Figure 2

Variance components of medical record review The sources of variability in physician assessments of quality of care based on reviews of the medical record are shown here, stratified by the levels of evidence available for decision-making. The much larger amounts of signal or true quality differences in reviews of the high evidence conditions will produce measurements that are more reliable. For the low evidence conditions, the noise component is quite large for the reviews of acute conditions and the reviewer components are relatively large for both the acute and COPD conditions. The conditions are hypertension (HTN), diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and acute conditions.