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A Novel Method for Assessing Task Complexity in Outpatient Clinical-Performance Measures.

Sylvia J Hysong1,2, Amber B Amspoker3,4, Laura A Petersen3,4

  • 1Center for Innovations in Quality, Safety, and Effectiveness, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd. Suite 01Y, Houston, TX, 77021, USA. hysong@bcm.edu.

Journal of General Internal Medicine
|March 9, 2016
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Summary

Assessing the difficulty of clinical performance measures (CPMs) requires evaluating task complexity, not just task count. This approach helps understand performance variations and inform healthcare quality improvement initiatives.

Keywords:
clinical performance measurementfunctional job analysisoutpatienttask complexity

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Area of Science:

  • Healthcare Quality Improvement
  • Clinical Performance Measurement
  • Task Analysis in Healthcare

Background:

  • Clinical-performance measurement aims to enhance healthcare quality, but achieving high quality across multiple domains remains inconsistent.
  • Variability in healthcare quality is often studied, yet the inherent difficulty of clinical tasks is under-examined.

Purpose of the Study:

  • To introduce a task-based methodology for evaluating the difficulty of clinical-performance measures (CPMs).
  • To assess the complexity of requisite tasks within CPMs as a measure of their difficulty.

Main Methods:

  • Functional Job Analysis (FJA) was employed with subject-matter experts (SMEs) to generate task lists for 17 CPMs.
  • Tasks were rated on ten complexity dimensions, and these ratings were aggregated into composite difficulty scores.
  • The study involved 11 outpatient work SMEs across 133 VA Medical Centers nationwide.

Main Results:

  • A considerable variation in the number of component tasks per CPM was observed (mean=10.56, SD=6.25).
  • Chronic care CPMs post-myocardial infarction showed significantly higher difficulty ratings than diabetes or screening measures.
  • Measure difficulty ratings were not significantly correlated with the number of component tasks (r=-0.30, p=0.23).

Conclusions:

  • Evaluating CPM difficulty necessitates assessing task complexity beyond mere task enumeration.
  • FJA offers a method to gauge CPM difficulty, aiding in understanding performance variations.
  • This methodology can inform performance reward programs and optimize workflow alignment with clinician capacity.