Structured Implicit Review for Physician Implicit Measurement of Quality of Care

In October 1985, RAND began an evaluation of the effect prospective payment based on diagnosis-related group was having on the quality of care given to hospitalized Medicare patients. This Note documents the structured implicit review form used for the implicit measurement of quality of care for Medicare patients hospitalized with congestive heart failure, acute myocardial infarction, pneumonia, cerebrovascular accident, and hip fracture. The structured implicit review form is designed to guide physicians in their review of the medical record for purposes of implicitly assessing quality of care. The form does not tell physicians how to rate quality of care — it guides the reviewer to consider certain topics. For each disease and for each item, the authors developed guidelines to encourage consistency in the way the items were interpreted. This Note presents a copy of the guidelines for each disease. Principles for using the form are outlined in the guidelines.