title: A Two-Step Method to Identify Positive Deviant Physician Organizations of Accountable Care Organizations with Robust Performance Management Systems.
abstract: To identify positive deviant (PD) physician organizations of Accountable Care Organizations (ACOs) with robust performance management systems (PMSYS).
  
  
  
  Third National Survey of Physician Organizations (NSPO3, n = 1,398).
  
  
  
  Organizational and external factors from NSPO3 were analyzed.
  
  
  
  Linear regression estimated the association of internal and contextual factors on PMSYS. Two cutpoints (75th/90th percentiles) identified PDs with the largest residuals and highest PMSYS scores.
  
  
  
  A total of 65 and 41 PDs were identified using 75th and 90th percentiles cutpoints, respectively. The 90th percentile more strongly differentiated PDs from non-PDs. Having a high proportion of vulnerable patients appears to constrain PMSYS development.
  
  
  
  Our PD identification method increases the likelihood that PD organizations selected for in-depth inquiry are high-performing organizations that exceed expectations.
authors.affiliation: School of Public Health - Health Policy and Management, University of California, Berkeley, CA.
authors.forename: Alexander F
authors.initials: AF
authors.lastname: Pimperl
authors.affiliation: School of Public Health - Health Policy and Management, University of California, Berkeley, CA.
authors.forename: Hector P
authors.initials: HP
authors.lastname: Rodriguez
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland, CA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Schmittdiel
authors.affiliation: School of Public Health - Health Policy and Management, University of California, Berkeley, CA.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
mesh_terms: D060866:Accountable Care Organizations / Q000458:organization & administration* / Q000592:standards; D019985:Benchmarking / Q000592:standards; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D016014:Linear Models; D061214:Patient Safety / Q000592:standards; D058996:Quality Improvement / Q000458:organization & administration; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D012111:Residence Characteristics; D014481:United States
keywords: Healthcare organizations and systems; health policy/politics/law/regulation; incentives in health care; information technology in health; quality improvement/report cards (interventions); quality of care/patient safety (measurement)