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- Title
Impact of Unannounced Standardized Patient Audit and Feedback on Care, Documentation, and Costs: an Experiment and Claims Analysis.
- Authors
Schwartz, Alan; Peskin, Steven; Spiro, Alan; Weiner, Saul J.
- Abstract
Background: Meaningful variations in physician performance are not always discernible from the medical record. Objective: We used unannounced standardized patients to measure and provide feedback on care quality and fidelity of documentation, and examined downstream effects on reimbursement claims. Design: Static group pre-post comparison study conducted between 2017 and 2019. Setting: Fourteen New Jersey primary care practice groups (22 practices) enrolled in Horizon BCBS's value-based program received the intervention. For claims analyses, we identified 14 additional comparison practice groups matched on county, practice size, and claims activity. Participants: Fifty-nine of 64 providers volunteered to participate. Intervention: Unannounced standardized patients (USPs) made 217 visits portraying patients with 1–2 focal conditions (diabetes, depression, back pain, smoking, or preventive cancer screening). After two baseline visits to a provider, we delivered feedback and conducted two follow-up visits. Measurements: USP-completed checklists of guideline-based provider care behaviors, visit audio recordings, and provider notes were used to measure behaviors performed and documentation errors pre- and post-feedback. We also compared changes in 3-month office-based claims by actual patients between the intervention and comparison practice groups before and after feedback. Results: Expected clinical behaviors increased from 46% to 56% (OR = 1.53, 95% CI 1.29–1.83, p < 0.0001), with significant improvements in smoking cessation, back pain, and depression screening. Providers were less likely to document unperformed tasks after (16%) than before feedback (18%; OR = 0.74, 95% CI 0.62 to 0.90, p = 0.002). Actual claim costs increased significantly less in the study than comparison group for diabetes and depression but significantly more for smoking cessation, cancer screening, and low back pain. Limitations: Self-selection of participating practices and lack of access to prescription claims. Conclusion: Direct observation of care identifies hidden deficits in practice and documentation, and with feedback can improve both, with concomitant effects on costs.
- Subjects
NEW Jersey; SIMULATED patients; LUMBAR pain; DOCUMENTATION; SMOKING cessation; BACKACHE; EARLY detection of cancer
- Publication
JGIM: Journal of General Internal Medicine, 2021, Vol 36, Issue 1, p27
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-020-05965-1