Charles E. Osborne

Development of Criteria for Quality Assurance of Ambulatory Child Health Care

Criteria were developed by the Joint Committee on Quality Assurance for evaluation of ambulatory child health care through chart audit. These covered history, physical examination, laboratory tests, and management in the areas of health supervision, tonsillopharyngitis, bronchial asthma, and urinary infection. Following testing for self-audit of patient records by practitioners, the criteria were rated for relevance to outcome and suitability for use in peer review by 390 “experts,” half academicians and half practitioners. The experts showed marked concordance, substantially agreeing as to relevance in 203 of 211 criteria and in 199 regarding use in peer review. Only three quarters of the criteria were, however, considered relevant to outcome by 85 per cent of the experts. The study suggests that academicians and practitioners will agree well in judging criteria for peer review; however, small groups unaccustomed to the task should not be charged with developing criteria of such importance.

Interdiagnosis relationships of physican recording in ambulatory child health care.

The joint Committee on Quality Assurance developed and validated by expert opinion a list of criteria for each of seven areas of ambulatory child health care: well-child supervision in four age ranges: bith to 1 year, 1 through 5 years, 6 through 12 years, and 13 through 18 years; and three diseases: bronchial asthma, tonsillopharyngitis, and urinary tract infection in the female. Each physician was scored on a list of criteria for each of the seven areas. The relationship among the areas was studied by correlating the scores on these criteria. The degrees of the relationships among the seven areas of care, and the reliability of each list of criteria are reported. All relationships were positive. Various age ranges of health supervision were more strongly related to one another than to any of the diseases. Individual diseases were more strongly related to one another than to health supervision. Reliabilities of each list ranged from .74 to .95. All correlations between areas were positive and, except for health supervision (birth to one year) with the three diseases, significant (p less than.01). These high correlations would imply a great deal of homogeneity among health care areas of ambulatory child health care.

Quality Assurance of Ambulatory Child Health Care Opinions of Practicing Physicians About Proposed Criteria

This paper reports the opinions of a representative sample of 1,329 physicians providing primary care regarding criteria developed by the Joint Committee on Quality Assurance for evaluation of ambulatory child health care. Areas of care were health supervision (in four age ranges), tonsillopharyngitis, bronchial asthma, and urinary infection. The criteria had been previously appraised by 452 “experts”— academicians and practitioners. Physicians rated criteria for relevance to health outcome, and desirability for use in peer review. They also stated whether they usually performed and recorded each item and gave reasons for not recording. Agreement between the pediatricians and other physicians of the sample and the “experts” was close regarding relevance to health outcome, but many fewer criteria were recommended for peer review by the sample. A significant number of respondents said they performed but did not record many of the criteria. Documentation of only abnormal findings was the main reason given for not recording. Criteria dealing with developmental or behavioral assessment or with counseling were rated lower in all categories than more easily measured items.

Assessing needs for community hospital continuing medical education.

Between July 1, 1979, and June 30, 1980, 765 programs eligible for Category 1 credit were offered in 35 community hospitals. Data were collected to determine how the need was identified, who was responsible for conducting the needs assessment, and what influenced the choice of method. Data were collected by two methods: reviewing records for each course and interviewing each course director. Courses were planned using analysis of hard data (16 per cent) and an impressionistic method (84 per cent). The course director conducted the needs assessment and chose topics for 47 per cent; learners determined needs for 19 per cent. Possibly, CME programs should be viewed as offering systematic assistance in identifying personal needs and stimulating a physician to learn more by providing an opportunity to compare ones current practice with a desired or standard level. If discrepancies are identified, the physician must decide why they exist and assign levels of priority on resolution.