Quality IQ Patient Simulation Physician Practice Measurement and Engagement

Primary care providers (PCPs) make many of the most important care decisions, especially for
patients with chronic conditions and multiple co-morbidities. Studies have confirmed that
unwarranted variation is common among PCPs, with high level of variation in care documented
between urban and rural practices, across regions, and even among providers within a single
healthcare system.

The investigators' previous work has shown that patient simulations can rapidly and reliably
measure unwarranted practice variation among providers. In addition, published work shows
that patient simulations, when administered serially and combined with customized feedback on
improvement opportunities can reduce practice variation and improve performance on
patient-level quality measures. Given the large scope of unwarranted variation in medical
practice, there is a need for scalable approaches to measure care decisions, provide feedback
on improvement opportunities and benchmark performance to peers.

This study seeks to evaluate the impact of measurement, feedback and competition on
evidence-based care decisions made by primary care providers across the country. It is a
randomized, controlled trial with multiple measurements across key domains of clinical care.
All participants are asked to care for simulated patients designed to look like typical
patients seen in a primary care practice. In each case, providers will answer multiple-choice
questions about their preferred course of action to work-up, diagnose and treat patients in
the primary care setting. After each question, providers will receive evidence-based
feedback, including references, on the appropriateness of each of their care decisions.
Feedback will be supported with relevant reference to evidence-based guidelines, including
national MIPS quality measures.

All participants will receive the following interventions:

- Feedback on care decisions made in each Quality IQ case, which will identify correct
care, unneeded care, or gaps in care. This feedback will recommend or reinforce
evidence-based care decisions and includes references.

- All cases will be scored against evidence-based criteria. For each case, providers will
start with 100 base points. Correct care decisions will add to that total, while
unnecessary care decisions will subtract from that total. A weekly leaderboard will be
posted online, allowing participants to see how they are performing relative to their
peers across the country. Participants will have the opportunity to select a unique
username or an anonymous user ID to be identified on the leaderboard, to maintain
anonymity.

Half of the recruits will be offered Category I CME credit approved by The University of
California, San Francisco School of Medicine (UCSF) which has been accredited by the
Accreditation Council of Continuing Medical Education to provide CME for physicians and MOC
points in the ABIM's MOC program.

Inclusion Criteria:

1. Board-certified in internal medicine or family medicine

2. Minimum patient panel size of 1,500 patients

3. English-speaking

4. Access to the internet

5. Informed, signed and voluntarily consented to be in the study

Exclusion Criteria:

1. Not board certified in either internal medicine or family medicine

2. Patient panel size less than 1,500 patients

3. Non-English speaking

4. Unable to access the internet

5. Does not voluntarily consent to be in the study