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

Abstract

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.