Peer review by criteria mapping: criteria for diabetes mellitus. The use of decision-making in chart audit

Abstract

The UCLA Experimental Medical Care Review Organization (EMCRO), in an attempt to minimize the problem of applying a general list of criteria to each patient with a specific condition, has developed a method called Criteria Mapping. This method uses sequential judgments based on the specific clinical data for the individual patient to assess the quality of care by medical record audit. The method does not penalize the physician for omitting unnecessary procedures by allowing alternate decisions when appropriate, and provides supporting reference materials to allow nonphysicians to make reliable medical interpretations of the data in medical records. It is expected that this method will more accurately reflect the physicians' intentions, and that process, when measured by this approach, may correlate better with the outcome of medical care.