American Board of Internal Medicine Establishes Methodology for Setting Standards on Patient Care through Composite Measures

(Philadelphia, PA) Using data from nearly 1,000 physicians and tens of thousands of patient charts and patient surveys, and with the expertise of practicing physicians and experts in quality improvement, the American Board of Internal Medicine (ABIM) has developed a performance standard on a composite measure for diabetes care that can effectively identify who provides less than minimally acceptable performance, according to "Setting a Fair Performance Standard for Physicians' Quality of Patient Care" published this week in the Journal of General Internal Medicine.

Data from the ABIM Diabetes PIM Practice Improvement Module was used to create an assessment of individual physicians' quality of diabetes care. As part of the PIM, physicians administered patient surveys and abstracted charts of eligible patients with Type 1 or Type 2 Diabetes, 18-75 years of age that had received care in the practice for at least one year with at least one visit in the past year. A total of 20,131 patient charts were abstracted and 18,974 patient surveys were obtained. Data from these two sources were used to develop a composite measure for diabetes care.

"The physician community has long felt that using only one or a few clinical measures to evaluate physician performance is not reliable and is complicated by different practice types and different patient panels," said Eric Holmboe, Chief Medical Officer of the American Board of Internal Medicine. "Composite measures can be more useful in assessing physician performance because they more accurately reflect the overall quality of care across a sample of patients within a physician's own practice."

Composite measures are gaining visibility as more groups develop them and seek to get them endorsed by the National Quality Forum; the Centers for Medicare/Medicaid Services also plans to link Medicare update payments to composites by 2015.

The analysis found that physicians who did not meet the standard on the composite diabetes measure had distinct and predictable characteristics: they had lower Internal Medicine certification or maintenance of certification examination scores, underscoring the relationship between what physicians know and what they do in practice. They also received lower ratings of clinical competence and professional behaviors from their program directors at the end of residency. This low performing group also tended to perform consistently low on most measures that were part of the composite – in other words, they did not compensate for poor performance on one measure with better performance on another.

According to the article, the methodology developed by ABIM researchers "represents one approach to identifying outlier physicians for intervention." The methodology could also potentially be used to establish other defined levels of care (e.g., excellent care). ABIM is currently exploring strategies to incorporate the standard-setting methodology into its Maintenance of Certification (MOC).

The standard-setting methodology is currently under review for a patent.

This article was published in the Journal of General Internal Medicine (JGIM). JGIM is the official journal of the Society of General Internal Medicine. It promotes improved patient care, research, and education in primary care, general internal medicine, and hospital medicine. Its articles focus on clinical medicine, epidemiology, prevention, health care delivery, curriculum development, and some non-traditional themes. JGIM offers early publication on www.SpringerLink.com to reach a broad audience, with online access to abstracts and full articles rapidly growing each year. Learn more about JGIM.

About ABIM
For more than 70 years, Certification by the American Board of Internal Medicine (ABIM) has stood for the highest standard in internal medicine and its 19 subspecialties and has meant that internists have demonstrated – to their peers and to the public – that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care. ABIM is not a membership society, but a non-profit, independent evaluation organization. Our accountability is both to the profession of medicine and to the public. ABIM is a member of the American Board of Medical Specialties. For additional updates, follow ABIM on Facebook.