Toward a Learning Health-Care System: Use of Colorectal Cancer Quality Measures for Physician Evaluation

Abstract

The development of evidence-based quality measures and benchmarks in colorectal cancer (CRC) screening is a critical step toward building a truly accountable health-care system. Indeed, much of the gastroenterology research literature in quality has focused on the scientific merit and reliability of these measures. Less attention has been placed on understanding the use of these measures for physician evaluation, an equally important part of the performance measurement and improvement cycle. In this chapter, we will address this information gap by reviewing the use of CRC quality measurement for physician evaluation. Our focus first includes the levers available for action in performance evaluation including physician feedback, pay for performance, public reporting, and physician designation programs including tiered provider networks. Second, we review existing evaluation systems in the government, commercial, regional, and integrated delivery systems. Third, we review limitations of these existing systems including the overreliance on process measures and rates of testing over outcomes, the difficulty in developing information systems to accommodate measurement, and the implications of physician resistance in the management and success of these programs. Finally, we conclude with recommendations for special societies to take and support the development of a quality improvement system that meets the needs of a modern learning health-care system.