title: Physician level reporting of surgical and pathology performance indicators: a regional study to assess feasibility and impact on quality.
abstract: BACKGROUND
  There is increased awareness that, to minimize variation in clinician practice and improve quality, performance reporting should be implemented at the provider level. This optimizes physician engagement and creates a sense of professional responsibility for quality and performance measurement at the individual and organizational levels.
  
  
  METHODS
  Individual provider level reporting was implemented within a provincial health region involving 56 clinicians (general surgeons, surgical oncologists, urologists and pathologists). The 2 surgical pathology indicators chosen were colorectal cancer (CRC) lymph node retrieval rate and pT2 prostate cancer margin positivity rate. Surgical resections for all prostate and colorectal cancer performed between Jan. 1, 2011, and Mar. 30, 2012, were included. We used a pre- and postsurvey design to obtain physician perceptions and focus groups with program leadership to determine organizational impact.
  
  
  RESULTS
  Survey results showed that respondents felt the data provided in the reports were valid (67%), consistent with expectations (70%), maintained confidentiality (80%) and were not used in a punitive manner (77%). During the study period the pT2 prostate margin positivity rate decreased from 57.1% to 27.5%. For the CRC lymph node retrieval rate indicator, high baseline performance was maintained.
  
  
  CONCLUSIONS
  We developed a robust process for providing physicians with confidential, individualized surgical and pathology quality indicator reports. Our results reinforce the importance of individual physician feedback as a strategy for improving and sustaining quality in surgical and diagnostic oncology.
authors.affiliation: Cancer Care Ontario, Toronto, Ont. and Trillium Health Partners, Mississauga, Ont.
authors.forename: Craig
authors.initials: C
authors.lastname: McFadyen
authors.affiliation: Cancer Care Ontario, Toronto, Ont.
authors.forename: Sara
authors.initials: S
authors.lastname: Lankshear
authors.affiliation: Cancer Care Ontario, Toronto, Ont. and Grand River Hospital, Kitchener, Ont.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Divaris
authors.affiliation: Grand River Hospital, Kitchener, Ont.
authors.forename: Mark
authors.initials: M
authors.lastname: Berry
authors.affiliation: Cancer Care Ontario, Toronto, Ont.
authors.forename: Amber
authors.initials: A
authors.lastname: Hunter
authors.affiliation: Trillium Health Partners, Mississauga, Ont.
authors.forename: John
authors.initials: J
authors.lastname: Srigley
authors.affiliation: Cancer Care Ontario, and Princess Margaret Cancer Centre, Toronto, Ont.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Irish
mesh_terms: D001291:Attitude of Health Personnel; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery; D005180:Faculty, Medical; D005240:Feasibility Studies; D005246:Feedback; D017144:Focus Groups; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D009864:Ontario; D010337:Pathology Department, Hospital / Q000592:standards*; D010818:Practice Patterns, Physicians'; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D012041:Regional Medical Programs; D013503:Surgery Department, Hospital / Q000592:standards*; D011795:Surveys and Questionnaires