Addressing physician concerns about performance profiling: experience with a local Veterans Affairs quality evaluation program.

The Authors investigated the addition of novel quality indicators, patient risk adjustment, and simple statistics in an ongoing clinician feedback initiative that profiles diabetes care for 13 Veterans Affairs (VA) clinics. Data were extracted from a computerized database for calendar years 2004 to 2005. Performance was assessed with 4 monitoring measures, 3 intermediate outcomes, and 3 appropriate treatment measures. Attainment rates for each indicator were calculated by clinic. The effect of risk adjustment and the significance of clinic performance variation were determined with multivariate logistic models. Analysis of the 10 quality measures revealed lower attainment and greater clinic-level variation for the less familiar indicators. Statistically significant performance variations were detected among clinics, with several being of a clinically important magnitude. Risk adjustment did not substantially change performance. The addition of clinically relevant quality measures and simple statistics appeared to enhance the characterization of performance by this profiling program.

Oral isotretinoin: an analysis of its utilization in a managed care organization.

OBJECTIVE: To assess utilization of oral isotretinoin within a managed care organization. METHODS: A retrospective analysis of pharmacy and medical claims from a southern California HMO was performed to (1) determine the prescribing patterns of oral isotretinoin from 1997 to 2000, stratified by age and gender, (2) categorize and quantify the use of antiacne prescriptions in the 6-month period immediately prior to the first oral isotretinoin prescription claim observed during this study; and (3) identify the amount of oral isotretinoin dispensed in a 210-day period following the dispensing date of the first oral isotretinoin prescription. RESULTS: The number of prescriptions was distributed almost equally between males and females, and the average number of prescriptions dispensed per patient decreased with age. A total of 39% of patients who received an oral isotretinoin prescription had not received a prescription for any antiacne medication in the preceding 6 months, and an additional 31% had not received a prescription for a topical retinoid. Approximately 27% of patients received more than a 150-day supply within the 210-day period following the first oral isotretinoin claim. CONCLUSIONS: These data suggest that in the 6 months preceding the first observed oral isotretinoin prescription, up to 70% of patients had not received a trial of a topical retinoid before receiving oral isotretinoin even though the product labeling advises that oral isotretinoin should be used only in patients unresponsive to.conventional therapy. (which is generally defined as at least a topical retinoid plus an oral antibiotic). Up to 27% of patients appeared to continue a course of treatment for longer than the 15-20 weeks advised in the isotretinoin product labeling.