Table 3.

Physician Performance on Chronic and Acute Conditions and Prevention

Item	Physician and Cluster Size		Adjusted for Patient Risks
				ICC
Description	K	n0*	Physician Level Mean (SD)	ρ	95% CI	N for Rm=0.85†
Chronic medical conditions diagnosed
Lipid control (CAD and DM)
CHD, DM: complete annual lipid test	236	39.3	0.74 (0.14)	0.19	0.15–0.23	23.9
CHD, DM: LDL<130 mg/dl3	236	38.5	0.65 (0.13)	0.12	0.09–0.14	42.4
Lipid-lowering therapy prescribed to eligible	236	38.4	0.76 (0.14)	0.21	0.16–0.25	22.0
Post-MI: with β-blocker	194	3.1	0.84 (0.06)	0.19	0.02–0.36	24.3
Eligible pts prescribed antiplatelet therapy	236	38.5	0.48 (0.15)	0.15	0.12–0.18	31.2
BP control (CAD/DM/CHF/HTN)
CVD: BP<140/90 mmHg3	236	70.3	0.62 (0.11)	0.09	0.07–0.11	54.9
CHD, HTN and DM: annual creatinine test done	236	70.1	0.82 (0.14)	0.22	0.18–0.26	20.0
Heart disease: functional status assessed	236	43.1	0.59 (0.42)	0.87	0.84–0.9	0.9
Diabetes care
Annual A1c test done	235	28.6	0.82 (0.13)	0.24	0.19–0.29	18.0
With HbA1C<7%‡	235	28.3	0.44 (0.11)	0.09	0.07–0.11	58.2
Annual eye exam documented	235	28.6	0.19 (0.14)	0.28	0.23–0.33	14.6
Annual complete foot exam documented	235	28.6	0.10 (0.19)	0.65	0.58–0.72	3.0
Annual urine protein test done	235	23.7	0.44 (0.32)	0.61	0.56–0.67	3.6
On an ACE or ARB	162	4.3	0.79 (0.11)	0.25	0.1–0.4	16.6
Congestive heart failure
Weight documented	220	6.4	0.90 (0.13)	0.47	0.35–0.58	6.5
Annual left ventricular function assessment	220	6.4	0.46 (0.15)	0.22	0.14–0.29	20.4
On an ACE or ARB	146	2.3	0.85 (0.07)	0.26	0.02–0.5	16.2
With β-blocker	167	2.5	0.83 (0.11)	0.34	0.12–0.57	10.8
Eligible pts prescribed Warfarin therapy	154	2.3	0.67 (0.11)	0.23	0.03–0.43	19.1
Osteoarthritis
Functional status assessed	233	20.1	0.61 (0.41)	0.87	0.84–0.91	0.8
On anti-inflammatory medications	233	20.1	0.7 (0.19)	0.32	0.27–0.38	11.9
With pain assessment	233	20.1	0.5 (0.33)	0.63	0.57–0.69	3.3
With level of pain documented	233	20.1	0.16 (0.23)	0.65	0.58–0.72	3.1
Upper respiratory infection
Appropriate (no) antibiotic use	234	19.6	0.45 (0.26)	0.42	0.36–0.48	7.9
Appropriate use of nasal decongestants	165	3.8	0.03 (0.07)	0.52	0.25–0.79	5.2
Urinary tract infection (females only)
With complete relevant history	236	8.7	0.50 (0.34)	0.70	0.63–0.76	2.5
Appropriate antibiotic use	227	6.8	0.17 (0.28)	0.80	0.73–0.87	1.4
Antibiotic treatment for LE 7 days	230	7.7	0.74 (0.2)	0.44	0.35–0.53	7.2
Low back pain
Essential physical documented	235	15.6	0.14 (0.19)	0.56	0.48–0.64	4.4
History red flags documented	235	15.6	0.37 (0.37)	0.80	0.76–0.85	1.4
Physical red flags documented	235	15.6	0.41 (0.39)	0.82	0.78–0.87	1.2
No drugs prescribed	235	15.6	0.86 (0.10)	0.24	0.18–0.3	17.9
No narcotics prescribed	235	15.6	0.66 (0.16)	0.23	0.18–0.28	19.3
Advised to avoid prolonged bed rest	235	15.6	0.07 (0.21)	0.86	0.81–0.91	0.9
No unnecessary imaging	228	10.4	0.46 (0.18)	0.26	0.2–0.32	15.9
Major depression
Receiving initial therapy	150	5.9	0.74 (0.33)	0.80	0.7–0.9	1.4
Receiving 6-month course of therapy	150	5.9	0.64 (0.37)	0.83	0.75–0.91	1.2
No inappropriate therapy	152	6.8	0.62 (0.29)	0.61	0.5–0.72	3.6
Prevention
Pts advised to exercise	235	43.5	0.58 (0.3)	0.58	0.53–0.64	4.1
Weight reduction for eligible	236	57.4	0.18 (0.16)	0.39	0.33–0.45	8.8
Smoking cessation counseling	233	10.8	0.62 (0.27)	0.52	0.44–0.59	5.3
Flu shot for eligible	236	60.6	0.40 (0.27)	0.48	0.43–0.53	6.1
Pneumococcal shot for eligible	236	60.6	0.38 (0.28)	0.51	0.46–0.56	5.4
Mammography screening age ≥40	236	49.9	0.61 (0.21)	0.28	0.23–0.32	14.9
Colorectal cancer screening for ≥50	236	71.1	0.49 (0.23)	0.31	0.27–0.35	12.5
Osteoporosis screening for ≥65 females	236	25.8	0.55 (0.26)	0.42	0.36–0.48	7.9

^*Cluster size , where and are the mean and variance of number of patients per physician, and K is the number of physicians; therefore, n₀ is slightly less than simple average, when number of patients are not same across physicians.

^†Sample size of patients (N) needed for a reliability (of the mean) for the measure of 0.85.

^‡Outcome measures.

CI, confidence interval; ICC, intraclass correlation coefficients.