Physicians’ Choice of Board Certification Activity Is Unaffected by Baseline Quality of Care: The TRADEMaRQ Study

Lars E. Peterson, John Johannides, R. Phillips
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Abstract

PURPOSE Physicians’ use of self-assessment to guide quality improvement or board certification activities often does not correlate with more objective measures, and they may spend valuable time on activities that support their strengths instead of addressing gaps. Our objective was to study whether viewing quality measures, with peer comparisons, would affect the selection of certification activities. METHODS We conducted a cluster-randomized controlled trial—the Trial of Data Exchange for Maintenance of certification and Raising Quality (TRADEMaRQ)—with 4 partner organizations during 2015-2017. Physicians were presented their quality data within their online certification portfolios before (intervention) vs after (control) they chose board certification activities. The primary outcome was whether the selected activity addressed a quality gap (a quality area in which the physician scored below the mean for the study population). RESULTS Of 2,570 invited physicians, 254 physicians completed the study: 130 in the intervention group and 124 in the control group. Nearly one-fifth of participating physicians did not complete any certification activities during the study. A sizable minority of those in the intervention group, 18.4%, never reviewed their quality dashboard. Overall, just 27.2% of completed certification activities addressed a quality gap, and there was no significant difference in this outcome in the intervention group vs the control group in either bivariate or adjusted analyses (odds ratio = 1.28; 95% CI, 0.90-1.82). CONCLUSIONS Physicians did not use quality performance data in choosing certification activities. Certification boards are being pressed to make their programs relevant to practice, less burdensome, and supportive of quality improvement in alignment with value-based payment models. Using practice data to drive certification choices would meet these goals.
医师对委员会认证活动的选择不受基线护理质量的影响:TRADEMaRQ研究
目的:医生使用自我评估来指导质量改进或委员会认证活动,往往与更客观的衡量标准不相关,他们可能会把宝贵的时间花在支持自己优势的活动上,而不是解决差距。我们的目标是研究查看质量度量,与同行比较,是否会影响认证活动的选择。方法:我们在2015-2017年与4个合作组织进行了一项集群随机对照试验-维护认证和提高质量的数据交换试验(TRADEMaRQ)。医生在选择委员会认证活动之前(干预)和之后(控制)向他们展示了在线认证组合中的质量数据。主要结果是选定的活动是否解决了质量差距(医生得分低于研究人群平均水平的质量区域)。结果在2570名受邀医生中,254名医生完成了研究:干预组130名,对照组124名。近五分之一的参与研究的医生在研究期间没有完成任何认证活动。在干预组中,有相当一部分人(18.4%)从未查看过他们的质量仪表板。总体而言,只有27.2%的完成认证活动解决了质量差距,在双变量或调整分析中,干预组与对照组的结果没有显著差异(优势比= 1.28;95% ci, 0.90-1.82)。结论医师在选择认证活动时没有使用质量绩效数据。认证委员会被要求使他们的项目与实践相关,减少负担,并支持与基于价值的支付模式相一致的质量改进。使用实践数据来驱动认证选择将满足这些目标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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