The impact of feedback to medical housestaff on chart documentation and quality of care in the outpatient setting.

OBJECTIVE

To determine whether feedback from attending physicians to residents about outpatient medical records improves chart documentation and quality of care.

DESIGN

Cross-sectional study with repeated measures.

SETTING

Primary care internal medicine clinic at a metropolitan community hospital.

PATIENT/PARTICIPANTS: Fifteen interns and 20 residents.

INTERVENTION

Attending physicians reviewed at least two charts for each resident on three occasions about 4 months apart and then discussed their findings with the residents.

MEASUREMENTS AND MAIN RESULTS

Explicit criteria defined the extent of chart documentation and the comprehensiveness of care delivery. Attending physicians also made a subjective assessment of the overall quality of care. All results were converted to 0-to-1 scales. From the first to the third period, chart documentation increased from 0.60 to 0.86 (p < .001), but there were no significant changes in the delivery of care or in the subjective assessments of the overall quality of care.

CONCLUSIONS

Both review of residents' outpatient medical records and periodic feedback from attending physicians improve how well medical housestaff document care in the chart.