When choosing a doctor based on increasingly popular
"doctor report cards," patients should be aware that the
areas in which physicians are graded are not always
clear-cut, according to researchers from the Johns Hopkins
Bloomberg School of Public
School of Medicine.
They examined the usefulness of quality indicators for
asthma specialists; that is, individual aspects of patient
care that can be used to "grade" physicians, such as
patient satisfaction with care or use of the correct
medication. The study is published in the January issue of
The American Journal of Managed Care.
Albert W. Wu, senior author of the study and associate
professor in the Department
of Health Policy and Management at the Bloomberg
School, explained that grading physicians can be difficult
for a variety of reasons. "If all physicians receive the
equivalent of an 'A' on a certain indicator, that does not
help distinguish between the doctors. For some indicators,
it can also be difficult to obtain reliable data from
patients. And finally, surveying a doctor who doesn't treat
enough patients won't give you an accurate picture of how
the physician is performing."
The researchers analyzed surveys collected from 2,515
asthmatic patients from 20 California-based physician
groups from 1998 to 1999. Doctors were assessed based on
six quality indicators, as reported by their patients
— accessibility of asthma care for patients,
self-management of asthma care, the use of inhaled
corticosteroids, satisfaction with asthma care, improvement
in health and the number of emergency department visits and
hospitalizations attributable to asthma.
The researchers found that patients were able to give
reliable answers about these indicators of the care they
were getting. However, they also found that having a
sufficient number of patients was key to getting useful
"Our findings have practical implications for managed
care decision makers and organizations engaged in physician
profiling for asthma or other diseases," said I-Chan Huang,
the first author of the study and a postdoctoral fellow in
the Bloomberg School's Department of Health Policy and
Management. "Variability in quality indicators is a
desirable attribute for performance measures. In addition,
our results suggest that the reliability of profiling
indicators is also an important consideration."
According to the study authors, not all quality
indicators are equal. Indicators should be something that
vary doctor to doctor, and they need to be measurable,
without much error.
"As doctor report cards become more popular across the
country, patients should know that quality of care does
vary, but there are clear-cut indicators that can help them
determine which doctor to go to. Our research found that
for asthma patients, the following may be useful indicators
to help them select among different doctors: asthma
self-management knowledge, use of inhaled steroids,
satisfaction with asthma care and self-reported improvement
in health status," said Wu, who also holds an appointment
at the School of Medicine.
The study was co-authored by I-Chan Huang, Gregory B.
Diette, Francesca Dominici, Constantine Frangakis and
Albert W. Wu, who were supported by grants from the Pacific
Business Group on Health.