While not common, some internally developed feedback reports include the performance scores of named physicians affiliated with a team, practice, or network as comparators instead of or in addition to other comparators. See a broader discussion of comparators in Section 2-3.
In the right environment and with supportive leaders, unblinded peer performance information may facilitate developing a group norm around which individual physicians can anchor their own performance. See case example in Text Box 7. Although physicians may be uncomfortable with their team, practice, or network colleagues seeing their individual performance scores, unblinded data may better support peer-based learning and enable below-average performers to improve. Physicians with below-average scores can shadow and be mentored by physicians with high scores to help identify specific strategies for improvement. Use of unblinded data might be staged, i.e., to follow use of blinded data.
Text Box 7. Case example of Massachusetts General Hospital
| Massachusetts General Hospital (MGH) developed a framework for an internal provider feedback report explicitly intended to provide a comprehensive view of the care—across providers—delivered to their patients. The hospital’s leadership, in working with affiliated primary care physicians, opted to share unblinded data.. Physicians could view their performance in relation to other named physicians in their practice and compare the performance of their practice with other practices within the network. Unblinded data allowed users to identify areas needing improvement, identify those in their practice or network who were excelling on those measures, and potentially make adjustments to their practice in order to improve their performance. Most individual physicians were comfortable with this transparency among their immediate peers but not among physicians in the broader network. MGH leaders viewed unblinded benchmarking as an effective method for encouraging transparency within and among provider teams and collaboration with peers and other practices. |
If opting for unblinded data, developers need to ensure that physicians understand that the data are only for internal use and cannot be shared with patients, insurers, or physicians not included in the report. Given the sensitivity of the data, robust security features (e.g., firewalls, password-secured shared drives) are critical to protect privacy.
* This section was excerpted and adapted from a contribution to Shaller D, Kanouse D. Working paper. Private physician feedback reports: a decision guide written by Steven J. Atlas, M.D., M.P.H., Director, Primary Care Research & Quality Improvement Network, and Charlotte Ward, M.P.H., System Innovation Analyst, Primary Care Operations Improvement Program.
