The Use of Inter-Clinician Variation in Measuring Healthcare Performance

Abstract

To monitor and improve healthcare in the US, providers are required to report healthcare measures as part of regulatory and compensatory systems. However, there are growing concerns that the collection and reporting of these measures may be counter-productive to provider efforts to improve care. Variations in care are known to adversely affect quality, but studies on the relationship of variation within measures and performance of those measures are lacking. We aimed to test if inter-clinician variation of a healthcare measure was associated with performance of that measure and to thereby establish a model for identifying measures that might be more likely associated with opportunities to improve care. We identified the proportion of diabetic patients with blood pressure under control as an important measure. Measure performance and inter-clinician variation was calculated each month and both visual and time series analyses were performed. We found that between 14% and 23% of the performance of our chosen measure was associated with variation between clinicians. This finding suggests that inter-clinician variance of a measure can be used to help identify measures where opportunities for improvement of clinical processes exist.