| Frequency of inappropriate medical exceptions to quality measures. | |
| | |
MedLine Citation:
|
PMID: 20157137 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Quality improvement programs that allow physicians to document medical reasons for deviating from guidelines preserve clinicians' judgment while enabling them to strive for high performance. However, physician misconceptions or gaming potentially limit programs. OBJECTIVE: To implement computerized decision support with mechanisms to document medical exceptions to quality measures and to perform peer review of exceptions and provide feedback when appropriate. DESIGN: Observational study. SETTING: Large internal medicine practice. PARTICIPANTS: Patients eligible for 1 or more quality measures. MEASUREMENTS: A peer-review panel judged medical exceptions to 16 chronic disease and prevention quality measures as appropriate, inappropriate, or of uncertain appropriateness. Medical records were reviewed after feedback was given to determine whether care changed. RESULTS: Physicians recorded 650 standardized medical exceptions during 7 months. The reporting tool was used without any medical reason 36 times (5.5%). Of the remaining 614 exceptions, 93.6% were medically appropriate, 3.1% were inappropriate, and 3.3% were of uncertain appropriateness. Frequencies of inappropriate exceptions were 7 (6.9%) for coronary heart disease, 0 (0%) for heart failure, 10 (10.8%) for diabetes, and 2 (0.6%) for preventive services. After physicians received direct feedback about inappropriate exceptions, 8 of 19 (42%) changed management. The peer-review process took less than 5 minutes per case, but for each change in clinical care, 65 reviews were required. LIMITATION: The findings could differ at other sites or if financial incentives were in place. CONCLUSION: Physician-recorded medical exceptions were correct most of the time. Peer review of medical exceptions can identify myths and misconceptions, but the process needs to be more efficient to be sustainable. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality. |
| | |
Authors:
|
Stephen D Persell; Nancy C Dolan; Elisha M Friesema; Jason A Thompson; Darren Kaiser; David W Baker |
Related Documents
:
|
1571087 - Quality assurance in cardiovascular and interventional radiology. 10128037 - 1993 up & comers. 10119097 - An in-house training program for hospital-based medical transcriptionists. 11438297 - Role of external quality assurance schemes in assessing and improving quality in medica... 21988627 - Improving the recruitment and retention of doctors by training medical students locally. 15742797 - Acute stress disorder symptoms in gunshot-injured youth. |
Publication Detail:
|
Type: Journal Article; Research Support, N.I.H., Extramural |
Journal Detail:
|
Title: Annals of internal medicine Volume: 152 ISSN: 1539-3704 ISO Abbreviation: Ann. Intern. Med. Publication Date: 2010 Feb |
Date Detail:
|
Created Date: 2010-02-16 Completed Date: 2010-03-17 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: United States |
Other Details:
|
Languages: eng Pagination: 225-31 Citation Subset: AIM; IM |
Affiliation:
|
Division of General Internal Medicine, Northwestern University, 750 North Lake Shore Drive, 10th Floor, Chicago, IL 60611, USA. spersell@nmff.org |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Decision Support Systems, Clinical
/
organization & administration* Electronic Health Records* Feedback Guideline Adherence* Humans Illinois Medical Audit / methods* Observation Peer Review, Health Care Practice Guidelines as Topic* |
| Grant Support | |
ID/Acronym/Agency:
|
1K08HS015647-01/HS/AHRQ HHS; 1R18HS17163-01/HS/AHRQ HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study.
Next Document: Narrative review: the role of th2 immune pathway modulation in the treatment of severe asthma and it...