Table 1.

Directly Observed Care Employing USPs Completes a Three-Part Strategy of Performance Assessment

What is assessed	How measured	What it Does	Limitations
Care processes as recorded in the chart	Information extracted from medical record and claims data	Rates evidence based indicators of quality	Relies on accuracy and completeness of information in the medical record
Care processes as experienced by patients	Patient ratings using surveys	Captures how patients describe and rate their experiences receiving care	Self-selection bias (dissatisfied patients don’t return) and limited frame of reference (most patients don’t have extensive comparative experience)
Care processes as directly observed	Currently not measured. Unannounced standardized patients	Rates how staff and clinicians conduct procedures, elicit and process information from patients, and attend to their needs	Relatively small sample sizes, technical challenge of creating subterfuge, costs of USPs, opportunity cost of displacing a patient, coding costs