Winning Abstracts from the 2009 Medical Student Abstract Competition: Which Physician Characteristics are Associated with Higher Quality of Care?
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 quality profiles.
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.