Most primary care practices too small for reliable quality comparisons

January 01, 0001

Most primary care practices too small for reliable quality comparisons

Quality of health care delivery is increasingly in the spotlight of many health care systems and pay-for-performance models have garnered attention. Primary care physicians provide a wide range of services to their patients. A group of US researchers sought to determine if primary care physicians see enough Medicare patients to detect meaningful differences in quality and cost measures between practices. Primary care physicians in the US were studied using the Healthcare Organization Services database maintained by IMS Health. Caseloads necessary to detect 10% relative differences in costs and quality were calculated.

The researchers found that primary care physician practices had annual median caseloads of 260 Medicare patients, 25 women eligible for mammography, 30 patients with diabetes eligible for hemoglobin A1c testing, and 0 patients hospitalized for CHF. For ambulatory costs, mammography rate, and hemoglobin A1c testing rate, the percentage of primary care physician practices with sufficient caseloads to detect 10% relative differences in performance ranged from less than 10% of practices with fewer than 11 primary care physicians to 100% of practices with more than 50 primary care physicians. None of the primary care physician practices had sufficient caseloads to detect 10% relative differences in preventable hospitalization or 30-day readmission after discharge for CHF.

The authors concluded: “Relatively few primary care physician practices are large enough to reliably measure 10% relative differences in common measures of quality and cost performance among fee-for-service Medicare patients.”

This study calls into question the use of some common quality of care measurements to compare physician performance as small differences are likely random and not reflecting actual differences in care.

For the full abstract, click here.

JAMA 302(22):2444-2450, 9 December 2009. © 2009 to the Ameridan Medical Association
Relationship of Primary Care Physicians' Patient Caseload With Measurement of Quality and Cost Performance. David J. Nyweide, William B. Weeks, Daniel J. Gottlieb, Lawrence P. Casalino, Elliott S. Fisher.

Category: HSR. Health Services Research. Keywords: quality of care, medical cost, practice size, benchmarks, Medicare, quality comparison feasibility study
Synopsis edited by Dr Paul Schaefer, Toledo, Ohio. Posted on Global Family Doctor 14 January 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.