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Proceedings of the AMIA Symposium logoLink to Proceedings of the AMIA Symposium
. 2002:2–6.

A framework for evidence-adaptive quality assessment that unifies guideline-based and performance-indicator approaches.

Aneel Advani 1, Mary Goldstein 1, Mark A Musen 1
PMCID: PMC2244239  PMID: 12463775

Abstract

Automated quality assessment of clinician actions and patient outcomes is a central problem in guideline- or standards-based medical care. In this paper we describe a unified model representation and algorithm for evidence-adaptive quality assessment scoring that can: (1) use both complex case-specific guidelines and single-step population-wide performance-indicators as quality measures; (2) score adherence consistently with quantitative population-based medical utilities of the quality measures where available; and (3) give worst-case and best-case scores for variations based on (a) uncertain knowledge of the best practice, (b) guideline customization to an individual patient or particular population, (c) physician practice style variation, or (d) imperfect reliability of the quality measure. Our solution uses fuzzy measure-theoretic scoring to handle the uncertain knowledge about best-practices and the ambiguity from practice variation. We show results of applying our method to retrospective data from a guideline project to improve the quality of hypertension care.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Eddy D. M. Performance measurement: problems and solutions. Health Aff (Millwood) 1998 Jul-Aug;17(4):7–25. doi: 10.1377/hlthaff.17.4.7. [DOI] [PubMed] [Google Scholar]
  2. Graham R. P., James P. A., Cowan T. M. Are clinical practice guidelines valid for primary care? J Clin Epidemiol. 2000 Sep;53(9):949–954. doi: 10.1016/s0895-4356(99)00224-3. [DOI] [PubMed] [Google Scholar]
  3. Hofer T. P., Hayward R. A., Greenfield S., Wagner E. H., Kaplan S. H., Manning W. G. The unreliability of individual physician "report cards" for assessing the costs and quality of care of a chronic disease. JAMA. 1999 Jun 9;281(22):2098–2105. doi: 10.1001/jama.281.22.2098. [DOI] [PubMed] [Google Scholar]
  4. McGlynn E. A., Asch S. M. Developing a clinical performance measure. Am J Prev Med. 1998 Apr;14(3 Suppl):14–21. doi: 10.1016/s0749-3797(97)00032-9. [DOI] [PubMed] [Google Scholar]
  5. Miller P. L. Goal-directed critiquing by computer: ventilator management. Comput Biomed Res. 1985 Oct;18(5):422–438. doi: 10.1016/0010-4809(85)90020-5. [DOI] [PubMed] [Google Scholar]
  6. Musen M. A., Tu S. W., Das A. K., Shahar Y. EON: a component-based approach to automation of protocol-directed therapy. J Am Med Inform Assoc. 1996 Nov-Dec;3(6):367–388. doi: 10.1136/jamia.1996.97084511. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Shahar Y., Miksch S., Johnson P. The Asgaard project: a task-specific framework for the application and critiquing of time-oriented clinical guidelines. Artif Intell Med. 1998 Sep-Oct;14(1-2):29–51. doi: 10.1016/s0933-3657(98)00015-3. [DOI] [PubMed] [Google Scholar]
  8. Shaneyfelt T. M., Mayo-Smith M. F., Rothwangl J. Are guidelines following guidelines? The methodological quality of clinical practice guidelines in the peer-reviewed medical literature. JAMA. 1999 May 26;281(20):1900–1905. doi: 10.1001/jama.281.20.1900. [DOI] [PubMed] [Google Scholar]
  9. Sim I., Gorman P., Greenes R. A., Haynes R. B., Kaplan B., Lehmann H., Tang P. C. Clinical decision support systems for the practice of evidence-based medicine. J Am Med Inform Assoc. 2001 Nov-Dec;8(6):527–534. doi: 10.1136/jamia.2001.0080527. [DOI] [PMC free article] [PubMed] [Google Scholar]

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