A structured judgement method to enhance mortality case note review: development and evaluation.

Area of Science:

• Healthcare Quality Assessment
• Medical Record Review
• End-of-Life Care Research

Background:

• Retrospective assessment of care quality is crucial.
• Existing methods for reviewing patient care can be enhanced.
• Focus on improving quality of care for patients who die in hospital.

Purpose of the Study:

• To evaluate a novel implicit judgment method for assessing hospital care quality.
• To combine structured reviewer comments with quality of care scores.
• To analyze the care provided to patients who die in hospital.

Main Methods:

• 1566 case notes from 20 English hospitals were reviewed by 40 physicians.
• Physicians provided structured, judgment-based comments and quality scores (1-6) for different care phases.
• Comments and scores for 119 deceased patients were analyzed for consistency and informativeness.

Main Results:

• Physician reviewers provided informative, judgment-based comments across all care phases.
• The majority of comments (83%) were explicit judgments.
• Approximately 20% of patients received less than satisfactory care, often due to adverse events.

Conclusions:

• A combined approach of implicit judgment, explicit comments, and quality scores effectively reviews care for hospital patients who die.
• This method facilitates rapid evaluation of deaths to learn from both poor and high-quality care.
• The findings support using this integrated method for quality improvement in end-of-life care.