Assessing the accuracy of profiling methods for identifying top providers: performance of mental health care providers.

Provider profiling as a means to describe and compare the performance of health care professionals has gained momentum in the past decade. As a key component of pay-for-performance programs profiling has been increasingly used to identify top-performing providers. However, rigorous examination of the performance of statistical methods for profiling when used to classify top-performing providers is lacking. The objective of this study was to compare the classification accuracy of three methods for identifying providers exceeding performance thresholds and to analyze data on satisfaction with mental health care providers at Group Health Cooperative using these methods. Questionnaire data on patient satisfaction with mental health care providers at Group Health Cooperative was collected between April 2008 and January 2010. Simulated data were used to compare the classification accuracy of alternative statistical methods. We evaluated sensitivity, specificity, and root mean squared error of alternative statistical methods using simulated data. For Group Health providers, we compared agreement of alternative approaches to classification. We found that when between-provider variability in performance was low, all three methods exhibited poor classification accuracy. When used to evaluate mental health care provider performance, we found substantial uncertainty in the estimates and poor agreement across methods. Based on these findings, we recommend providing uncertainty estimates for provider rankings and caution against the use of any classification method when between-provider variability is low.