, medical director for quality improvement of the American Academy of Family Physicians, said family physicians will need to do more to track quality data. He is optimistic that more doctors will begin embracing quality improvement methods in their practices.
"Doctors are going to need to collect data and be public about their data and learn to collect it in a way that's efficient," he said. "We do think the pace [of implementing quality improvements] is about to pick up, and it's pay-for-performance that is going to do it."