Improving Performance Evaluation of Clinicians to Support National Standards of Practice

改进临床医生的绩效评估以支持国家实践标准

• 批准号: 10538934
• 负责人: Jacob A Doll
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2026-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10538934
• 关键词: Adherence; Agreement; American Medical Association; Benchmarking; Blinded; Cardiac; Cardiology; Caring; Certification; Clinical; Clinical assessments; Collaborations; Data; Decentralization; Development; Electronic Health Record; Electronics; Ensure; Evaluation; Face; Feedback; Goals; Healthcare; Hospitals; Intervention; Interview; Investigation; Joints; Knowledge; Licensure; Link; Measurement; Measures; Medical; Medical center; Methodology; Methods; Monitor; Online Systems; Outpatients; Patient Care; Patient-Focused Outcomes; Peer Review; Perception; Performance; Policies; Positioning Attribute; Procedures; Process; Professional Practice; Provider; Quality of Care; Reporting; Research; Safety; Sample Size; Surveys; System; Testing; Validity and Reliability; Veterans; Work; care delivery; case-based; clinical care; clinical practice; cohort; evidence base; implementation barriers; improved; innovation; instrument; medical specialties; novel; prevent; programs; theories; tool; trustworthiness; web platform; Adherence; Agreement; American Medical Association; Benchmarking; Blinded; Cardiac; Cardiology; Caring; Certification; Clinical; Clinical assessments; Collaborations; Data; Decentralization; Development; Electronic Health Record; Electronics; Ensure; Evaluation; Face; Feedback; Goals; Healthcare; Hospitals; Intervention; Interview; Investigation; Joints; Knowledge; Licensure; Link; Measurement; Measures; Medical; Medical center; Methodology; Methods; Monitor; Online Systems; Outpatients; Patient Care; Patient-Focused Outcomes; Peer Review; Perception; Performance; Policies; Positioning Attribute; Procedures; Process; Professional Practice; Provider; Quality of Care; Reporting; Research; Safety; Sample Size; Surveys; System; Testing; Validity and Reliability; Veterans; Work; care delivery; case-based; clinical care; clinical practice; cohort; evidence base; implementation barriers; improved; innovation; instrument; medical specialties; novel; prevent; programs; theories; tool; trustworthiness; web platform

Background: Clinician performance is a critical determinant of high-quality care delivery and patient outcomes. VA medical centers assess clinicians with Ongoing and Focused Professional Practice Evaluations (OPPE and FPPE), which require bi-annual chart abstraction by clinicians to assess for adherence to quality measures. This process is inefficient, lacks evidence of validity or impact, and has been the subject of multiple investigations by the Office of the Inspector General. VA has therefore committed to establishing national standards of practice for all clinicians for use in OPPE/FPPE. The Office of Specialty Care has selected a set of 154 performance indicators across 33 subspecialities. Of these, cardiology is best positioned to test novel methods for clinician assessment because of existing evidence-based quality measures and established mechanisms for quality measurement via the Clinical Assessment, Reporting and Tracking (CART) program. Significance: Two critical knowledge gaps prevent effective performance assessment of cardiology providers in VA: 1) existing quality measures for general cardiology practice have not been tested for validity and reliability; and 2) effective case-based peer review methods are unavailable for outpatient cardiology care. Since these two assessment methods are linked both conceptually and in current VA practice, we propose to test both in a novel, mixed methods study. Our overall goal is to provide practical tools to assess VA cardiology clinicians while demonstrating proof-of-concept of this novel paradigm. Innovation and Impact: These novel assessment methods would free VA clinicians from the burden of low- value chart abstraction, advance VA’s commitment to be a High Reliability Organization, and improve the overall quality and safety of Veteran healthcare. In addition, the research will provide generalizable knowledge to advance the field of clinician performance assessment and improvement. Specific aims: 1) To assess the reliability and validity of quality measures obtained from electronic health record data for cardiology clinician assessment; 2) To test the validity of case-based peer review of cardiology clinician performance; and 3) To identify barriers and facilitators to the use of these assessment methodologies for OPPE/FPPE in VA practice. Methodology: This mixed-methods study will build on the evidence-based Clinical Practice Feedback Intervention Theory and existing methods of quality assessment and peer review for cardiac procedures. In Aim 1, we will use electronic health record data to assess cardiology clinician performance on 4 indicators that are currently used for OPPE. Measures will be tested for reliability and validity. A composite measure will be developed to provide a summary assessment of clinician performance. In Aim 2, we will engage expert clinicians and other stakeholders to develop and test a web-based platform for blinded, case-based peer review. We will determine the reliability of peer review assessments and determine the optimal number of reviews. Finally, we will interview and survey clinicians to determine how these assessment methodologies may impact clinical care and can be most effectively implemented in practice. Next Steps/Implementation: This research will develop a trustworthy method for review of clinician performance that could replace the current inefficient and ineffective OPPE/FPPE process. We will work with our partners in the Program Offices of Cardiology and Specialty Care to implement in practice.

背景：临床医生的表现是对高质量护理和患者预后的重要确定。 VA医疗中心评估临床医生进行了持续和重点的专业实践评估（Oppe and oppe和 FPPE），它需要临床医生两年一次的图表抽象，以评估遵守质量度量的依从性。 这个过程效率低下，缺乏有效性或影响的证据，并且已成为多个的主题 监察长办公室的调查。因此，VA致力于建立国家 所有临床医生用于OPPE/FPPE的实践标准。专业护理办公室选择了一套 在33个亚科的154个绩效指标中。其中，心脏病学最适合测试小说 由于现有的基于证据的质量措施而建立的临床评估方法 通过临床评估，报告和跟踪计划（CART）计划进行质量测量的机制。 意义：两个关键的知识差距阻止心脏病学提供者的有效绩效评估 VA：1）尚未对有效性和可靠性测试一般心脏病学实践的现有质量措施； 2）有效的基于病例的同行评审方法无法用于门诊心脏病学护理。由于这些 两种评估方法在概念上和当前的VA实践中都链接 新颖的混合方法研究。我们的总体目标是提供评估VA心脏病学临床医生的实用工具 同时展示了这种新颖范式的概念概念。 创新和影响：这些新颖的评估方法将使VA临床医生免于低燃烧 价值图表抽象，提前VA成为高可靠性组织的承诺，并改善 资深医疗保健的整体质量和安全。此外，研究将提供可普遍的知识 推进临床性能评估和改进领域。 具体目的：1）评估电子健康获得的质量度量的可靠性和有效性 记录心脏病学临床评估的数据； 2）测试基于病例的同伴心脏病学的有效性 临床表现； 3）确定使用这些评估方法的障碍和促进者 对于VA实践中的Oppe/FPPE。 方法论：这项混合方法研究将基于循证临床实践反馈 干预理论和质量评估的现有方法和心脏程序的同行评审。在 AIM 1，我们将使用电子健康记录数据来评估4个指标的心脏病学临床表现 目前用于Oppe。措施将测试可靠性和有效性。复合测量将是 开发以提供临床性能的摘要评估。在AIM 2中，我们将吸引专家 临床医生和其他利益相关者开发和测试一个基于网络的平台，用于盲目的，基于病例的同伴 审查。我们将确定同行评审评估的可靠性，并确定最佳数量 评论。最后，我们将采访和调查临床医生，以确定这些评估方法如何 可能会影响临床护理，并且可以在实践中最有效地实施。 下一步/实施：这项研究将开发一种可信赖的方法来审查临床 可以取代当前效率低下且无效的OPPE/FPPE过程的性能。我们将与 我们在心脏病学和专业护理计划办公室的合作伙伴在实践中实施。