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Physician-level quality measurement: Using control charts with national benchmarks to identify common and special cause variation in patients' systolic blood pressures.


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

Presented: Joint Statistical Meetings Conference, August 2009

Abstract: Control charts that identify common or special cause variation in processes are used for physician-level quality measurement. The American Board of Internal Medicine's Maintenance of Certification program includes an assessment of physicians' efforts to improve the quality of patient care through Web-based tools called Practice Improvement Modules. Using the Hypertension PIM, 283 physicians abstracted data from 7,215 medical records of their hypertensive patients. Systolic blood pressures for patients (n>=20) per physician are plotted with short-run, individual moving-range charts. Special cause variation is identified with standard sensitizing rules; rules using systolic BP benchmarks; systolic specification limits not exceeding 20 mm Hg above goals. The benchmark control chart measures quality and consistency of patient care relative to national standards at the physician level.

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