Good Today, Good Tomorrow? – How Psychiatrist Performance on Patient Self-Reported Outcomes Evolves
Previously, MHO explored discharge severity as a metric for evaluating physician clinical performance. We found psychiatrists who achieve better outcomes as measured by overall discharge severity achieve these outcomes even when patients admit with higher severity. Additionally, these psychiatrists were found to have a narrower range of discharge severity, an indication they are consistent in the discharge severity achieved by their patients. We wondered, then, if such performance was sustainable from one year to the next, or if perhaps even psychiatrists not in the top performing group could improve over time.
Data for 196 attending psychiatrists with at least 50 patients admitted to an adult inpatient program in both 2021 and 2023 were analyzed. First, a simple linear regression showed a statistically significant relationship between a psychiatrist’s 2021 and 2023 average discharge severities, in which 2023 performance was found to be partially predicted by 2021 performance (b = 0.54043, p <= 0.001, df = 195, r2 = 0.27). In fact, when each psychiatrist’s actual percentile value in 2021 was compared to 2023, on average there was absolutely no change.
As follow-up, for each year psychiatrists were categorized based on their average discharge severity: Lowest “Most Ideal” Discharge Severity (25th percentile or less), Middle Discharge Severity (26th to 74th percentile), or Highest “Least Ideal” Discharge Severity (75th percentile or higher). Comparing 2021 to 2023, over half of psychiatrists did change categories. From 2021 to 2023, only 9% of top performing psychiatrists moved to a lower performing category vs the 13% of bottom performing psychiatrists moving to a higher performing category. Very little “extreme” movement occurred, however, with only 2% of top or bottom performing psychiatrists moving to the opposite end of the performance spectrum.
Figure 1. Psychiatrists categorized based on their patient outcomes, and their performance changes in patient-reported outcomes from 2021 to 2023.
Wrapping it Up
Although it seems current psychiatrist performance on outcomes measures is an indicator of future performance, there is potential for change, emphasizing the importance of training and improvement initiatives. It’s worth pointing out this does not imply fate particularly for individual patients as it’s likely external factors such as nursing and other staff changes, policy changes, and/or patient characteristics affect individual patient discharge severity in some way. Afterall, inpatients are expected to achieve a certain level of wellness prior to discharge as evidenced by the relatively small overall variance in discharge severity. Furthermore, it’s important to consider potential compliance issues as a limitation that may have influenced our findings, such as bias in whether patients completed assessments at discharge.
