Outpatient Care: A Conceptual Framework and a Form for Structured Implicit Review

by Michael S. Broder, Carole Oken, Malcolm Parker, Mary Giammona, Jeffrey Newman, Charlene Harrington, Lisa V. Rubenstein


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This monograph describes the development of a structured implicit reviewtool that physicians can use to evaluate the quality of care in theoutpatient setting, where most care is now provided. Structured implicitreview specifies the key aspects of care and data sources for review whilepreserving individual reviewer judgments about quality. The work is part ofa broader effort to improve the process of Medicare peer review.We first conceptualized outpatient care with a single, comprehensiveframework developed from a review of existing literature and modified withinput from an expert panel. We then used the conceptual framework to developa structured implicit review form that, along with its associated guidelinesand instructions, allows physicians to assess the quality of outpatientmedical care. This tool is intended to be used after a formal trainingsession.

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