IIR 98-118
Measuring Primary Care Competency-Linking Knowledge to Clinical Behavior
John W. Peabody, MD PhD DTM&H VA Palo Alto Health Care System, Palo Alto, CA Palo Alto, CA Funding Period: January 2000 - December 2002 Portfolio Assignment: Quality Measurement Development |
BACKGROUND/RATIONALE:
Valid and cost effective measures of quality are needed to assess physician competency and systems effects on clinical practice. OBJECTIVE(S): To further develop a valid, responsive, case mix adjusted and inexpensive method to measure the quality of care.To further develop a valid, responsive, case mix-adjusted, and inexpensive method to measure the quality of care, physicians’ management of computerized clinical vignette scenarios were compared to the "gold standard" of standardized patients (SPs) and to abstracted medical records of the SP visits. METHODS: We used a randomized, controlled design to compare vignette to standardized patients measurement of the quality of care in 4 outpatient clinics. Measurements were done for four common acute and chronic diseases that are common in the primary care setting. Two different clinical scenarios are being developed for each of the four diseases. Clinical vignettes and actor patient scripts are also being developed to reflect these scenarios. The measurement criteria, appropriate to each scenario, are based on national guidelines and further reviewed by expert panels. Subjects were general internal medicine residents (excluding interns) and faculty providing care in the primary care clinics at two sites in Los Angeles and two sites in San Francisco VA Medical Centers. After obtaining consent from over 95% of eligible physicians, 10 physicians are being randomly selected at each site to receive vignettes and see standardized patients. These "patients" are experienced actors who underwent a rigorous training protocol and ongoing quality assessment. The standardized patients are being scheduled into regular clinic slots without notification to the physician. Each participating physician will complete all eight vignettes and see eight standardized patients. To assure the accuracy of the gold standard, a random selection of visits for each actor will be record and then compared with patient reports. Vignettes and chart abstractions are being scored by trained abstractors and compared to the quality criteria. The data analysis will compare provider scores for each encounter for each method. The complete analytical model will be a 3-way crossed, one way nested analysis of variance (ANOVA) model. The main effect will be methodology. Case type and facility were included as random effects. FINDINGS/RESULTS: 10% of the SP visits, Transcription, 50% of the vignettes are pending and electronic word recognition programs are pending. IMPACT: Vignettes are an inexpensive method to measure the quality of outpatient care. Potential uses include evaluation of physician training, incentive programs, and comparative evaluation of health care systems. External Links for this ProjectDimensions for VADimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.Learn more about Dimensions for VA. VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address. Search Dimensions for this project PUBLICATIONS:Journal Articles
DRA:
Health Systems Science
DRE: Technology Development and Assessment Keywords: Quality assessment, Research method MeSH Terms: none |