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Authors: Rachel Lynn Orler,B.A.; University of
Pittsburgh School of Medicine, Ateev Mehrotra, M.D., M.P.H., M.S.;
University of Pittsburgh Division of General Internal Medicine;
RAND Health, Pittsburgh
As evidenced by pay-for-performance incentives and physician report
cards, there is a growing interest in identifying high quality
physicians. However, looking only at individual quality leaves an
important corollary unaddressed: What kinds of physicians provide
the best care? Previous studies on this question have been limited
by the number of physicians, available physician characteristics,
or scope of quality metrics. In this study we examined the
relationship between individual physician characteristics and
healthcare quality using over one hundred quality indicators across
a large sample of physicians in Massachusetts.
The study sample was comprised of 13,788 active Massachusetts
physicians in 27 common specialties. Quality of care was measured
using the RAND claims-based QA Toolkit of 131 indicators for 21
conditions. Examples of quality metrics included such guidelines as
having INR checked every three months for atrial fibrillation
patients on warfarin or screening pregnant patients for anemia at
their first prenatal visit. The basis of the quality measurement
was a database of de-identified insurance claims for 1.13 million
adult patients continuously enrolled in one of the four major
Massachusetts health plans in 2004-05. The following physician
characteristics were obtained from the Massachusetts Board of
Registration: gender, medical school attended, years in practice,
board certification status, and disciplinary and malpractice
information. Quality of medical school was measured by US News and
World Report rankings of the physician's medical school. Of the
12,781 active physicians, 10,768(84.25%) were linked and had
complete demographic and quality profiles. We evaluated the
univariate and multivariate relationship between physician
characteristics and overall, condition-type, and specialty-type
The overall quality profile was 68.7% across the physicians. The
only physician characteristics associated with significantly higher
overall quality profiles were gender (female physicians 1.45%
higher quality profile than male physicians), board certification
status (board certified physicians 2.56% higher quality profile
than non-certified physicians), and malpractice claims status
(those with out claims 1.02% higher quality profile than those with
claims against them). There was significant variation in the
relationship between physician characteristics and quality profiles
broken down by condition type or physician specialty type. For
example, while a significant negative association was found between
years of experience and quality for primary care specialties, a
significant positive association was found between quality and
experience for surgical specialties. Conclusion: Few physician
characteristics were consistently associated with higher quality
across conditions. Many physician characteristics that seem
naturally linked to high or low quality care are not necessarily as
clearly predictive as assumed.
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