Clinical vignette-based surveys have been used for more than 30 years to measure variation in physicians' approaches to the diagnosis and treatment of patients with similar health problems. Vignettes offer advantages over medical record reviews, analysis of claims data, and standardized patients. A vignette-based survey can be completed more quickly than a record review or standardized patient program. Research has shown that vignette-based surveys produce better measures of quality of care than medical record reviews when used to measure differential diagnosis, selection of tests, and treatment decisions. Although standardized patients are preferred when measuring communication and physical examination skills, vignettes are more cost-effective than standardized patients when assessing clinical physicians' decision making. Vignettes offer better opportunities to isolate physicians' decision making and to control case-mix variation than do analyses of claims data sets. Clinical vignette-based surveys are simple and economical tools that can be used to characterize physicians' practice variation.

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In the 6 months after sumatriptan therapy was initiated, health care resource use and time lost from workplace productivity and nonworkplace activity were reduced, while health-related quality of life and patient satisfaction scores improved for the managed care migraineurs enrolled in this study.

Electronic prescribing (E-RX) is a component of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). The objective of this study was to identify factors related to physicians' adoption of E-RX for outpatients. This study employed an electronic survey of US physicians who subscribe to the Physicians Online Internet service. Electronic prescribers were compared to traditional prescribers in terms of demographics, practice type and location, technology use, and beliefs about E-RX. A total of 1104 physicians responded, 19% of whom prescribed electronically. Electronic prescribers were more likely to be generalists practicing in academic or publicly funded centers, have fewer years in practice, and work in technology-equipped offices. They also held different beliefs versus traditional prescribers in terms of E-RX limitations and its potential to improve medication safety and prescribing efficiency. In addition to financial incentives established by MMA, adoption can be stimulated by improvements in the technology and on organizational commitment.

Evaluation of the relationship between a chronic disease care management program and California pay-for-performance diabetes care cholesterol measures in one medical group.

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Medical students need to be well informed about medical errors and patient safety. Pursuant to a needs assessment and pilot program, 229 third-year students participated in a 1-day program on patient safety including a plenary session and workshops. Attitudes and beliefs were measured by a survey at the beginning and end of the program. Completed surveys were returned by 124 (54%) students. Their level of agreement with 14 of 21 rating scale items changed in the expected direction. There were 7 items in which the students' baseline responses were already positive and did not change significantly. A 1-day program on patient safety in the third year of medical school can change students' attitudes and beliefs. There may be a subset of students needing closer attention. The findings provide evidence for the validity of the attitude survey and reinforce the effectiveness of interclerkship programs in medical schools.

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