Information patients use to pick physicians not always good predictor of quality, study finds

September 13, 2010

When looking for a new physician, patients are often encouraged to select those who are board certified or who have not made payments on malpractice claims. Yet these characteristics are not always a good predictor of which physicians will provide the highest quality medical care, according to a new study from the RAND Corporation, a nonprofit research organization, and the University of Pittsburgh School of Medicine.

"We found that the types of information widely available to patients for choosing a physician do not predict whether that physician will deliver evidence-based care," said Rachel Reid, the study's lead author and a medical student at the University of Pittsburgh School of Medicine. "These findings underscore the need for better physician performance data to help consumers choose their doctor."

Studying a large group of physicians over a two-year period, researchers found that three characteristics were associated with better quality medical care: being female, being board certified and graduating from a domestic medical school.

But each of these characteristics increased quality only a small amount and none offers consumers much guidance when it comes to choosing a high-quality medical provider, according to findings appearing in the Sept. 13 edition of the .

Because detailed information about physician performance is seldom available to the general public, patients are encouraged to select physicians based on characteristics such as board certification, educational history and whether they have made payments on malpractice claims.

To test this advice, researchers examined the care provided by about 10,000 Massachusetts physicians to more than 1.3 million adults during 2004 and 2005. Using information from insurance claims, researchers evaluated the quality of care the physicians provided for 22 common such as diabetes and , by examining the fraction of the time physicians delivered guideline-based care to their patients.

Researchers found that the physicians studied provided on average about 63 percent of the recommended care. Average performance varied by condition, ranging from 31 percent for cataract care to 68 percent for care of congestive heart failure.

The difference in quality between the physicians with the best combination of characteristics (female, board-certified and domestically trained) and the average physician with the worst combination (male, noncertified and internationally trained) was only 6 percentage points, according to the study. But even among physicians with the best combination of characteristics, quality was uneven, ranging from 49 to 75 percent of recommended care.

"Few characteristics were consistently associated with high quality care and those we did find were so small in magnitude that they are not significant in a practical sense," said study co-author Ateev Mehrotra, an assistant professor at the University of Pittsburgh School of Medicine and a researcher at RAND. "There is little evidence to suggest that a patient would consistently receive higher quality care by switching to a physician with the combination of characteristics identified by our work to be associated with high-quality care."

Board certification was the characteristic associated with the largest increase in performance (3.3 percentage points) and also was associated with higher performance scores with both acute and preventive care. The finding provides preliminary evidence that there may be some quality benefit to be derived from maintenance of certification programs or the inclusion of board-certification activities as a requirement for maintaining a physician's medical license.

Researchers say it is striking that the study found no consistent association between the number of malpractice payments or disciplinary actions against and the quality of care they provide. Researchers also did not find any association between physicians' years of experience and quality.

Researchers say that public reporting of individual physician quality information may provide consumers with more valuable guidance when they need to choose a new physician.

More information: Arch Intern Med. 2010;170[16]:1442-1449.

Related Stories

Recommended for you

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.