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Editorials |16 November 2004

Back to the Future: Clinical Vignettes and the Measurement of Physician Performance

John Norcini, PhD

Article, Author, and Disclosure Information
Author, Article, and Disclosure Information
  • From Foundation for Advancement of International Medical Education and Research, Philadelphia, PA 19104.

    Potential Financial Conflicts of Interest: None disclosed.

    Requests for Single Reprints: John Norcini, PhD, Foundation for Advancement of International Medical Education and Research, 3624 Market Street, Philadelphia, PA 19104; e-mail, jnorcini@faimer.org.

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The past 2 decades have seen many efforts to improve the quality of health care. These efforts have relied on a series of methods devised by workers in the field of quality management science and, in some cases, used successfully in industry for more than 50 years (1, 2).
Measuring performance is central to the quality management sciences. The principal measures in health care are patient outcomes and the process of care that physicians provide in practice. These measures identify areas that need improvement, signal the accomplishment of goals, and respond to the need for accountability (3). Unfortunately, methods of assessing physicians' practice performance are in their infancy, and they face unresolved logistic and psychometric challenges. For instance, comparing physicians on the basis of their daily work is difficult because they see patients who have different conditions (case mix) and, even when the conditions are the same, patients' severity of illness and comorbid conditions differ. Furthermore, attributing patient outcomes solely to individual physicians may be inappropriate because care is often rendered by teams (4).
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Norcini J. Back to the Future: Clinical Vignettes and the Measurement of Physician Performance. Ann Intern Med. 2004;141:813–814. doi: 10.7326/0003-4819-141-10-200411160-00014

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Published: Ann Intern Med. 2004;141(10):813-814.

DOI: 10.7326/0003-4819-141-10-200411160-00014

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2004 American College of Physicians
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