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To the Editor: I commend Dr Marshall and colleagues¹ on their efforts to assess the impact of performance data on clinical behavior and outcomes. Having spent a good deal of time working with clinicians and using data to influence change,^2-3 I certainly agree with the authors that physicians are often skeptical about performance data. Skepticism arises from concerns related to intent, accuracy, physician attribution, and relevance. Intent relates to the concern that data will be used punitively rather than to identify opportunities for improvement. Accuracy is an issue because of concerns related to errors in coding, chart documentation, and the questionable clinical assumptions and interpretations derived from administrative data sets. As a result, the first reaction on the part of many clinicians is to challenge the accuracy of performance data. The third issue is relevance. Given the subtleties of medical management among unique patient populations, physicians may not view performance . . . [Full Text of this Article]

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The Public Release of Performance Data: What Do We Expect to Gain? A Review of the Evidence
Martin N. Marshall, Paul G. Shekelle, Sheila Leatherman, and Robert H. Brook
JAMA. 2000;283(14):1866-1874.
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