Application of a Propensity Score Approach for Risk Adjustment in Multiple Physician Group Profiling on Asthma Care

• Activity Number: 232
• Type: Topic Contributed
• Date/Time: Tuesday, August 5, 2003 : 10:30 AM to 12:20 PM
• Sponsor: Section on Health Policy Statistics
• Author(s): I-Chan Huang*+
• Companies: Johns Hopkins University
• Keywords: physician groups ; profiling ; propensity score ; regression-to-the-mean ; risk adjustment

Abstract

Risk adjustment is used to fairly compare provider performance. However, the commonly applied regression-based risk-adjustment methods cannot guarantee balanced distributions of covariates among providers. We developed a propensity score method to compare performance of multiple providers (20 physician groups). Patient satisfaction with asthma care was the indicator of group performance. We compared this propensity score-based risk-adjustment method to a conventional method using a hierarchical modeling but without propensity score techniques. The propensity score based method was validated by showing its balanced distributions in all covariates among the 20 physician groups. Moreover, the propensity score-based method resulted in substantially different rankings from those of the hierarchical model-based method without using propensity scores (75% of groups differed in absolute ranking, and 50% in quintile ranking, weighted kappa = 0.69). We developed and tested a propensity score method for profiling multiple physician groups, and found that it gives substantially different profiles compared to conventional methods.