Physician preference for criteria mapping in medical care evaluation

This study was designed to determine which of three quality assessment methods most validly identifies deficient care. Process criteria were developed to assess outpatient care for urinary tract infection using each of three methods: a limited "list" of seven criteria, an extensive "list" of 40 criteria, and a criteria map (CM) which uses branching logic to identify applicable criteria according to the specific needs of each case. Defining deficiency as compliance with less than 60 percent of criteria, the extensive list found all 66 cases deficient; the limited list, 27 (41.0 percent); and the CM system, 15 (22.7 percent). After excluding the extensive list because of its nondiscrimination, 23 discrepancies in rating remained between the limited list and the CM. Ten physicians unaware of the results reviewed all 23 cases. In 12 of these 23 cases, at least seven of the ten physicians preferred the rating of one method over another; the CM assessment was preferred in 11 of the 12 cases (P less than .01). Criteria maps, providing a patient-specific approach, offer a more valid assessment of medical care than either the extensive or limited list.