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Anesthesia Report Card – A Customizable Tool for Performance Improvement

  • Systems-Level Quality Improvement
  • Published:
Journal of Medical Systems Aims and scope Submit manuscript

Abstract

Purpose

Measuring and providing performance feedback to physicians has gained momentum not only as a way to comply with regulatory requirements, but also as a way to improve patient care. Measurement of structural, process, and outcome metrics in a reliable, evidence-based, specialty-specific manner maximizes the probability of improving physician performance. The manner in which feedback is provided influences whether the measurement tool will be successful in changing behavior. We created an innovative reporting tool template for anesthesiology practitioners designed to provide detailed, continuous feedback covering many aspects of clinical practice.

Methods

The literature regarding quality metric measurement and feedback strategies was examined to design a reporting tool that could provide high quality information and result in improved performance of clinical and academic tasks. A committee of department leaders and information technology professionals was tasked with determining the measurement criteria and infrastructure needed to generate these reports. Data was collected in a systematic, unbiased manner, and reports were populated with information from multiple databases and software systems. Feedback would be based on frequently updated information and allow for analysis of historical performance as well as comparison amongst peers.

Results

A template for an anesthesia report card was created. Categories included compliance, credentialing and qualifications, education, clinical and operating room responsibilities, and academic achievements. Physicians were able to choose to be evaluated in some of the categories and had to meet a minimum number of criteria within each category. This allowed for customization to each practitioner’s practice. Criteria were derived from the measures of academic and clinical proficiency, as well as quality metrics. Criteria were objective measures and data gathering was often automated. Reports could be generated that were updated daily and provided historical information, and information about peers in the department and within each subspecialty group.

Conclusions

We demonstrate the creation of an online anesthesia report card that incorporates metrics most likely to engender positive changes in practice and academic responsibilities. This tool provides timely and customized information for each anesthesia practitioner, designed to be easily modifiable to improve the quantity, quality, and substance of metrics being measured. Finally, our tool could serve as a template for a performance measuring tool that can be customizable to a wide variety of practice settings, and upon which both monetary and non-monetary incentives might be based in the future.

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References

  1. Willig, J. H., Krawitz, M., Panjamapirom, A., Ray, M. N., Nevin, C. R., English, T. M., et al., Closing the feedback loop: an interactive voice response system to provide follow-up and feedback in primary care settings. Journal of medical systems 37(2):9905, 2013. Epub 2013/01/24.

    Article  Google Scholar 

  2. The Joint Commission: Telephone Conference Call Transcript. Audio conference with The Joint Commission President Dennis S. O'Leary, MD: Joint Credentialing and Privileging Standard.

  3. The Joint Commission. 2012 Comprehensive Accreditation Manual for Hospitals: The Official Handbook. The Joint Commission Resources, 2011. .

  4. The Joint Commission. Revised credentialing and privileging standards. This Month at The Joint Commission. State Hospital Association Edition, June 2006.

  5. Freedman, S., How 2007 The Joint Commission standards expand hospital peer review. Patient Safety & Quality Healthcare 4(5):14–16, 2007.

    Google Scholar 

  6. Benn, J., Arnold, G., Wei, I., Riley, C., and Aleva, F., Using quality indicators in anaesthesia: feeding back data to improve care. British journal of anaesthesia 109(1):80–91, 2012. Epub 2012/06/05.

    Article  Google Scholar 

  7. Simpao, A. F., Ahumada, L. M., Galvez, J. A., and Rehman, M. A., A review of analytics and clinical informatics in health care. Journal of medical systems 38(4):45, 2014. Epub 2014/04/04.

    Article  Google Scholar 

  8. Glance, L. G., Neuman, M., Martinez, E. A., Pauker, K. Y., and Dutton, R. P., Performance measurement at a "tipping point". Anesthesia and analgesia 112(4):958–66, 2011. Epub 2011/03/10.

    Article  Google Scholar 

  9. Donabedian, A., Evaluating the quality of medical care. 1966. The Milbank quarterly 83(4):691–729, 2005.

    Article  Google Scholar 

  10. Kurz, A., Sessler, D. I., and Lenhardt, R., Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. The New England journal of medicine. 334(19):1209–15, 1996. Epub 1996/05/09.

    Google Scholar 

  11. Moola, S., and Lockwood, C., Effectiveness of strategies for the management and/or prevention of hypothermia within the adult perioperative environment. International journal of evidence-based healthcare 9(4):337–45, 2011. Epub 2011/11/19.

    Article  Google Scholar 

  12. Bernard H. Patient warming in surgery and the enhanced recovery. Br J Nurs. 2013;22(6):319–20, 22–5. Epub 2013/08/02.

  13. Myles, P. S., Reeves, M. D., Anderson, H., and Weeks, A. M., Measurement of quality of recovery in 5672 patients after anaesthesia and surgery. Anaesthesia and intensive care 28(3):276–80, 2000. Epub 2000/06/15.

