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September 6, 2000

Use of Performance Data to Change Physician Behavior

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(9):1079. doi:10.1001/jama.284.9.1079

To the Editor: I commend Dr Marshall and colleagues1 on their efforts to assess the impact of performance data on clinical behavior and outcomes. Having spent a good deal of time working with clinicians and using data to influence change,2,3 I certainly agree with the authors that physicians are often skeptical about performance data. Skepticism arises from concerns related to intent, accuracy, physician attribution, and relevance. Intent relates to the concern that data will be used punitively rather than to identify opportunities for improvement. Accuracy is an issue because of concerns related to errors in coding, chart documentation, and the questionable clinical assumptions and interpretations derived from administrative data sets. As a result, the first reaction on the part of many clinicians is to challenge the accuracy of performance data. The third issue is relevance. Given the subtleties of medical management among unique patient populations, physicians may not view performance data as a meaningful measure of their individual practice efficiency.

Physicians also have concerns about the impact of data sharing in relation to financial risk, public availability, and provider accountability. As a result, many clinicians may not change their behavior on the basis of performance data. To motivate changes in clinician behavior, the scientific approach can be used with the assumption that, when given data supporting best practice care, clinicians will naturally migrate in this direction. In reality, however, change may be sustained only if there are continued reminders or assistance at the time and point of care. An economic approach, in which changes in behavior may occur if clinicians perceive positive financial gains or incentives or fear loss of patient access due to economic credentialing or restriction of privileges, also can be used. True measurable impact may occur, however, only if meaningful information becomes widely available to the public.

Marshall  MNShekelle  PGLeatherman  SBrook  RH The public release of performance data: what do we expect to gain? a review of the evidence.  JAMA. 2000;283:1866-1874.Google Scholar
Rosenstein  AH Provider profiling: promises and pitfalls.  Manag Care Med. October 1995:10-35.Google Scholar
Rosenstein  AH Using information management to implement a clinical resource management program.  Jt Comm J Qual Improv. 1997;23:653-666.Google Scholar