# Improving Performance Evaluation of Clinicians to Support National Standards of Practice

> **NIH VA I01** · VA PUGET SOUND HEALTHCARE SYSTEM · 2024 · —

## Abstract

Background: Clinician performance is a critical determinant of high-quality care delivery and patient outcomes.
VA medical centers assess clinicians with Ongoing and Focused Professional Practice Evaluations (OPPE and
FPPE), which require bi-annual chart abstraction by clinicians to assess for adherence to quality measures.
This process is inefficient, lacks evidence of validity or impact, and has been the subject of multiple
investigations by the Office of the Inspector General. VA has therefore committed to establishing national
standards of practice for all clinicians for use in OPPE/FPPE. The Office of Specialty Care has selected a set
of 154 performance indicators across 33 subspecialities. Of these, cardiology is best positioned to test novel
methods for clinician assessment because of existing evidence-based quality measures and established
mechanisms for quality measurement via the Clinical Assessment, Reporting and Tracking (CART) program.
Significance: Two critical knowledge gaps prevent effective performance assessment of cardiology providers in
VA: 1) existing quality measures for general cardiology practice have not been tested for validity and reliability;
and 2) effective case-based peer review methods are unavailable for outpatient cardiology care. Since these
two assessment methods are linked both conceptually and in current VA practice, we propose to test both in a
novel, mixed methods study. Our overall goal is to provide practical tools to assess VA cardiology clinicians
while demonstrating proof-of-concept of this novel paradigm.
Innovation and Impact: These novel assessment methods would free VA clinicians from the burden of low-
value chart abstraction, advance VA’s commitment to be a High Reliability Organization, and improve the
overall quality and safety of Veteran healthcare. In addition, the research will provide generalizable knowledge
to advance the field of clinician performance assessment and improvement.
Specific aims: 1) To assess the reliability and validity of quality measures obtained from electronic health
record data for cardiology clinician assessment; 2) To test the validity of case-based peer review of cardiology
clinician performance; and 3) To identify barriers and facilitators to the use of these assessment methodologies
for OPPE/FPPE in VA practice.
Methodology: This mixed-methods study will build on the evidence-based Clinical Practice Feedback
Intervention Theory and existing methods of quality assessment and peer review for cardiac procedures. In
Aim 1, we will use electronic health record data to assess cardiology clinician performance on 4 indicators that
are currently used for OPPE. Measures will be tested for reliability and validity. A composite measure will be
developed to provide a summary assessment of clinician performance. In Aim 2, we will engage expert
clinicians and other stakeholders to develop and test a web-based platform for blinded, case-based peer
review. We will determine the re...

## Key facts

- **NIH application ID:** 10752628
- **Project number:** 5I01HX003653-02
- **Recipient organization:** VA PUGET SOUND HEALTHCARE SYSTEM
- **Principal Investigator:** Jacob A Doll
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2023-01-01 → 2026-12-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10752628

## Citation

> US National Institutes of Health, RePORTER application 10752628, Improving Performance Evaluation of Clinicians to Support National Standards of Practice (5I01HX003653-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/10752628. Licensed CC0.

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