    Google Scholar 

  14. Haller, G., Stoelwinder, J., Myles, P. S., and McNeil, J., Quality and safety indicators in anesthesia: a systematic review. Anesthesiology 110(5):1158–75, 2009. Epub 2009/04/09.

    Article  Google Scholar 

  15. Landon, B. E., Normand, S. L., Blumenthal, D., and Daley, J., Physician clinical performance assessment: prospects and barriers. JAMA : the journal of the American Medical Association 290(9):1183–9, 2003. Epub 2003/09/04.

    Article  Google Scholar 

  16. Benn, J., Koutantji, M., Wallace, L., Spurgeon, P., Rejman, M., Healey, A., et al., Feedback from incident reporting: information and action to improve patient safety. Quality & safety in health care 18(1):11–21, 2009. Epub 2009/02/11.

    Article  Google Scholar 

  17. Veloski, J., Boex, J. R., Grasberger, M. J., Evans, A., and Wolfson, D. B., Systematic review of the literature on assessment, feedback and physicians' clinical performance: BEME Guide No. 7. Medical teacher 28(2):117–28, 2006.

    Article  Google Scholar 

  18. de Vos, M., Graafmans, W., Kooistra, M., Meijboom, B., Van Der Voort, P., and Westert, G., Using quality indicators to improve hospital care: a review of the literature. International journal for quality in health care : journal of the International Society for Quality in Health Care/ISQua 21(2):119–29, 2009. Epub 2009/01/22.

    Article  Google Scholar 

  19. Kaye, A. D., Okanlawon, O. J., and Urman, R. D., Clinical performance feedback and quality improvement opportunities for perioperative physicians. Advances in medical education and practice. 5:115–23, 2014. Epub 2014/05/17.

  20. Ramaprasad, A., On the definition of feedback. Systems Research and Behavioral Science 28(1):4–13, Jan 1983.

  21. Oxman AD, Thomson MA, Davis DA, Haynes RB. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 1995;153(10):1423–31. Epub 1995/11/15.

  22. Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O'Brien, M. A., and Oxman, A. D., Does telling people what they have been doing change what they do? A systematic review of the effects of audit and feedback. Quality & safety in health care 15(6):433–6, 2006. Epub 2006/12/05.

    Article  Google Scholar 

  23. Chaillet, N., Dube, E., Dugas, M., Audibert, F., Tourigny, C., Fraser, W. D., et al., Evidence-based strategies for implementing guidelines in obstetrics: a systematic review. Obstetrics and gynecology 108(5):1234–45, 2006. Epub 2006/11/02.

    Article  Google Scholar 

  24. van der Veer, S. N., de Keizer, N. F., Ravelli, A. C., Tenkink, S., and Jager, K. J., Improving quality of care. A systematic review on how medical registries provide information feedback to health care providers. International journal of medical informatics. 79(5):305–23, 2010. Epub 2010/03/02.

    Google Scholar 

  25. Ehrenfeld, J. M., Henneman, J. P., Peterfreund, R. A., Sheehan, T. D., Xue, F., Spring, S., et al., Ongoing professional performance evaluation (OPPE) using automatically captured electronic anesthesia data. Joint Commission journal on quality and patient safety/Joint Commission Resources 38(2):73–80, 2012. Epub 2012/03/01.

    Google Scholar 

  26. Speck RM, Neuman MD, Bond AR, Fleisher LA. Strategies to promote reporting of Surgical Care Improvement Project (SCIP) measures: a pilot survey of anesthesia department leaders. Perioper Med (Lond). 2012;1:5. Epub 2012/01/01.

  27. Custers, T., Hurley, J., Klazinga, N. S., and Brown, A. D., Selecting effective incentive structures in health care: A decision framework to support health care purchasers in finding the right incentives to drive performance. BMC health services research. 8:66, 2008. Epub 2008/03/29.

  28. Doran, T., Fullwood, C., Gravelle, H., Reeves, D., Kontopantelis, E., Hiroeh, U., et al., Pay-for-performance programs in family practices in the United Kingdom. The New England journal of medicine 355(4):375–84, 2006. Epub 2006/07/28.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Christian D. Peccora, Robert Gimlich, Richard P. Cornell, Charles A. Vacanti & Richard D. Urman

  2. Department of Anesthesiology, Vanderbilt University School of Medicine, Nashville, TN, USA

    Jesse M. Ehrenfeld

Authors
  1. Christian D. Peccora
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  2. Robert Gimlich
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  3. Richard P. Cornell
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  4. Charles A. Vacanti
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  5. Jesse M. Ehrenfeld
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  6. Richard D. Urman
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Corresponding author

Correspondence to Richard D. Urman.

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This article is part of the Topical Collection on Systems-Level Quality Improvement

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Peccora, C.D., Gimlich, R., Cornell, R.P. et al. Anesthesia Report Card – A Customizable Tool for Performance Improvement. J Med Syst 38, 105 (2014). https://doi.org/10.1007/s10916-014-0105-2

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  • DOI: https://doi.org/10.1007/s10916-014-0105-2

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