ArticleHealth services research2017
Misclassification Risk of Tier-Based Physician Quality Performance Systems.
Article in Health services research, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
2 citing papers in PubMed.
- Using United States medicare program claims to identify reliable measures of low value services influenced by primary care physician decisions.BMC health services research · 2026Observational
- Relative contribution of pharmacists and primary care providers to shared quality measures.Exploratory research in clinical and social pharmacy · 2022Article
Corrections and comments
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Authors and funding
2 authors.
Funding
Abstract
objectiveThere is increasing interest in identifying high-quality physicians, such as whether physicians perform above or below a threshold level. To evaluate whether current methods accurately distinguish above- versus below-threshold physicians, we estimate misclassification rates for two-category identification systems. DATA SOURCES: Claims data for Medicare fee-for-service beneficiaries residing in Florida or New York in 2010. STUDY
designEstimate colorectal cancer, glaucoma, and diabetes quality scores for 23,085 physicians. Use a beta-binomial model to estimate physician score reliabilities. Compute the proportion of physicians whose performance tier would be misclassified under three scoring systems. PRINCIPAL
findingsIn the three scoring systems, misclassification ranges were 8.6-25.7 percent, 6.4-22.8 percent, and 4.5-21.7%. True positive rate ranges were 72.9-97.0 percent, 83.4-100.0 percent, and 34.7-88.2 percent. True negative rate ranges were 68.5-91.6 percent, 10.5-92.4 percent, and 81.1-99.9 percent. Positive predictive value ranges were 70.5-91.6 percent, 77.0-97.3 percent, and 55.2-99.1 percent.
conclusionsCurrent methods for profiling physicians on quality may produce misleading results, as the number of eligible events is typically small. Misclassification is a policy-relevant measure of the potential impact of tiering on providers, payers, and patients. Quantifying misclassification rates should inform the construction of high-performance networks and quality improvement initiatives.
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