A Model for Performance Evaluation of Emergency Department Physicians

Abstract

Performance of Emergency Department (ED) physicians (MDs) is multi-faceted since it impacts multiple dimensions such as health outcomes of patients, utilization of resources, throughput of patients and timeliness of care. Therefore, the assessment of their performance demands the use of a tool that allows considering multiple evaluation criteria. However, commonly used multi-criteria evaluation methods often require assigning weights to dimensions in order to define their relative importance on a final performance score. This feature introduces subjectivity in the development of weights and has the potential to produce biased results. The purpose of this thesis research is to develop a multi-dimensional evaluation tool for evaluating performance of ED MDs. The proposed evaluation tool relies on a mathematical programming model known as Data Envelopment Analysis (DEA). The use of DEA does not ask for subjective weighting assignments for each dimension that describe the ED MDs’ performance. It is capable of considering multiple heterogeneous performance measures to identify benchmark practice and the individual improvements leading to best practice of each evaluated unit. The DEA model described here was developed from real data to assess the performance of 20 PED MDs from the Children’s Hospital of Eastern Ontario (CHEO). Multiple evaluations were run on stratified data in order to identify benchmark practice in each of seven categories of patients’ complaints and to determine the impact of accompanying MD trainees on PED MDs’ performance. For each PED MD, performance scores and improvements in each category of patients’ complaints (i.e. respiratory, trauma, abdominal, fever, gastroenterology, allergy and Ear-Nose-Throat complaints) were determined. This helped identifying the required improvements that would lead PED MDs to achieve benchmark performance. Regarding the influence of MD trainees on PED MDs’ performance, results show that most PED MDs (15 out of 20) perform better when they are not accompanied by a trainee which motivates further research to assess trade-offs between teaching and clinical performance. In summary, DEA proved to be an appropriate tool for performance evaluation of PED MDs because it helped to identify benchmark performers and provided information for performance improvements under a multi dimensional performance evaluation framework.