JAMA Logo While picking out a doctor, an individual like many others will probably look for education, board certification and malpractice claims. It seems that all these factors are not enough to guarantee high-quality care. A recent study affirms that public information about board certification, education and malpractice claims need not provide consumers with detailed information about the quality of care an individual physician gives.

The study scrutinized claims data from 1.13 million adults from 2004 to 2005. Calculation on overall performance scores were made on 124 quality measures for each of 10,408 Massachusetts physicians. Information about the same physicians was obtained by the Massachusetts Board of Registration in Medicine. Authors observed that the average overall performance score for the physicians was 62.5 percent. Among the publicly known data, three were apparently linked with higher overall performance. These probably included female sex, board certification and graduation from a domestic medical school.

Experts highlight, “To improve the quality of care received by their beneficiaries, some health plans use physician report cards and tiered physician networks to steer their members toward physicians who provide high-quality care. However, most patients do not have access to physician quality measures. Patients are therefore encouraged to use publicly available proxies for clinical performance when choosing a physician. The Agency for Healthcare Research and Quality advises patients to consult state medical boards and to seek information on board certification and training as a way to assess the quality of care physicians provide.”

Having monitored the claims, only minute variations appeared and the experts were possibly unable to find any significant associations between malpractice claims and performance. No correlation with quality, the difference in overall composite performance between the average physician with best combination of these characteristics and average physician with the worst combination was noted by authors. An average physician with best combination encompassed factors like female, board-certified, domestically trained. On the other hand, an average physician with worst combination included characteristics like male, non-certified, internationally trained physician.

It was observed that in physicians with the best combination, there is a wide range of performance which included 48.8 percent to 75.3 percent, fifth to 95th percentile. This range appears to be similar with the range of all physicians which is 48.2 percent to 74.9 percent. So a patient may get higher quality care by selecting a physician with these characteristics. An absence of a link between malpractice claims or disciplinary actions and quality was monitored.

Rachel O. Reid, B.A., of the University of Pittsburgh, and colleagues therefore conclude that malpractice claims reflect more about physician communication style and other attributes. These claims are apparently unable to give information about negligent care. It was noted that individual physician characteristics are poor proxies for performance on clinical quality measures and are not well suited for use as such by patients. Investigators suggest that public reporting of individual physician quality data can be a better alternative as it provides the consumer with more valuable guidance when seeking providers of high-quality health care.

The study is published in the September 13 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.