title: A Novel Method for Assessing Task Complexity in Outpatient Clinical-Performance Measures.
abstract: BACKGROUND
  Clinical-performance measurement has helped improve the quality of health-care; yet success in attaining high levels of quality across multiple domains simultaneously still varies considerably. Although many sources of variability in care quality have been studied, the difficulty required to complete the clinical work itself has received little attention.
  
  
  OBJECTIVE
  We present a task-based methodology for evaluating the difficulty of clinical-performance measures (CPMs) by assessing the complexity of their component requisite tasks.
  
  
  METHODS
  Using Functional Job Analysis (FJA), subject-matter experts (SMEs) generated task lists for 17 CPMs; task lists were rated on ten dimensions of complexity, and then aggregated into difficulty composites.
  
  
  METHODS
  Eleven outpatient work SMEs; 133 VA Medical Centers nationwide.
  
  
  METHODS
  Clinical Performance: 17 outpatient CPMs (2000-2008) at 133 VA Medical Centers nationwide. Measure Difficulty: for each CPM, the number of component requisite tasks and the average rating across ten FJA complexity scales for the set of tasks comprising the measure.
  
  
  RESULTS
  Measures varied considerably in the number of component tasks (M = 10.56, SD = 6.25, min = 5, max = 25). Measures of chronic care following acute myocardial infarction exhibited significantly higher measure difficulty ratings compared to diabetes or screening measures, but not to immunization measures ([Formula: see text] = 0.45, -0.04, -0.05, and -0.06 respectively; F (3, 186) = 3.57, p = 0.015). Measure difficulty ratings were not significantly correlated with the number of component tasks (r = -0.30, p = 0.23).
  
  
  CONCLUSIONS
  Evaluating the difficulty of achieving recommended CPM performance levels requires more than simply counting the tasks involved; using FJA to assess the complexity of CPMs' component tasks presents an alternate means of assessing the difficulty of primary-care CPMs and accounting for performance variation among measures and performers. This in turn could be used in designing performance reward programs, or to match workflow to clinician time and effort.
authors.affiliation: Center 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.|Department of Medicine - Health Services Research Section, Baylor College of Medicine, Houston, TX, USA. hysong@bcm.edu.
authors.forename: Sylvia J
authors.initials: SJ
authors.lastname: Hysong
authors.affiliation: Center for Innovations in Quality, Safety, and Effectiveness, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd. Suite 01Y, Houston, TX, 77021, USA.|Department of Medicine - Health Services Research Section, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Amber B
authors.initials: AB
authors.lastname: Amspoker
authors.affiliation: Center for Innovations in Quality, Safety, and Effectiveness, Michael E. DeBakey VA Medical Center, 2450 Holcombe Blvd. Suite 01Y, Houston, TX, 77021, USA.|Department of Medicine - Health Services Research Section, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
mesh_terms: D000553:Ambulatory Care / Q000379:methods* / Q000592:standards*; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D010045:Outpatients; D000071066:Patient Reported Outcome Measures; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*; D058014:Veterans Health / Q000592:standards*
keywords: clinical performance measurement; functional job analysis; outpatient; task complexity