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Feasibility of measuring quality of patient care in comprehensive care practices in the United States.

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Lipner RS, Weng W, Arnold GK, Duffy DF, Holmboe ES. — American Board of Internal Medicine

Presented: Ottawa International Conference on Clinical Competence, March 2008

Background: Internists play a central role in U.S. health care in treatment and diagnosis of multiple conditions and also provide preventive services. Physician performance measurement typically focuses on quality indicators for single conditions and does not reflect a comprehensive view of an internist’s practice.

Aims: To assess the feasibility of measuring quality performance across multiple conditions in an internist's practice using a Web-based tool called the Comprehensive Care Practice Improvement Module.

Methods: Trained third-party auditors abstracted 14,091 patient charts for 58 performance measures among 146 physicians. Targeted chronic conditions were hypertension, diabetes, heart disease and knee or hip osteoarthritis. Acute conditions were low back pain, urinary tract infection, upper respiratory infection and major depression. Counseling, screening and immunization constituted preventive care services. Means with reliabilities (ICC and Cronbach’s α) were computed for each measure.

Results: On average 97 patient charts were audited per practice (SD =10.9) and sufficient patients were attainable for most but not all quality measures. Mean physician performance ranged from 11% (complete foot exam for diabetics) to 86% (documented weight in chart). Process measures such as annual eye exam for diabetics could be measured reliably (R=.85) with 32 patients, whereas outcomes measures such as BP <140/90 mm Hg required more patients (n=82).

Conclusion: It is feasible to reliably measure quality performance in a comprehensive care practice for most but not all conditions. Performance varied widely across conditions within and between physicians. More research on combining measures into composites to increase reliability of the comprehensive assessment is needed.

For more information about this presentation, please contact Research@abim.org.