Outpatient Care: A Conceptual Framework and a Form for Structured Implicit Review

One-liner: As part of a broader effort to improve the process of Medicare peer review, this monograph describes the development of a review tool that physicians can use to evaluate the quality of care in the outpatient setting. This monograph describes the development of a structured implicit review tool that physicians can use to evaluate the quality of care in the outpatient setting, where most care is now provided. Structured implicit review specifies the key aspects of care and data sources for review while preserving individual reviewer judgments about quality. The work is part of a broader effort to improve the process of Medicare peer review. We first conceptualized outpatient care with a single, comprehensive framework developed from a review of existing literature and modified with input from an expert panel. We then used the conceptual framework to develop a structured implicit review form that, along with its associated guidelines and instructions, allows physicians to assess the quality of outpatient medical care. This tool is intended to be used after a formal training session.