53. DEVELOPMENT OF PROGRESS NOTE ASSESSMENT AND PLAN EVALUATION (PNAPE) TOOL

Background Daily progress notes are vital cross disciplinary communication tools. The electronic medical record has influenced progress note content and length. Previously developed note assessment tools, such as the Physician Documentation Quality Instrument (PDQI-9), have not focused on the assessment and plan of the note, which are often most informative. Objective Develop a reliable and valid tool to evaluate the assessment and plan of resident daily progress notes. Methods A committee of pediatric resident, hospitalist and critical care physicians generated a list of common pitfalls associated with daily progress notes. A standardized ideal progress note assessment and plan was developed using a cause and effect diagram, literature review, consultation with billing expert and institutional documentation best practice guidelines. From this ideal state, a progress note evaluation tool PNAPE was developed using Modified Delphi technique. Four faculty experts used PNAPE and PDQI-9 to independently review resident progress notes identified from a convenience sample from each intern on the hospitalist service in fall 2017. Inter-rater reliability of the PNAPE was assessed using intraclass correlation coefficient (ICC). External validity was assessed by correlation between mean PNAPE and PDQI-9 scores using Pearson's coefficient. Results PNAPE is shown in figure 1. In all, 13 Notes were assessed with an ICC of 0.85. Pearson's r is 0.63 between mean PNAPE and PDQI-9 scores. Conclusion These findings suggest that the PNAPE is a reliable and valid tool for evaluation of resident progress note assessment and plan by expert assessors. Next steps will include use of PNAPE to track note quality over time, provide feedback and to assess notes in other inpatient settings and specialties.