CONCLUSION: There needs to be established criteria which patients must meet to remain in the clinic that will to be utilized by all providers in the clinic to reduce variability in care. There needs to be improved consistency and decreased variability in return to clinic times to improve access in the cardiology clinic setting. Return visit time should be based on severity and stablility of patient's illness and not on individual provider preference. Centers for Disease Control and Prevention, Atlanta, GA PURPOSE: Influenza vaccine is the primary method for preventing influenza. Delay in influenza vaccine distribution was expected for the 2000 ± 01 influenza season. We conducted a cross-sectional study to characterize practice adjustments and expectations of physicians regarding influenza vaccine delay. METHODS: We sent a two-page mail survey to a national random sample of 1606 internists (IM) and family physicians (FP). Participants answered questions regarding their usual influenza vaccine administration period, their practices' capacity for identifying high-risk patients, and modifications in their clinical practice for the 2000 ± 01 influenza season. The first mailing was conducted in September, 2000; non-respondents received another mailing in October, with a $2 incentive. Tests of significance were computed using likelihood ratio chisquare. RESULTS: Response rate was 60% after two mailings and did not differ significantly by respondent specialty. Of 952 respondents currently practicing, 756 (79%) typically administered influenza vaccine; family physicians were more likely than internists to administer influenza vaccine (82% vs. 76%; p < 0.05). Among physicians administering vaccine, 356 (47%) selfidentified as IM and the remainder as FP. At the time of survey completion, 13% of respondents had received their full order of vaccine; another 23% reported receipt of a partial order. Whereas 37% of physicians who had already received their full order had modified their practices this influenza season, 70% of physicians who had received either partial or no shipment reported practice changes (p < 0.001). The most commonly reported practice modification was to target high-risk patients for receipt of available doses. However, only one-quarter of physicians (28% IM vs. 24% FP; NS) had experience with mail or telephone reminder systems to contact high-risk patients. Of concern, 43% of providers were hesitant about administering vaccine after the onset of influenza season in their practice area. CONCLUSION: Facing delays in influenza vaccine distribution, many physicians reported an intention to vaccinate high-risk patients first. However, few physicians had experience using reminder systems, and nearly half of physicians were hesitant about administering vaccine after influenza season has begun. These findings raise concerns about the capacity for physicians to meet domestic vaccination goals during this influenza season and in the future, and the possibility of preventable morbidity and mortality attributable to influenza as a result. PURPOSE: Payers and institutions use chart abstraction to measure physician performance, despite its underestimation of the quality of care due to recording bias. We wondered if the medical record might also overestimate the quality of care through false, and potentially unethical, documentation by providers. To determine this, we compare the quality of care as documented in the medical record with the reports of actor patients. METHODS: Twenty physicians in the primary care clinics of two Veterans Affairs Medical Centers were randomly selected among consenting residents and faculty (97% agreed to participate). Data were collected from standardized (actor) patients, who served as the gold standard and presented undetected as patients to physician subjects, and from the medical record generated from these visits. Quality criteria were developed from national guidelines and a modified Delphi technique for four common medical conditions. These were then recorded by a standardized patient or abstracted from the medical record. Physician subjects completed 160 evaluations of standardized patients (8 cases Â 20 physicians). We determined the proportion of criteria reported in the medical record but not by the standardized patient (false positives). We also determined the distribution of false positives according to domain (history, physical exam, diagnosis, treatment), study site, physician subjects, and actor patients. False positive rates at the two study sites were compared by t-test.