Age-Related Illnesses
Concerns about physicians with possible cognitive impairments
remain an issue. In 2013, a number of physicians required external
neurological, neuro-psychological, internal medicine, and/or geriatric
neuro-psychiatric assessments. The need for multiple assessments,
while essential, lengthened the time to complete many capacity investigations.
We continued an emphasis on resolving capacity matters quickly,
and with dignity for the member, where the issue relates to aging
members with serious cognitive decline. Where cognitive decline has
become evident during investigation, staff collaborate with the physician, family and legal counsel to negotiate solutions that protect
patients, while obviating the need for further incapacity inquiries or
possible serious outcomes relating to clinical competence.
The physicians and their families have appreciated this resolution
approach.
How Many Charts Need to be Reviewed
to Accurately Assess Quality of Care?
That is the question at the heart of a research project currently
underway at the College.
The ICR Committee and Quality Assurance Committee rely
on chart reviews to assess a physician’s standard of care. A chart
review, as part of an assessment, is a widely-accepted practice in
most regulatory bodies. There is no consensus from regulatory
bodies as to how many charts need to be reviewed. There is only
one published research paper on this topic.
The College’s historical practices have been 20-30 charts +/- interview for a peer assessment and 25 charts + interview +/- observation for a Registrar’s investigation. However, assessors from both
processes have told the College that they often form their opinion
with fewer charts.
Assessors who agree to participate in the study are being asked
standard questions that aim to understand the value of the incremental information. The study sample size is targeted for 100
cases. The study will continue throughout 2014.
Annual Report 2013
27