Improving Performance Evaluation of Clinicians to Support National Standards of Practice

背景：临床医生的表现是高质量护理服务和患者结局的关键决定因素。 VA医疗中心通过持续和重点专业实践评估（OPPE和 FPPE），这需要临床医生每两年进行一次图表摘要，以评估对质量措施的遵守情况。 这一过程效率低下，缺乏有效性或影响力的证据，并一直是多个问题的主题。 监察主任办公室的调查。因此，它致力于建立国家 所有临床医生在OPPE/FPPE中使用的实践标准。专科护理办公室选择了一套 33个子专业的154个绩效指标。其中，心脏病学是最好的定位，以测试新的 由于现有的基于证据的质量措施和建立的临床医生评估方法 通过临床评估、报告和跟踪（CART）计划进行质量测量的机制。 重要性：两个关键的知识差距阻碍了对心脏病提供者的有效绩效评估， VA：1）普通心脏病学实践的现有质量措施尚未进行有效性和可靠性测试; 以及2）有效的基于病例的同行评议方法对于门诊心脏病护理不可用。由于这些 两种评估方法在概念上和当前的VA实践中都有联系，我们建议在一个 新颖的混合方法研究。我们的总体目标是提供实用的工具来评估VA心脏病学临床医生 同时展示了这种新颖范例的概念验证。 创新和影响：这些新的评估方法将使VA临床医生摆脱低成本的负担， 价值图抽象，推进VA成为高可靠性组织的承诺，并提高 退伍军人医疗保健的整体质量和安全。此外，研究将提供可推广的知识 推进临床医生绩效评估和改进领域。 具体目的：1）评估电子健康质量测量的信度和效度 记录数据以供心脏病学临床医生评估; 2）检验基于病例的心脏病学同行评议的有效性 临床医生表现;和3）确定使用这些评估方法的障碍和促进因素 OPPE/FPPE在VA实践中的应用 方法学：这项混合方法研究将建立在循证临床实践反馈的基础上 干预理论和心脏手术质量评估和同行评审的现有方法。在 目的1，我们将使用电子健康记录数据评估心脏病学临床医生在4个指标上的表现， 目前用于OPPE。将对措施的可靠性和有效性进行测试。综合措施将是 旨在提供临床医生表现的总结评估。在目标2中，我们将聘请专家 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， 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。 后续步骤/实施：本研究将开发一种值得信赖的方法，用于临床医生的审查 这将有助于提高效率，取代目前效率低下和无效的OPPE/FPPE流程。我们将与 我们在心脏病学和专科护理项目办公室的合作伙伴在实践中实施。

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.