The Outcomes Card

Development of a Systems-Based Practice Educational Tool


  • The authors have no relevant financial interests and no other conflicts of interest related to this manuscript.

  • This pilot study has been presented at the 15th Annual National Forum on Quality Improvement in Health Care, 9th Annual International Scientific Symposium on Improving Quality and Value of Health Care, December 2003 and Society for General Internal Medicine 27th Annual Meeting, May 2004.

Address correspondence and reprint requests to Dr. Tomolo: Louis Stokes Cleveland DVAMC, 170A(W), 10701 East Boulevard, Cleveland, OH 44106 (e-mail:


Introduction: The Accreditation Council for Graduate Medical Education requires competence in systems-based practice (SBP) demonstrating understanding of complex interactions between systems of care and its impact upon care delivery. Patient safety is a useful vehicle to facilitate learning about these interactions.

Aim: Develop an educational tool, Outcomes Card (OC), to reinforce core concepts of SBP.

Setting: Urgent Care Center at Louis Stokes Cleveland Department of Veterans Affairs Medical Center.

Program Description: Pilot study of an educational intervention for residents that included patient safety didactic sessions and analysis of 2 self-identified clinical cases using the OC. Residents entered the following information on the OC: case description, type of event (error, near miss, and/or adverse event), error type(s), systems, and system failures.

Program Evaluation: Two reviewers independently analyzed 98 cards completed during 60 two-week trainee rotations (81.7% return rate). Interrater reliability for error types between residents and physician supervisor and between reviewers was excellent (κ=0.88 and 0.95, respectively), and for system identification was good (κ=0.66 and 0.68, respectively). The self-assessment survey (56.6% return rate) suggests that residents improved their knowledge of patient safety and had positive attitudes about the curriculum.

Discussion: This pilot study suggests that OCs are feasible and reliable educational tools for enhancing competence in SBP.