Physicians are inundated with performance reporting and performance incentive plans. One goal of these should be to provide doctors with information which actually helps them improve in areas where they may be deficient. A report from the Agency for Healthcare Research and Quality examines how to best design physician feedback reports. (AHRQ Report) The purposes of feedback reports include creating awareness about best practices and about new clinical treatments and diagnostics which should be used; helping doctors assess performance, in general and against standards or against peer performance; providing information to aid in quality improvement efforts; motivating efforts to improve, partially through peer competition; and, through an ongoing time series of reports, to provide guidance on the results of past improvement programs and where gaps still remain. Research suggests that the design of feedback reports is important; some appear to have no impact and others seem to spur substantial change in performance. The AHRQ report suggests four critical aspects of feedback report design: identifying a clinical focus; ensuring underlying data supports aims of report; optimizing user functionality and delivering the report in a way that creates the greatest impact.
Relevant research findings include that the measures reported on should be perceived as important by the doctor; that the area targeted by the measure should be one that has relatively low baseline performance, giving an opportunity for improvement, and that the measure can actually be affected by physician behavior and the behavior change is simple. In regard to data, it should be viewed as credible according to usual research standards, including timeliness, adequate sample sizes, transparent methods and appropriate case mix adjustments. Usability is enhanced by having performance displayed next to a good comparator or benchmark; a goal is presented for desired performance and recommendations for an improvement plan are provided. The report should make it easy to identify where the physician has a performance gap. Use of effective graphics is important, as is an ability to drill down beneath summary feedback and to tailor analysis. Delivery of feedback may be unitary or multistage. Multistage may be appropriate when more complex clinical change is needed to improve performance or the physician has not been involved in feedback reporting before. Generally, delivery of feedback is more effective when it includes a verbal review from a trusted source, it is routinized and it is part of a larger quality improvement effort.
One problem which should be addressed is that so many payers and other groups are measuring performance and providing reports that it adds administrative burden, confuses doctors, and leads to contradictory feedback. Data should be combined and one feedback report across all payers should be given to a physician. A combined data-gathering, analysis and feedback approach is also more credible since in would cover a greater proportion of the care delivered by the doctor. This AHRQ Report provides a lot of valuable information, particularly in light of the ever-expanding role of performance reporting and pay-for-performance systems.