Patterns of outpatient rheumatology practice: A pilot assessment of clinical record content

Author(s): Louis Abe

Objectives For high-quality patient care, high-quality medical records with detailed information about the patient and the disease are essential. RHEVER is a network of hospital- and office-based rheumatologists that was established in 1999 with the intention of pursuing a number of goals. One of those goals is the creation of recommendations regarding things that ought to be recorded consistently at each patient visit. In this way, one of the RHEVER individuals explored whether these suggestions were trailed by RHEVER members at an educating clinic.

Methods At the rheumatology clinic of the Cochin Teaching Hospital in Paris, France, a sample of paper-based outpatient records was examined. The sample consisted of 30 rheumatoid arthritis patients' files and 50 files chosen at random.

Conclusion The feasibility of rheumatologists evaluating practice patterns is demonstrated in this pilot study. Participants in the office-based RHEVER study ought to be the subject of a similar study. Evaluations of medical records have an effect on the quality of care, but further research is needed to assess the impact.