6 data sources for ambulatory care competence assessment

In today’s ambulatory settings, what you measure will be affected by your organization’s willingness to invest in the resources needed to understand and manage quality as an essential part of your business rather than as a regulatory requirement. The questions for organizations outside the hospital are as follows: first, what should you measure and then what type—rule or rate—would work best based on volume and data collection resources? Just as with review indicators, the peer review committee needs to determine what ambulatory care practices are important enough to evaluate by rule or rate measures, which form of feedback is best, and how it will obtain the data. Here are some places to find data and how to relate them to the six core competencies:

• Data already being collected and submitted electronically such as physician quality reporting system (PQRS) measures. Many of these measures would fall under the core compe­tency of medical knowledge. Although these may be treated as a rate indicator, they are often useful as a rule indicator if compliance is generally high and feedback is desired on an individ­ual event basis to get to 100% compliance goals. As ambulatory EMRs and the use of ICD-10 in the ambulatory setting increases, this data should be obtainable by queries of your EMR instead of by manual data abstraction.
• Abstracted patient records for general care measures or for policies specific to your organiza­tion’s functions. These measures typically fall under the core competency of interpersonal and communication skills or systems-based practice. For example, abstracting random charts to ensure that key elements of care are addressed in a patient visit could be useful for primary care internists as a measure of communication within the team. If this is done manually by physi­cians, making the cost high, use a relatively small sample and treat it as a rule indicator so that feedback is reviewed on single cases of noncompliance. To the extent that this can be done by nonphysician abstractors or through EMR queries, the cost can be reduced and the sample size increased. A second example might be for referral patterns that may reflect over- or under-utilization of consultants as a measure of systems-based practice in the use of resources. That information should be obtainable from the billing system based on coding data.
• Patient perception data either from complaints or patient satisfaction surveys. The questions patients are asked typically relate to interpersonal skills. Because the encounters in the ambula­tory care setting tend to be with individual physicians, the survey attribution for survey data tends to be much better than in the hospital setting.
• Specialty societies or specialty boards. In some specialties, physicians participating in ongo­ing maintenance of certification regularly submit data to their medical specialty board. If the organization found it useful, it could either request the information from the physicians if all are participating and willing to allow it or determine to collect the same data internally from physicians. These measures typically fall under medical knowledge.
• Patient access. Patient access is a key issue in ambulatory care. Measures related to cancelled clinics or appointment availability may reflect either professionalism or systems-based prac­tice. This information should be obtained through the patient scheduling system for integrated groups. This may be more difficult for CINs unless a scheduling infrastructure is in place. 

Source: Effective Peer Review, Fourth Edition