Realizing the potential of practice pattern profiling.
In January 1992, the Physician Payment Review Commission held a conference to learn about the appropriateness of present uses of profiling of practice patterns, and to identify what will be required to realize the full potential of this technique in the future. The conference addressed the data needs of profiling, the development of valid and relevant profiles, the impact of profiles on medical practice, and controversies surrounding public access to profiling information and the uses to which profiling has been put. This paper, based in part on that conference, reviews the basic concepts that underlie profiling and describes the roles that profiling can play in quality improvement, assessment of provider performance, and utilization review. It uses case studies to illustrate the types of problems that have arisen in actual usage and discusses what will be required to resolve them. The final section describes the roles that profiling can play in achieving the goals of health care reform, and concludes with what is needed in data and infrastructure development to improve the quality and usefulness of profiling.
Lasker
R D
RD
Physician Payment Review Commission, Washington, DC 20037.
Shapiro
D W
DW
Tucker
A M
AM
D003625:Data Collection / Q000379:methods / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D009026:Mortality; D009937:Organizational Objectives; D010043:Outcome and Process Assessment, Health Care / Q000458:organization & administration; D015284:Physician Payment Review Commission; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D017062:Small-Area Analysis; D016896:Treatment Outcome; D014481:United States; D014600:Utilization Review / Q000379:methods