1:50 - 2:10 pmSunday, September 18
Plenary Hall
Directly observing care: deploying unannounced standardized patients to improve quality
Plenary Hall
Directly observing care: deploying unannounced standardized patients to improve quality
Co-Founder and Principle: Institute for Practice and Provider Performance Improvement (I3PI)
Although technology and “big data” are increasingly evoked as tools for evaluating and improving care, much of what matters in quality assessment can only be directly observed. Some nurses measure... Read more

Description

Although technology and “big data” are increasingly evoked as tools for evaluating and improving care, much of what matters in quality assessment can only be directly observed. Some nurses measure blood pressure accurately while others don’t. Some physicians provide effective preventive care counseling, or correctly examine the feet of their diabetic patients, while other only report doing so. All too often, clinicians miss critical clues during the medical encounter of patient life challenges, or context — such as an inability to afford a medication or take it correctly — and devise care plans that appear appropriate in the medical record, but are nearly certain to fail. A growing body of evidence suggests that current strategies for evaluating performance cannot differentiate between effective and ineffective approaches to care. Over a decade we have covertly observed over one thousand encounters, comparing what actually occurs during a visit to what is recorded. We have employed both unannounced standardized patients (USPs), and real patients who audio record their visits. We have documented wide discrepancies, and also demonstrated that observed lapses in care that are undocumented account for both excess costs due to overuse and misuse of medical services, and diminished patient outcomes. Finally, we have demonstrated that USPs can provide a cost effective way of identifying practice and performance deficits, and remediating those deficits using an audit and feedback approach. We have developed and employed software for synthesis and analysis of data collected by USPs, and demonstrated that errors detected based on direct observation predict both health care outcomes and costs. We propose that directly observing care using such a “mystery patient” approach could address currently unmeasured lapses in quality and performance and is in fact scalable.

Dr. Weiner is an internist, pediatrician and health services researcher. For over a decade he has studied clinical decision making and care planning utilizing methods for directly observing care. His particular interest is in identifying and preventing "contextual errors" which occur when care plans are evidence based but nevertheless fail because they are not adapted to patients' individual circumstances and needs.  Dr. Weiner has conducted the largest study employing a team of actors as unannounced standardized patients, and worked with over a thousand real patient volunteers to carry concealed audio recorders while receiving care.  All of his research has been endorsed by Institutional Review Boards and participating health care providers.  He and Alan Schwartz, PhD, editor of the journal Medical Decision Making, founded the Institute for Practice and Provider Improvement (I3PI) to apply methods of directly observed care to health plans and individual practices seeking to identify and address lapses in care that diminish the value of health services but are undetectable using conventional chart and claims based data collection methods. Dr. Weiner is also a professor of medicine, pediatrics and medical education at the University of Illinois at Chicago, and Deputy Director of the VA Center for Innovation in Complex Chronic Healthcare.

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