Comparison of Vignettes, Standardized Patients, and Chart Abstraction: A Prospective Validation Study of 3 Methods for Measuring Quality

Abstract

Assessing quality must ultimately rely on measures that are inexpensive, reliable, and able to adequately control for case-mix variation.^1-3 Health outcome measures, although a direct assessment of health status, also reflect a spectrum of confounding events such as comorbidities and the socioeconomic determinants of health—factors that are generally beyond the control of a physician's daily practice. As a result, process measures of quality are increasingly being used.^4,5 If linkages between the provision of care and better health status have been firmly established, there are substantiated benefits to measuring process over measuring outcomes.⁶ Processes can be measured more frequently than outcomes (eg, a death or complication), do not require a lengthy interval to become manifest,⁷ and are generally less expensive to monitor.^8,9