Measuring adequacy of physician performance. A preliminary comparison of four methods in ambulatory care of chronic obstructive pulmonary disease.

Issues that arise in the development of methods for measuring adequacy of physician performance (MAPP) are discussed. The comparative content validity, scorability, cost, and acceptability of four MAPP strategies are assessed using a sample of clinic-based physicians treating 30 patients with chronic obstructive pulmonary disease (COPD). Criteria for adequate care are contained in a "criteria map." No one of the four methods (physician interview, patient interview, videotaped observation, and chart audit) was best at capturing all aspects of the management of COPD. The relative content validity of a method depended on the aspect of care evaluated. The interviews provided the broadest range of information and the chart audit the most limited. The patient interview yielded the largest proportion of encounters upon which physician performance could be scored, although specific criteria map subscales were differentially scorable depending on the method used. Relative cost and acceptability are also discussed.