The DOI matches its Crossref record; 6 of the 6 references it cites were found in a registry or an index.
Frequency of Inappropriate Medical Exceptions to Quality Measures
Abstract
Background Quality improvement programs that allow physicians to document medical reasons for deviating from guidelines preserve clinicians' judgment while enabling them to strive for high performance. However, physician misconceptions or gaming potentially limit programs. Objective To implement computerized decision support with mechanisms to document medical exceptions to quality measures and to perform peer review of exceptions and provide feedback when appropriate. Design Observational study. Setting Large internal medicine practice. Participants Patients eligible for 1 or more quality measures. Measurements A peer-review panel judged medical exceptions to 16 chronic disease and prevention quality measures as appropriate, inappropriate, or of uncertain appropriateness. Medical records were reviewed after feedback was given to determine whether care changed. Results Physicians recorded 650 standardized medical exceptions during 7 months. The reporting tool was used without any medical reason 36 times (5.5%). Of the remaining 614 exceptions, 93.6% were medically appropriate, 3.1% were inappropriate, and 3.3% were of uncertain appropriateness. Frequencies of inappropriate exceptions were 7 (6.9%) for coronary heart disease, 0 (0%) for heart failure, 10 (10.8%) for diabetes, and 2 (0.6%) for preventive services. After physicians received direct feedback about inappropriate exceptions, 8 of 19 (42%) changed management. The peer-review process took less than 5 minutes per case,…
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“Alert nonadherence, or clinician overrides, is one key barrier that occurs for 49%–96% of alerts.13–23”
From Clinician collaboration to improve clinical decision support: the Clickbusters initiative (2022) · cites this paper as [16]
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Metadata
- Authors
- Persell, S. D., Dolan, N. C., Friesema, E. M., Thompson, J. A., Kaiser, D., & Baker, D. W.
- Affiliations
- Northwestern University (US)
- Venue
- Annals of Internal Medicine
- Publisher
- American College of Physicians
- Published
- 2010-02-16
- Volume
- 152
- Issue
- 4
- Pages
- 225-231
- ISSN
- 0003-4819 (ISSN-L)
- 1539-3704
- OpenAlex
- W2052196077
- Cited by
- 66
- References
- 6
- Citations by year
- 2025: 1 · 2024: 3 · 2022: 2 · 2020: 2 · 2019: 3 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 2 · 2014: 7 · 2013: 5 · 2012: 4
- FWCI
- 17.42
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Annals of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (1k08hs015647-01, 1R18HS17163-01)
- Topics
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Healthcare Quality and Management
- Keywords
- quality metrics, decision support system, peer review, preventive services, coronary artery disease, heart failure, diabetes mellitus, clinical feedback, internal medicine practice
- MeSH terms
- Feedback, Humans, Illinois, Medical Audit, Practice Guidelines as Topic, Peer Review, Health Care, Observation, Guideline Adherence, Decision Support Systems, Clinical, Electronic Health Records
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