58. ASSESSMENT THAT MATTERS FOR PATIENTS: POSITIVE ASSOCIATION BETWEEN ENTRUSTMENT DECISIONS AND QUALITY CARE MEASURES FOR RESIDENTS CARING FOR PATIENTS WITH ASTHMA

Abstract

Background Recent focus has been placed on the entrustment construct for assessing residents; specifically, how much supervision is needed to provide safe care. This method of assessment puts the patient at its core. However, whether entrustment decisions are related to quality care is not known. Objective Determine the association between entrustment decisions made about pediatric residents in the pediatric emergency department (PED) caring for patients presenting with acute asthma exacerbations and resident quality measures for those patient encounters. Methods During the 2016-2017 academic year, we obtained the following for encounters of patients presenting with asthma exacerbation to the Cincinnati Children's PED: 1) 6 question resident entrustment score based on Chen's supervision scale and Kennedy's trustworthiness construct (6 item total score: 0-6), and 2) resident quality measure score (proportion of 21 quality measures achieved). Supervising faculty and fellows completed the entrustment questions for each encounter. Quality measures were developed through expert consensus to meet two criteria (importance to asthma care and likelihood the resident, and not another team member, completes the measure) and were manually extracted from the electronic medical record. To account for nested data within residents, association of entrustment with quality was evaluated using mixed models adjusting for patient acuity and complexity. Results 59 residents provided care for 110 unique patients. Table 1 summarizes measurement descriptive statistics. Entrustment scores exhibited a significant positive linear relationship with quality scores (p-value = 0.04), with entrustment scores increasing by 0.16 (95% CI: 0.01, 0.31) for every 0.10 increase in quality. Conclusion This study demonstrates a statistically significant association between resident performance assessments and quality of care for the patients treated by those residents. This offers initial validity evidence for the use of entrustment decisions as well as quality measures as resident performance assessment frameworks.