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Evaluation & the Health Professions, Vol. 30, No. 4, 376-392 (2007)
DOI: 10.1177/0163278707307924
© 2007 SAGE Publications

Assessment of Family Physicians' Performance Using Patient Charts

Interrater Reliability and Concordance With Chart-Stimulated Recall Interview

François Goulet

Collège des médecins du Québec, Montreal, goulet.cmq{at}sympatico.ca.

André Jacques

Collège des médecins du Québec, Montreal

Robert Gagnon

Collège des médecins du Québec, Montreal

Pierre Racette

Collège des médecins du Québec, Montreal

William Sieber

University of California, San Diego

Peer-assessment processes with chart review have been used for many years to assess the clinical performance of physicians. The Quebec medical licensing authority has been required by provincial law to assess the practicing Quebec physicians on a nonvoluntary basis. During the period from January 2001 to November 2004, 25 family physicians in active practice were randomly selected from a pool of about 300. For each physician, 25 to 40 patients' medical charts were randomly selected to evaluate the interrater reliability of peer-review assessment of medical charts and to compare ratings based on chart review with a chart-stimulated recall interview to those based on chart review alone. The concordance between chart review alone and that of chart review with chart-stimulated recall interview was 75% for chart keeping, 69% for clinical investigation, 81% for diagnostic accuracy, and 74% for treatment plan. Ratings based on chart review alone achieve moderate levels of reliability (Kappa = 0.44 to 0.56). It appears that some important information about quality of care is missed when only chart review is used.

Key Words: family physicians' clinical performance assessments • peer-assessment review • interrater reliability • chart-stimulated recall interview


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