A Two-Step Method to Identify Positive Deviant Physician Organizations of Accountable Care Organizations with Robust Performance Management Systems

Health Serv Res. 2018 Jun;53(3):1851-1869. doi: 10.1111/1475-6773.12693. Epub 2017 Apr 6.

Abstract

Objective: To identify positive deviant (PD) physician organizations of Accountable Care Organizations (ACOs) with robust performance management systems (PMSYS).

Data source: Third National Survey of Physician Organizations (NSPO3, n = 1,398).

Study design: Organizational and external factors from NSPO3 were analyzed.

Data collection/extraction methods: Linear regression estimated the association of internal and contextual factors on PMSYS. Two cutpoints (75th/90th percentiles) identified PDs with the largest residuals and highest PMSYS scores.

Principal findings: A total of 65 and 41 PDs were identified using 75th and 90th percentiles cutpoints, respectively. The 90th percentile more strongly differentiated PDs from non-PDs. Having a high proportion of vulnerable patients appears to constrain PMSYS development.

Conclusions: Our PD identification method increases the likelihood that PD organizations selected for in-depth inquiry are high-performing organizations that exceed expectations.

Keywords: Healthcare organizations and systems; health policy/politics/law/regulation; incentives in health care; information technology in health; quality improvement/report cards (interventions); quality of care/patient safety (measurement).

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accountable Care Organizations / organization & administration*
  • Accountable Care Organizations / standards
  • Benchmarking / standards
  • Health Policy
  • Health Services Research
  • Humans
  • Linear Models
  • Patient Safety / standards
  • Quality Improvement / organization & administration
  • Quality Indicators, Health Care
  • Quality of Health Care / organization & administration*
  • Quality of Health Care / standards
  • Residence Characteristics
  • United States