CPV® vignettes


What are Clinical Performance and Value® vignettes?

Clinical Performance and Value (CPV®) vignettes are the industry’s most effective tool to measure, monitor, and improve clinical performance and variation. CPV® vignettes are computerized cases that have a physician care for a simulated patient as he or she would a regular patient.

Doctors and other providers are measured in 5 domains: history taking, physical examination, radiologic and laboratory testing, diagnostic accuracy and clinical treatment or management.

Each case takes about 15 minutes to complete, and doctors are only required to complete four cases before an accurate picture emerges.  Moreover, once a baseline is established, interventions designed to improve the quality of care can be monitored or evaluated over time. Watch a demonstration video about the actual process of filling out a CPV® vignette.

How are they different from clinical vignettes?

Clinical vignettes are a learning tool for medical students. As concise descriptions of patient encounters, clinical vignettes concentrate on a particular aspect of the encounter to teach students how to treat/diagnose patients.

QURE’s Clinical Performance and Value® vignettes, on the other hand, are combined with customized evidence-based medicine scoring procedures to evaluate and analyze the performance of physicians. They are written in such a way that physicians respond as if they were treating an actual patient. The results of CPV® vignettes can be used to gauge the quality of doctor care, identify areas for improvement, and even test the efficacy of healthcare policy and medical technology interventions.

How do they work?

QURE’s proprietary scoring technology is modeled after evidence-based clinical standards. After receiving the completed CPV® vignettes, our selected group of specially trained physicians verify the data to determine the value of clinical practice.

Clinical Performance and Value® vignettes have been rigorously evaluated in prospective trials of randomly selected physicians.  In each instance, CPV® vignettes, when compared to the gold standard of standardized patients, were more valid than medical record abstraction at measuring the quality of clinical care.  This validity was maintained regardless of the site where the study was done, the cases that were completed, or the level of training of the physician. These findings have been published in leading peer-reviewed medical journals, including JAMA, Health Policy and Planning, Annals of Internal Medicine, Medical Informatics and many other leading journals.

Why use Clinical Performance and Value® vignettes?

CPV® vignettes are unaffected by variation in case mix among the population.  They are therefore ideal for comparative studies among different groups of doctors, healthcare facilities, systems of care—or countries.  They are also ideally suited to estimate the impact of new programs designed to improve the quality of care.  Because of their simplicity to administer, their ease in scoring, and their rigorously tested validity, there is a growing demand for their use in a variety of settings.

CPV® vignettes fulfill all of the criteria laid out by Chassin, et al. in their article titled, “Accountability Measures-Using Measurement to Promote Quality Improvement” in The New England Journal of Medicine.* Members of the Joint Commission developed the following set of criteria to gauge the effectiveness of measures like CPV® vignettes.

Four Criteria for Accountability Measure That Address Processes of Care

  1. There is a strong evidence base showing that the care process leads to improved outcomes.
  2. The measure accurately captures whether the evidence-based care process has, in fact, been provided.
  3. The measure addresses a process that has few intervening care processes that must occur before the improved outcome is realized.
  4. Implementing the measure has little or no change of inducing unintended adverse consequences.

CPV® vignettes only measure processes that have a full body of research proving it improves health outcomes, and the open-response format captures actual physician behavior.

As a validated measure of clinical behavior, CPV® vignettes allow for real world assessments of clinical practice. By using a uniform patient presentation that holds patient characteristics constant across physician respondents, CPV® vignettes can directly compare:

  • How physicians practice
  • How their practice varies against one another
  • How practice compares and deviates from objective quality standards

At a fraction of the cost of other forms of data collection and research, CPV® vignettes provide peer review quality data for your use. Since they are sample cases, there cannot be any adverse consequences involved with completing them.

*Chassin, Mark R., Jerod M. Loeb, Stephen P. Schmaltz, and Robert M. Wachter. “Accountability Measures-Using Measurement to Promote Quality Improvement.” New England Journal of Medicine. 363.7 (2010).