Public reporting and the evolution of diabetes quality
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Public reporting and the evolution of diabetes quality Jeffrey S. McCullough · Daniel J. Crespin · Jean M. Abraham · Jon B. Christianson · Michael Finch
Received: 13 August 2014 / Accepted: 30 January 2015 / Published online: 6 March 2015 © Springer Science+Business Media New York 2015
Abstract We address three questions related to public reports of diabetes quality. First, does clinic quality evolve over time? Second, does the quality of reporting clinics converge to a common standard? Third, how persistent are provider quality rankings across time? Since current methods of public reporting rely on historic data, measures of clinic quality are most informative if relative clinic performance is persistent across time. We use data from the Minnesota Community Measurement spanning 2007–2012. We employ seemingly-unrelated regression to measure quality improvement conditional upon cohort effects and changes in quality metrics. Basic autoregressive models are used to measure quality persistence. There were striking differences in initial quality across cohorts of clinics and early-reporting cohorts maintained higher quality in all years. This suggests that consumers can infer, on average, that non-reporting clinics have poorer quality than reporting clinics. Average quality, however, improves slowly in all cohorts and quality dispersion declines over time both within and across cohorts. Relative clinic quality is highly persistent year-to-year, suggesting that publiclyreported measures can inform consumers in choice of clinics, even though they represent measured quality for a previous time period. Finally, definition changes in measures can make it difficult to draw appropriate inferences from longitudinal public reports data. Keywords
Public reporting · Quality measurement · Diabetes · Longitudinal analysis
JEL Classification
I11 · I18 · C22
J. S. McCullough (B) · D. J. Crespin · J. M. Abraham · J. B. Christianson Division of Health Policy and Management, School of Public Health, University of Minnesota, 420 Delaware Street SE, MMC 729, Minneapolis, MN 55455, USA e-mail: [email protected] M. Finch Finch & King, 5917 Girard Avenue South, Minneapolis, MN 55419, USA
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Introduction While the public reporting of hospital performance and the performance of cardiac surgeons has been ongoing for two decades in some states (e.g., Dranove et al. 2003; Wang et al. 2011), there is a much shorter history of public reporting of ambulatory care quality measures. However, over the last decade, health plans have begun to share physician practice performance with their members, typically using claims data and a “star” system or some similar methodology to designate clinics or medical groups as “high” or “low” performers (Higgins et al. 2013). Under this approach, plan members often do not have access to specific measures of clinic or group performance. Where measures are available, they are process measures, although there is a growing consensus that intermediate outcome measures constructed from m
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