Biomedical subjects
Todd Gruber
Publications and source records attributed to Todd Gruber.
The Hawthorne effect in the assessment of pain by house staff.
Internal medicine residents are one component of the healthcare delivery team in the hospital setting. Their ability to assess and treat pain should be considered in quality improvement efforts. We surveyed our residents, using a 0 to 10 scale to determine how well they assessed their patients' level of pain. We then asked half of these residents to write down their patients' pain score as a fifth vital sign in the medical record. We repeated the house staff survey three weeks later. The residents improved their assessment as a whole, with the nonintervention group faring better on the follow-up surveys. We believe that the residents' improvement can be attributed to the Hawthorne effect, in which a group that is singled out for special study or consideration has its performance positively affected. The residents' ability to accurately rate patients with moderate and severe pain is still an area for further development. Improvements in our palliative care curriculum have been implemented to enhance our residents' education and performance in this area.
Can we be certain of PRO accuracy and accountability? Inaccurate "report cards" generated by medicare claims data as a marker for laboratory testing in diabetic patients.
Quality of care attributed to individual physicians will be made public more frequently in the future. Inaccurate reports could damage physicians both professionally and financially. Using claims data for services rendered to Medicare patients from 1997 through 2000, The New Jersey Peer Review Organization (PRO) reported the percentage of each physician's patients who received testing for HgB A1c and for lipid profiles. We reviewed the patient records kept by these physicians to calculate the actual percentage of patients who received these tests. A statistically significant difference existed between the PRO's data and our results. Use of claims data as a marker for services provided can lead to inaccurate inferences about the quality of care provided by individual physicians, which can have potentially negative consequences to these providers.