Comparison of case note review methods for evaluating quality and safety in health care

Hutchinson, Allen; Coster, Joanne; Cooper, Katy; McIntosh, Aileen; Walters, Stephen J.; Bath, Peter A.; Pearson, M; Young, Tracey; Rantell, Khadija; Campbell, Mike; Ratcliffe, Julie

doi:10.3310/hta14100

Cited by 22 publications

(27 citation statements)

References 24 publications

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“…93 The findings show stronger correlation coefficients for intercorrelations between the various holistic measures than for correlations between criterion-based and holistic review measures, despite the criterion-based review being carried out first for each record. This appears to support the view that holistic review is assessing aspects of quality not reflected in criterion-based review 94 and a thorough assessment of performance should combine the two approaches. Furthermore, the inter-rater reliability results illustrate the benefit of enhanced reliability when using two reviewers and taking an average measure of quality of care.…”

Section: Quality Of Care Provided By Foundation Year 2 Doctorssupporting

confidence: 48%

“…The findings in relation to inter-rater reliability were broadly consistent with those of other studies, showing lower scores for holistic reviews. The review methods used in this study are consistent with those employed by Hutchinson et al 94 …”

Section: Introductionsupporting

confidence: 50%

“…The correlations for the holistic review are lower and more variable (0.08-0.66) but are reasonably consistent with those from other studies. 93,94 These studies also report lower ICC statistics for holistic review than for criterion-based review.…”

Section: Resultsmentioning

confidence: 99%

“…The structured review form used for the holistic review was consistent with that in previous studies using this approach 88,94 in providing a framework to structure implicit judgements with a view to maximising inter-rater reliability. Unlike the criterion-based approach, reviewers were not provided with any specific criteria for current best practice and were asked to use their professional judgement.…”

Section: Development Of the Holistic Review Formmentioning

confidence: 89%

“…A more recent study by Hutchinson et al 94 aimed to determine which of the two methods provides the most useful and reliable information for assessing quality of care. The study entailed a large-scale review of case notes across several hospitals and reviewers using both holistic and criterion-based review methods.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]

Mason

O’Keeffe

Carter

et al. 2013

Health Services and Delivery Research

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BackgroundA major reform of junior doctor training was undertaken in 2004–5, with the introduction of foundation training (FT) to address perceived problems with work structure, conditions and training opportunities for postgraduate doctors. The well-being and motivation of junior doctors within the context of this change to training (and other changes such as restrictions in working hours of junior doctors and increasing demand for health care) and the consequent impact upon the quality of care provided is not well understood.ObjectivesThis study aimed to evaluate the well-being of foundation year 2 (F2) doctors in training. Phase 1 describes the aims of delivering foundation training with a focus on the role of training in supporting the well-being of F2 doctors and assesses how FT is implemented on a regional basis, particularly in emergency medicine (EM). Phase 2 identifies how F2 doctor well-being and motivation are influenced over F2 and specifically in relation to EM placements and quality of care provided to patients.MethodsPhase 1 used semistructured interviews and focus groups with postgraduate deanery leads, training leads (TLs) and F2 doctors to explore the strategic aims and implementation of FT, focusing on the specialty of EM. Phase 2 was a 12-month online longitudinal study of F2 doctors measuring levels of and changes in well-being and motivation. In a range of specialties, one of which was EM, data from measures of well-being, motivation, intention to quit, confidence and competence and job-related characteristics (e.g. work demands, task feedback, role clarity) were collected at four time points. In addition, we examined F2 doctor well-being in relation to quality of care by reviewing clinical records (criterion-based and holistic reviews) during the emergency department (ED) placement relating to head injury and chronic obstructive pulmonary disease (COPD).ResultsPhase 1 of the study found that variation exists in how successfully FT is implemented locally; F2 lacks a clearly defined end point; there is a minimal focus on the well-being of F2 doctors (only on the few already shown to be ‘in difficulty’); the ED presented a challenging but worthwhile learning environment requiring a significant amount of support from senior ED staff; and disagreement existed about the performance and confidence levels of F2 doctors. A total of 30 EDs in nine postgraduate medical deaneries participated in phase 2 with 217 foundation doctors completing the longitudinal study. F2 doctors reported significantly increased confidence in managing common acute conditions and undertaking practical procedures over their second foundation year, with the biggest increase in confidence and competence associated with their ED placement. F2 doctors had levels of job satisfaction and anxiety/depression that were comparable to or better than those of other NHS workers, and adequate quality and safety of care are being provided for head injury and COPD.ConclusionsThere are ongoing challenges in delivering high-quality FT at the local level, especially in time-pressured specialties such as EM. There are also challenges in how FT detects and manages doctors who are struggling with their work. The survey was the first to document the well-being of foundation doctors over the course of their second year, and average scores compared well with those of other doctors and health-care workers. F2 doctors are benefiting from the training provided as we found improvements in perceived confidence and competence over the year, with the ED placement being of most value to F2 doctors in this respect. Although adequate quality of care was demonstrated, we found no significant relationships between well-being of foundation doctors and the quality of care they provided to patients, suggesting the need for further work in this area.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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Section: Quality Of Care Provided By Foundation Year 2 Doctorssupporting

confidence: 48%

Section: Introductionsupporting

confidence: 50%

Section: Resultsmentioning

confidence: 99%

Section: Development Of the Holistic Review Formmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]

Mason

O’Keeffe

Carter

et al. 2013

Health Services and Delivery Research

View full text Add to dashboard Cite

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Assessing Early Performance in the Patient‐Doctor Relationship in Dental Education

Kalenderian

Maramaldi

Kinnunen³

et al. 2012

Journal of Dental Education

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In addition to current admissions criteria, the assessment of qualities related to humanistic medicine may help predict clinical and academic performance in dental education. The objective of this feasibility study was to develop and assess the reliability of a coding scheme to quantify and rate qualitative formative narratives describing individual student performance in a medical interview course that utilizes principles of humanistic medicine. A mixed method, using focus groups and individual interviews, was used to develop a coding strategy. Three coders retrospectively rated 209 formative narratives evaluating irst-year students at the Harvard School of Dental Medicine to determine high and low performance in this course. Interrater reliability was tested. The focus groups yielded the use of superlatives to identify high performance, with their absence indicating low performance. This study found a high level of calibration among independent coders (Cronbach's alpha 0.75). Twenty-four (11.5 percent) of the narrative evaluations were coded as "high performers" and seven (3.3 percent) as "low performers." The results demonstrate the feasibility of quantifying narrative evaluations to determine high and low performance in a patient-centered course for dental students. It may be that humanistic qualities taught in a patient-centered medical interview course are more signiicant competencies than previously thought.

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Surgical residents and the adequacy of dictated operative reports

Zwintscher

Johnson

Martin

et al. 2012

Journal of Surgical Research

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Comparison of case note review methods for evaluating quality and safety in health care

Cited by 22 publications

References 24 publications

An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]

An evaluation of foundation doctor training: a mixed-methods study of the impact on workforce well-being and patient care [the Evaluating the Impact of Doctors in Training (EDiT) study]

Assessing Early Performance in the Patient‐Doctor Relationship in Dental Education

Surgical residents and the adequacy of dictated operative reports

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