The Use of Individual Provider Performance Reports by US Hospitals
Joshua A. Rolnick, MD, JD, University of Pennsylvania, National Clinician Scholars Program, Blockley Hall, 13th Floor, 423 Guardian Drive, Philadelphia, PA 19104-6021; Telephone: 617-538-5191; Fax: 610-642-4380; E-mail: email@example.com
Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; 4Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania. Medicare reimbursement for hospitals is increasingly tied to performance. The use of individual provider performance reports offers the potential to improve clinical outcomes through social comparison, and isolated cases of clinical dashboard uses at specific institutions have been previously reported. However, little is known about overall trends in how hospitals use the electronic health record to track and provide feedback on provider performance. We used data from 2013 to 2015 from the American Hospital Association (AHA) Annual Survey Information Technology Supplement, which asked hospitals if they have used electronic data to create performance profiles. We linked these data to AHA Annual Survey responses for all general adult and pediatric hospitals. Multivariable logistic regression was used to model the odds of use as a function of hospital characteristics. In 2015, 65.8% of the 2334 respondents used performance profiles, whereas 59.3% of the 2077 respondents used them in 2013. Report use was associated with non-profit status (odds ratio [OR], 2.77; 95% confidence interval [CI], 1.94-3.95) compared to for-profit, large hospital size (OR, 2.37; 95% CI, 1.56-3.60) compared to small size, highest quartile of bed-adjusted expenditures compared to bottom quartile (OR, 2.09; 95% CI, 1.55-2.82; P < .01), and participation in a health maintenance organization (OR, 1.50; 95% CI, 1.17-1.90; P < .01) or bundled payment program (OR, 1.61; 95% CI, 1.18-2.19; P < .01). While a majority of hospitals now use such profiles, more than a third do not. The hospitals that do not use performance profiles may be less well positioned to adapt to value-based payment reforms.