How well does chart abstraction measure quality? A prospective comparison of standardized patients with the medical record

Luck, James V.; Peabody, John; Dresselhaus, Timothy R.; Lee, Martin L.; Glassman, Peter

doi:10.1016/s0002-9343(00)00363-6

Cited by 274 publications

(259 citation statements)

References 38 publications

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“…An additional limitation is that survey responses may not reflect actual decision-making in clinical practice. Although survey-based clinical vignettes are widely recognized to be a valid, reliable, practical, and cost-effective technique to assess process of care (43)(44)(45)(46), our vignettes do not represent all possible scenarios in CKD; however, we followed steps to ensure adequate content validity of our vignettes, including using guidelines to identify key relevant clinical factors, reviewing by clinical nephrologists, and pilot testing for comprehensibility.…”

Section: Discussionmentioning

confidence: 99%

Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

Whitman

Shreay

Gitlin

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Red blood cell transfusion was previously the principle therapy for anemia in CKD but became less prevalent after the introduction of erythropoiesis-stimulating agents. This study used adaptive choice-based conjoint analysis to identify preferences and predictors of transfusion decision-making in CKD.Design, setting, participants, & measurements A computerized adaptive choice-based conjoint survey was administered between June and August of 2012 to nephrologists, internists, and hospitalists listed in the American Medical Association Masterfile. The survey quantified the relative importance of 10 patient attributes, including hemoglobin levels, age, occult blood in stool, severity of illness, eligibility for transplant, iron indices, erythropoiesis-stimulating agents, cardiovascular disease, and functional status. Triggers of transfusions in common dialysis scenarios were studied, and based on adaptive choice-based conjoint-derived preferences, relative importance by performing multivariable regression to identify predictors of transfusion preferences was assessed.Results A total of 350 providers completed the survey (n=305 nephrologists; mean age=46 years; 21% women). Of 10 attributes assessed, absolute hemoglobin level was the most important driver of transfusions, accounting for 29% of decision-making, followed by functional status (16%) and cardiovascular comorbidities (12%); 92% of providers transfused when hemoglobin was 7.5 g/dl, independent of other factors. In multivariable regression, Veterans Administration providers were more likely to transfuse at 8.0 g/dl (odds ratio, 5.9; 95% confidence interval, 1.9 to 18.4). Although transplant eligibility explained only 5% of decision-making, nephrologists were five times more likely to value it as important compared with non-nephrologists (odds ratio, 5.2; 95% confidence interval, 2.4 to11.1).Conclusions Adaptive choice-based conjoint analysis was useful in predicting influences on transfusion decisions. Hemoglobin level, functional status, and cardiovascular comorbidities most strongly influenced transfusion decision-making, but preference variations were observed among subgroups.

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Section: Discussionmentioning

confidence: 99%

Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

Whitman

Shreay

Gitlin

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…Previous studies have demonstrated that the medical record itself may have a substantial number of errors. (30)(31)(32) Because we use the medical record as the "gold standard" to which we compare self-report, it is possible that this assessment also has error. For some of the diseases the sample size of the inaccurate reporters was small which may have contributed to the lack of associations due to a lack of power to measure a difference between the inaccurate and accurate self-reporters.…”

Section: Discussionmentioning

confidence: 99%

Accuracy of Patients' Reports of Comorbid Disease and Their Association With Mortality in ESRD

Cavanaugh

Merkin

Plantinga

et al. 2008

American Journal of Kidney Diseases

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“…Low rates of some diabetes care activities in study practices may have been a function of incomplete (and then improved) documentation rather than inadequate (and then improved) delivery of care (39). However, for purposes of accountability, improved documentation is equivalent to improved care delivery.…”

Section: Effects Of the Interventionmentioning

confidence: 99%

A Controlled Trial of Web-Based Diabetes Disease Management

et al. 2003

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OBJECTIVE -To test effects of a web-based decision support tool, the diabetes Disease Management Application (DMA), developed to improve evidence-based management of type 2 diabetes.RESEARCH DESIGN AND METHODS -We conducted a group randomized controlled trial of 12 intervention and 14 control staff providers and 307 intervention and 291 control patients with type 2 diabetes in a hospital-based internal medicine clinic. Providers were randomly assigned from May 1998 through April 1999 to have access to the DMA (intervention) or not to have access (control). The DMA displays interactive patient-specific clinical data, treatment advice, and links to other web-based care resources. We compared patients in the intervention and control groups for changes in processes and outcomes of care from the year preceding the study through the year of the study by intention-to-treat analysis.RESULTS -The DMA was used for 42% of scheduled patient visits. The number of HbA 1c tests obtained per year increased significantly in the intervention group (ϩ0.3 tests/year) compared with the control group (Ϫ0.04 tests/year, P ϭ 0.008), as did the number of LDL cholesterol tests (intervention, ϩ0.2 tests/year; control, ϩ0.01 tests/year; P ϭ 0.02) and the proportions of patients undergoing at least one foot examination per year (intervention, ϩ9.8%; control, Ϫ0.7%; P ϭ 0.003). Levels of HbA 1c decreased by 0.2 in the intervention group and increased by 0.1 in the control group (P ϭ 0.09); proportions of patients with LDL cholesterol levels Ͻ130 mg/dl increased by 20.3% in the intervention group and 10.5% in the control group (P ϭ 0.5).CONCLUSIONS -Web-based patient-specific decision support has the potential to improve evidence-based parameters of diabetes care. Diabetes Care 26:750 -757, 2003D iabetes, primarily type 2 diabetes, affects Ͼ12% of the adult U.S. population and has become increasingly common over the past decade (1). Patients with type 2 diabetes are affected by microvascular complications, but cardiovascular disease (CVD) complications take the greatest toll (2). Diabetes and its complications cause substantial loss in quality of life, are the fourth most frequent reason for ambulatory physician visits, and incur Ͼ100 billion dollars in U.S. health care expenditures annually (3-5). There is probably no other common condition with a more pernicious effect than diabetes on patient health and health care budgets.Fortunately, there is now abundant evidence that complications of diabetes are preventable. Simple screening interventions can prevent visual loss and serious foot lesions (6,7), and intensive control of glycemia, blood pressure, and lipid levels slow the incidence and progression of microvascular and CVD complications (8). This evidence provides the basis for diabetes care guidelines promulgated by the American Diabetes Association (ADA) and other expert panels (9 -12). Regrettably, studies consistently document a large gap between evidencebased standards and current diabetes care in the U.S. For instance, only ϳ50% of ...

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How well does chart abstraction measure quality? A prospective comparison of standardized patients with the medical record

Cited by 274 publications

References 38 publications

Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

Clinical Factors and the Decision to Transfuse Chronic Dialysis Patients

Accuracy of Patients' Reports of Comorbid Disease and Their Association With Mortality in ESRD

A Controlled Trial of Web-Based Diabetes Disease Management

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