P4P Quality

Physician Performance in Ambulatory Practice

A paper by Holmboe et al. (2010) evaluates physician performance on quality measure.  The authors use a sampled the medical records of an average of 95 patients per general internist.  They found that “performance on the individual and composite measures varied substantially within and between physicians…Higher certification exam scores were associated with better performance on the overall, chronic care, and preventive services composites.

The interesting part of the paper, however, is the explanations for why there is variation in physician scores.  The explanations include:

  1. Varying degrees of physician knowledge and/or skill
  2. Lack of sufficient documentation in certain physician offices
  3. Some physicians’ office systems may be more suitably configured to execute certain tasks (e.g., immunizations, test ordering)
  4. Patient demand for preventive and other services will affect medical service provision and scores.


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