Analysis of emailed provider dashboards and improvement in clinical performance among low and high performers

Background: A dashboard was developed to display a primary care provider's individual performance against a peer benchmark on ten clinical quality measures and ten EHR utilization measures. These measures track population-level trends within patient panels and provide information on clinical performance and practice workflows. Objective/purpose: To explore trends in improvement among poor vs. better performers on several dimensions of care pre- and post- receipt of a comprehensive primary care provider dashboard. Methods: Using data from 137 providers who received a dashboard in fall 2010, we compared the subsequent performance on eight clinical quality measures, including measures related to blood pressure control, diabetes management, and cholesterol screening. Providers were classified by their initial performance on measures. High performers were those with performance at or above the 50th percentile benchmark, and poor performers were those with performance below the benchmark. A GEE model was used to explore whether poor and better performers improved more pre- vs. post receipt of their first dashboard. Results: In the year prior to the receipt of the first dashboard, improvement levels were variable, with high performers improving significantly more than poor performers on four of the eight dashboard measures; low performers improving significantly more than high on two measures; and no significant difference between the groups on two measures. During the year after all providers received their dashboards, low performers improved more than high performers on all measures. In addition, low performers had a higher improvement rate after receipt of the dashboard than in the dashboard receipt pre-period. Improvement was significantly higher (p<.0001) for poor performers vs. high on six of the eight measures. Discussion/conclusions: Findings support improvement was more consistent and more significant for low performers in the post period, suggesting dashboards may be effective in assisting low performing providers improve on domains of clinical performance.