TY - CHAP M1 - Book, Section TI - Can Intensivist Performance Be Measured? A1 - Leung, Sharon A2 - Oropello, John M. A2 - Pastores, Stephen M. A2 - Kvetan, Vladimir Y1 - 1 N1 - T2 - Critical Care AB - KEY POINTSCMS launched Physician Compare in December of 2010, and it expanded to include information on the quality of physicians’ care in 2013. Measuring and reporting on the performance of doctors represents an effort to move to a more transparent healthcare system.The strategy the IOM recommended to improve quality of care was to pay for performance (P4P) or financial incentives to transform behaviors to achieve greater value.Process measures are more highly sensitive to differences in the quality of care and are easier to interpret. However, a process measure is only of value if it is assumed to have a link to a meaningful outcome. By itself, it has little intrinsic value.One advantage of outcome measurement, for example, mortality rate, is that it is a measure that is important on its own, even if the differences have nothing to do with the quality of care.One of the main issues of measuring intensivist performance is physician attribution. Each episode of care would involve multiple intensivists and other physicians.Using ICU LOS as a process measure would discourage intensivists from providing time-consuming, yet important, end-of-life care for ICU patients, leading to more fragmentation of care.Even though risk adjustment applies, using hospital mortality as a quality-outcome measure would not account for the impact of palliative care and the ability to transfer to LTACs.The current system has not yet been made to link the fragmented entities caring for these patients with critical illnesses around accountability for value.To improve service productivity, measuring and monitoring performance and its variance is a fundamental requirement for identifying efficiencies and best practices and for spreading them throughout the system or organization.Advancing performance measurement at the physician level is the vital strategy on the policy agenda when considerable unexplained variation exists in practices that lead to poor quality, inefficient care delivery, and waste of resources. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=1136418864 ER -