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Allison, J.J., Wall, T.C., Spettell, C.M., and others (2000, March). "The art and science of chart review." (AHRQ grant HS09446). Joint Commission Journal on Quality Improvement 26(3), pp. 115-136.

Using a study of care of patients with depression as a model, these authors recommend specific methods for conducting chart review as part of research to improve quality of care. They point out that chart review is more difficult than it appears on the surface. It is also project-specific, making a "cookbook" approach difficult. Many factors, such as imprecisely worded research questions, vague specification of variables, poorly designed abstraction tools, and poor recording of data or missing data in the chart may compromise data quality. In designing a chart review software module for the quality of depression care study, they considered four key aspects of chart review: classification, format, definition, and presentation. In this article, they describe how they integrated data collection with project design, chose the appropriate data collection format, designed the chart abstraction tool, precisely defined each variable, best used chart review personnel, and monitored data quality.

Morris, A.H. (2000, March). "Developing and implementing computerized protocols for standardization of clinical decisions." (AHRQ grant HS06594). Annals of Internal Medicine 132(5), pp. 373-383.

The human ability to retain only four to seven data constructs simultaneously in short-term memory contrasts sharply with the hundreds of variables encountered by doctors in the clinical environment. Give this fact, these researchers point out that computerized protocols can improve clinical decisionmaking. Such protocols can be configured to contain much more detail than textual guidelines or paper-based flow diagrams. Computerized protocols also can generate patient-specific instructions for therapy that can be carried out with little variation from one clinician to another. However, clinicians must be willing to modify their personal styles of clinical management, note the authors. The authors examine this issue through case studies of the use of computerized protocols for mechanical ventilation and for management of intravenous fluid in patients with acute respiratory distress.

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Current as of May 2000
AHRQ Publication No. 00-0040

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