title: Improving physician clinical documentation quality: evaluating two self-efficacy-based training programs.
abstract: BACKGROUND
  Clinical documentation is critical to health care quality and cost. The generally poor quality of such documentation has been well recognized, yet medical students, residents, and physicians receive little or no training in it. When clinical documentation quality (CDQ) training for residents and/or physicians is provided, it excludes key constructs of self-efficacy: vicarious learning (e.g., peer demonstration) and mastery (i.e., practice). CDQ training that incorporates these key self-efficacy constructs is more resource intensive. If such training could be shown to be more effective at enhancing clinician performance, it would support the investment of the additional resources required by health care systems and residency training programs.
  
  
  OBJECTIVE
  The aim of this study was to test the impact of CDQ training on clinician self-efficacy and performance and the relative efficacy of intervention designs employing two versus all four self-efficacy constructs.
  
  
  METHODS
  Ninety-one internal medicine residents at a major academic medical center in the northeastern United States were assigned to one of two self-efficacy-based training groups or a control group, with CDQ and clinical documentation self-efficacy measured before and after the interventions. A structural equation model (AMOS) allowed for testing the six hypotheses in the context of the whole study, and findings were cross-validated using traditional regression.
  
  
  RESULTS
  Although both interventions increased CDQ, the training designed to include all four self-efficacy constructs had a significantly greater impact on improving CDQ. It also increased self-efficacy.
  
  
  CONCLUSIONS
  CDQ may be significantly improved and sustained by (a) training physicians in clinical documentation and (b) employing all four self-efficacy constructs in such training designs.
authors.affiliation: Health Information Technology, City University of New York/Borough of Manhattan Community College, NY, USA. ruthannrusso@gmail.com
authors.forename: Ruthann
authors.initials: R
authors.lastname: Russo
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Fitzgerald
authors.forename: J D
authors.initials: JD
authors.lastname: Eveland
authors.forename: Barry D
authors.initials: BD
authors.lastname: Fuchs
authors.forename: D Patrick
authors.initials: DP
authors.lastname: Redmon
mesh_terms: D000046:Academic Medical Centers; D002983:Clinical Competence / Q000706:statistics & numerical data*; D035061:Control Groups; D004282:Documentation / Q000592:standards*; D006801:Humans; D007318:Inservice Training / Q000379:methods*; D007396:Internship and Residency; D008297:Male; D019300:Medical Errors / Q000517:prevention & control; D008961:Models, Structural; D009511:New England; D019982:Organizational Case Studies; D012044:Regression Analysis; D020377:Self Efficacy; D012959:Socioeconomic Factors; D013337:Students, Medical / Q000523:psychology; D011795:Surveys and Questionnaires