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CONTEXT Better health care quality is a universal goal, yet measuring quality has proven to be difficult and problematic. A central problem has been isolating physician practices from other effects of the health care system. OBJECTIVE To validate clinical vignettes as a method for measuring the competence of physicians and the quality of their actual(More)
BACKGROUND Worldwide efforts are under way to improve the quality of clinical practice. Most quality measurements, however, are poorly validated, expensive, and difficult to compare among sites. OBJECTIVE To validate whether vignettes accurately measure the quality of clinical practice by using a comparison with standardized patients (the gold standard(More)
PURPOSE Despite widespread reliance on chart abstraction for quality measurement, concerns persist about its reliability and validity. We prospectively evaluated the validity of chart abstraction by directly comparing it with the gold standard of reports by standardized patients. SUBJECTS AND METHODS Twenty randomly selected general internal medicine(More)
OBJECTIVE To determine how accurately preventive care reported in the medical record reflects actual physician practice or competence. DESIGN Scoring criteria based on national guidelines were developed for 7 separate items of preventive care. The preventive care provided by randomly selected physicians was measured prospectively for each of the 7 items.(More)
BACKGROUND Administrative data play a central role in health care. Inaccuracies in such data are costly to health systems, they obscure health research, and they affect the quality of patient care. OBJECTIVES We sought to prospectively determine the accuracy of the primary and secondary diagnoses recorded in administrative data sets. RESEARCH DESIGN(More)
OBJECTIVE To determine whether clinical vignettes can measure variations in the quality of clinical care in two economically divergent countries. DATA SOURCE/STUDY SETTING Primary data collected between February 1997 and February 1998 at two Veterans Affairs facilities in the United States and four government-run outpatient facilities in Macedonia. (More)
OBJECTIVE To assess the validity of standardised patients to measure the quality of physicians' practice. DESIGN Validation study of standardised patients' assessments. Physicians saw unannounced standardised patients presenting with common outpatient conditions. The standardised patients covertly tape recorded their visit and completed a checklist of(More)
BACKGROUND Use of standardized patients for evaluating the clinical skills of medical students and medical trainees is commonplace. This has encouraged the use of standardized patients to evaluate the quality of physician practice in outpatient settings. However, there may be substantive differences between observing student performance and evaluating(More)
OBJECTIVE To determine time allocation and the perceived value to education and patient care of the weekday activities of internal medicine housestaff on inpatient rotations and to compare the work activities of interns and residents. DESIGN An observational study. We classified activities along five dimensions (association, location, activity, time, and(More)
OBJECTIVE To determine if the medical record might overestimate the quality of care through false, and potentially unethical, documentation by physicians. DESIGN Prospective trial comparing two methods for measuring the quality of care for four common outpatient conditions: (1) structured reports by standardised patients (SPs) who presented unannounced to(More)