The examination of misclassification risk for quality measures is timely given the burgeoning interest in health care value, as reflected by constructing HPNs using quality information and pending changes in Medicare physician payments.
The misclassification rates we found might be pessimistic relative to profiling physicians on a composite constructed from numerous inputs or for other ways to select thresholds when designing HPNs. Regardless of how physician quality profiles are derived and categorized, the framework presented here for evaluating misclassification risk can be applied.
There is the potential to miss gains from recognizing and encouraging high-quality care when provider performance is misclassified, such as including physicians in an HPN who are erroneously classified as above a performance threshold while excluding those performers with true strong performance who are incorrectly classified below the threshold (Kassirer 1994; Werner and Asch 2005).
The second system will identify a narrow HPN by identifying providers with performance above the 75th percentile.
Positive predictive value may be the most relevant summary from a plan enrollee's point of view in terms of trusting whether the physicians included in an HPN are actually better-performing than others (Sinaiko and Rosenthal 2010).
Table 3 presents the misclassification rates for the six state-measure combinations for a mean-based high-performance system (Table 3A), broad network with exclusions of providers below the 25th percentile of performance (Table 3B), and the narrow HPN of providers above the 7.5th percentile of performance (Table 3C).
Interestingly, we did not find an increase of sensitivity with molecular mass for our HPN resist systems.
We describe here a novel resist system based on halogenophenol novolac (HPN) and melamine crosslinker.
Such resists show an even higher sensitivity as compared with HPN resists with other crosslinkers and exhibit the same good resolution properties.
The HPN component acts as a proton donator and as an essential part of the novolac binder simultaneously.
Thus, the halogenophenol novolacs in fact are synergists for crosslinking in the resist materials described, especially in the melamine systems, where the HPN enhances the activity of the crosslinker.