Dr. O'Neill is an MD candidate, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Dr. Henschen is an internal medicine resident, Department of Medicine, Northwestern McGaw Medical Center, Northwestern University, Chicago, Illinois. Dr. Unger is an internal medicine resident, Department of Medicine, Northwestern McGaw Medical Center, Northwestern University, Chicago, Illinois. Mr. Jansson is an MD candidate, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Ms. Unti is an MD candidate, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Mr. Bortoletto is an MD candidate, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Ms. Gleason is clinical quality leader, Clinical Quality Department, Northwestern Memorial Hospital, Chicago, Illinois. Dr. Woods is research associate professor, Center for Healthcare Studies-Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois. Dr. Evans is assistant professor, Division of General Internal Medicine, Northwestern Medical Faculty Foundation, Northwestern University, Chicago, Illinois.
Acad Med. 2013 Oct;88(10):1564-9. doi: 10.1097/ACM.0b013e3182a36bb5.
Quality improvement (QI) requires measurement, but medical schools rarely provide opportunities for students to measure their patient outcomes. The authors tested the feasibility and perceived impact of a quality metric report card as part of an Education-Centered Medical Home longitudinal curriculum.
Student teams were embedded into faculty practices and assigned a panel of patients to follow longitudinally. Students performed retrospective chart reviews and reported deidentified data on 30 nationally endorsed QI metrics for their assigned patients. Scorecards were created for each clinic team. Students completed pre/post surveys on self-perceived QI skills.
A total of 405 of their patients' charts were abstracted by 149 students (76% response rate; mean 2.7 charts/student). Median abstraction time was 21.8 (range: 13.1-37.1) minutes. Abstracted data confirmed that the students had successfully recruited a "high-risk" patient panel. Initial performance on abstracted quality measures ranged from 100% adherence on the use of beta-blockers in postmyocardial infarction patients to 24% on documentation of dilated diabetic eye exams. After the chart abstraction assignment, grand rounds, and background readings, student self-assessment of their perceived QI skills significantly increased for all metrics, though it remained low.
Creation of an actionable health care quality report card as part of an ambulatory longitudinal experience is feasible, and it improves student perception of QI skills. Future research will aim to use statistical process control methods to track health care quality prospectively as our students use their scorecards to drive clinic-level improvement efforts.
质量改进（QI）需要进行测量，但医学院校很少为学生提供测量患者结果的机会。作者测试了质量指标报告卡作为以教育为中心的医疗之家纵向课程的一部分的可行性和感知影响。
学生团队被嵌入到教师的实践中，并为他们分配一组需要进行纵向跟踪的患者。学生进行回顾性图表审查，并为他们分配的患者报告 30 项国家认可的 QI 指标的匿名数据。为每个诊所团队创建记分卡。学生完成了自我感知 QI 技能的预/后调查。
共有 149 名学生（76%的响应率；平均每人 2.7 份病历）对 405 名患者的病历进行了摘要。平均摘要时间为 21.8 分钟（范围：13.1-37.1 分钟）。摘要数据证实，学生已经成功招募了一组“高风险”患者。对摘要质量指标的初始表现从心肌梗死后使用β受体阻滞剂的 100%一致性到糖尿病性视网膜扩张检查记录的 24%不等。在进行图表抽象分配、全院查房和背景阅读后，学生对所有指标的自我评估的 QI 技能显著提高，尽管仍然较低。
作为门诊纵向体验的一部分，创建一个可操作的医疗保健质量报告卡是可行的，并且可以提高学生对 QI 技能的感知。未来的研究将旨在使用统计过程控制方法来前瞻性地跟踪医疗保健质量，因为我们的学生使用他们的记分卡来推动诊所层面的改进工作。
