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January 5, 2000

Unreliability of Physician "Report Cards" to Assess Cost and Quality of Care

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(1):51-54. doi:10-1001/pubs.JAMA-ISSN-0098-7484-283-1-jbk0500

To the Editor: Dr Hofer and colleagues1 use the example of diabetes care to provide a convincing demonstration of the limitations of outcomes-based physician profiling and the perverse incentives such profiling may introduce. Although Hofer et al briefly acknowledge the potential virtues of process measurement, both they and Dr Bindman,2 in his editorial, suggest that these limitations undermine the value of all quality measurement activities involving report cards. We argue for a more sanguine view. Appropriately adjusted outcomes may still provide valuable quality measures for acute illnesses and procedures that carry significant short-term risks of morbidity and mortality, such as myocardial infarction3 and cardiac surgery.4 For chronic illnesses, such as diabetes, important outcome differences between providers may take years to accrue, so that focusing on processes of care with proven benefits to patients may be preferable to outcomes-based performance measurement.

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