Utilization of health care quality markers in a family medicine outpatient setting.

BACKGROUND AND OBJECTIVES: There is a growing demand for quality improvement in the health care system. This study sought to generate "report cards" for primary care resident physicians on their use of quality markers related to diabetes care. METHODS: Electronic medical records [electronic health records] were reviewed for the care provided to diabetics by resident physicians. RESULTS: We were able to generate a report card for each resident physician. We found that compliance rates and mean values improved with increased frequency of visits for the following parameters: (1) HgbA1c testing and mean values, (2) lipid profile screening and mean values of low density lipoproteins, (3) administration of pneumococcal vaccine, and (4) prescription of angiotensin converting enzyme inhibitor or angiotensin receptor blockers. CONCLUSIONS: It is possible to generate report cards for resident physicians to evaluate their performance related to diabetes care. There was a correlation between increased frequency of visits and better performance.

An incentive compensation system that rewards individual and corporate productivity.

INTRODUCTION: An economically mature health care market has led to increased cost competition. Subsequently, a perceived need for productivity-based physician compensation has developed. While some institutions have rewarded individual productivity based on specific facets of academic responsibility, such as teaching, research, and patient care, we chose to develop an incentive compensation system that rewards both individual and group productivity. PROGRAM DEVELOPMENT: We developed a physician incentive compensation system that rewards individual and group productivity by capturing multiple aspects of work activity. Faculty members are given compensation value points for clinical productivity, scholarship activities, teaching activities, service activities, and achievement of the department's goals. The system was implemented in a graduated fashion in the Department of Family Medicine at Indiana University beginning July 1, 2000. PROGRAM EVALUATION: In April 2003, all faculty physicians (n=18) participated in a survey about the compensation system. The majority of faculty view the system as a necessity for the department (72.2%); 35.2% were satisfied with the system overall; 35.3% were neutral; and 27.4% were dissatisfied or not sure of their overall satisfaction. CONCLUSIONS: A comprehensive physician incentive compensation system incorporating department goals can be designed and implemented in an academic setting.

Students' experience with women's health care in a family medicine clerkship.

UNLABELLED: Clerkship encounter forms were used to assess the types of diagnoses seen, the level of activities performed (student responsibility), and self-reported competence (comfort level) in dealing with patients. INTRODUCTION: Many medical schools require a family medicine clerkship, yet little is known about the quantity and diversity of the diagnoses encountered by the students. This study examines clerkship students' experience with women's health care diagnoses. METHODS: Over a 2-year period, 445 students completed 3320 patient encounter forms for patients with a women's health diagnosis, noting patient age, location of care (office, hospital, etc.), up to four presenting diagnoses, the degree to which the student was involved with selected activities (taking a history, performing a physical examination, observing only, etc.) and the degree of self-reported competence. RESULTS: Of the 78 854 diagnoses presented, 3677 (6.1%) were women's health conditions, most commonly normal pregnancy (47.5%), disorders of menstruation (8.2%), menopausal and postmenopausal disorders (7.4%), disorders of the breast (6.0%), pain in female genital organs (5.7%), and disease of the cervix, vagina and vulva (5.2%). Students reported a high level of competence in diagnosing and treating these patients. The students routinely discussed women's health cases with their preceptors. DISCUSSION: Students reported that they were 'unskilled' or 'marginally competent' with approximately 10% of the women's health patient encounters, compared with 6% for all other encounters. The clerkship provided students with the greatest opportunity to observe and discuss individual cases with a preceptor. However, students infrequently suggested a treatment or provided patient education or women's health counselling.