title: The comprehensive care project: measuring physician performance in ambulatory practice.
abstract: OBJECTIVE
  To investigate the feasibility, reliability, and validity of comprehensively assessing physician-level performance in ambulatory practice.
  
  
  METHODS
  Ambulatory-based general internists in 13 states participated in the assessment.
  
  
  METHODS
  We assessed physician-level performance, adjusted for patient factors, on 46 individual measures, an overall composite measure, and composite measures for chronic, acute, and preventive care. Between- versus within-physician variation was quantified by intraclass correlation coefficients (ICC). External validity was assessed by correlating performance on a certification exam.
  
  
  METHODS
  Medical records for 236 physicians were audited for seven chronic and four acute care conditions, and six age- and gender-appropriate preventive services.
  
  
  RESULTS
  Performance on the individual and composite measures varied substantially within (range 5-86 percent compliance on 46 measures) and between physicians (ICC range 0.12-0.88). Reliabilities for the composite measures were robust: 0.88 for chronic care and 0.87 for preventive services. Higher certification exam scores were associated with better performance on the overall (r = 0.19; p<.01), chronic care (r = 0.14, p = .04), and preventive services composites (r = 0.17, p = .01).
  
  
  CONCLUSIONS
  Our results suggest that reliable and valid comprehensive assessment of the quality of chronic and preventive care can be achieved by creating composite measures and by sampling feasible numbers of patients for each condition.
authors.affiliation: American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106, USA. eholmboe@abim.org
authors.forename: Eric S
authors.initials: ES
authors.lastname: Holmboe
authors.forename: Weifeng
authors.initials: W
authors.lastname: Weng
authors.forename: Gerald K
authors.initials: GK
authors.lastname: Arnold
authors.forename: Sherrie H
authors.initials: SH
authors.lastname: Kaplan
authors.forename: Sharon-Lise
authors.initials: SL
authors.lastname: Normand
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenfield
authors.forename: Sarah
authors.initials: S
authors.lastname: Hood
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Lipner
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000328:Adult; D000367:Age Factors; D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000458:organization & administration* / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012737:Sex Factors
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