Measuring the Quality of Physician Practice by Using Clinical Vignettes: A Prospective Validation Study

Peabody, John; Luck, Jeff; Glassman, Peter; Jain, Sharad; Hansen, Joyce M.; Spell, Maureen; Lee, Martin

doi:10.7326/0003-4819-141-10-200411160-00008

Cited by 591 publications

(533 citation statements)

References 49 publications

Supporting

Mentioning

521

Contrasting

Unclassified

Order By: Relevance

“…The responses to clinical cases may be biased towards treatment guidelines recommendations as a result of desirability phenomena [34] and it may be that they do not reflect their true beliefs and attitudes in a real clinical work environment. Some studies, however, indicate that quality of health care can be measured in an outpatient setting by using clinical vignettes with no differences with real clinical practice [35,36]. 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 [37], so vignettes appear to be a valid, comprehensive and inexpensive method that directly focuses on the process of care provided in actual clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Psychometric properties and factor structure of the Spanish version of the HC-PAIRS questionnaire

et al. 2012

View full text Add to dashboard Cite

Objective To develop a Spanish version of the Health Care Providers' Pain and Impairment Relationship Scale (HC-PAIRS) and to test its psychometric properties. Methods A forward and backward translation methodology was used to translate the questionnaire, which was then applied to 206 participants (174 physiotherapy students and 32 family physicians). The intraclass correlation coefficient was calculated to assess test-retest reliability. Internal consistency was evaluated using Cronbach's alpha and item analysis. Construct validity was measured using Pearson correlation coefficients between HC-PAIRS and FABQ, FABQ-Phys, FABQ-Work and the responses given by participants to three clinical case scenarios. An exploratory factor analysis was carried out following the Kaiser normalization criteria and principal axis factoring with an oblique rotation (quartimax). Sensitivity to change was assessed after a teaching module.Results Test-retest reliability was ICC 0.50 (p \ 0.01) and Cronbach's alpha was 0.825. The HC-PAIRS scores correlated significantly with the scores of the FABQ and also with the recommendations for work and activity given by the participants in the three clinical case scenarios. Sensitivity to change test showed an effect size of 1.5, which is considered a large change. Factor analysis suggests that the Spanish version of HC-PAIRS measures a unidimensional construct. Conclusion The Spanish version of the HC-PAIRS has proven to be a reliable, valid and sensitive instrument to assess health care providers' attitudes and beliefs about LBP. It can be used in evaluating clinical practice and in undergraduate acquisition of skills and knowledge.

show abstract

Section: Discussionmentioning

confidence: 99%

Psychometric properties and factor structure of the Spanish version of the HC-PAIRS questionnaire

et al. 2012

View full text Add to dashboard Cite

show abstract

“…[22][23][24][25] The survey used vignettes, which are accurate and validated tools for measuring preventive care practices. [26][27][28] The Women's Health Survey was sent to 3,200 physicians under age 65 who practiced in either an office or hospital based setting; it achieved a 61.7 % response rate. Using stratified random sampling, these physicians were selected from the 2008 American Medical Association (AMA) Physician Masterfile, a national list of all licensed physicians, in roughly equal numbers of family physicians, general internists, and obstetrician-gynecologists to ensure adequate numbers of respondents from each specialty type.…”

Section: Survey Design and Samplementioning

confidence: 99%

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

et al. 2013

View full text Add to dashboard Cite

“…Another concern might be the use of vignettes to search for evidence of stereotyping in decision-making, although several studies have shown vignettes to be accurate in reflecting actual clinical practice. [39][40][41][42][43] The survey response rate among students at participating schools (40.2 %) is low enough that some might question the validity of the sample. Although our data show relatively few differences among survey respondents and the larger population of senior medical students as depicted by the AAMC survey, suggesting sample validity, it is possible that non-participants and students from non-participating schools may demonstrate different decision-making tendencies than those reflected in these data.…”

Section: Discussionmentioning

confidence: 99%

Racial, Gender, and Socioeconomic Status Bias in Senior Medical Student Clinical Decision-Making: A National Survey

et al. 2015

View full text Add to dashboard Cite

BACKGROUND:Research suggests stereotyping by clinicians as one contributor to racial and gender-based health disparities. It is necessary to understand the origins of such biases before interventions can be developed to eliminate them. As a first step toward this understanding, we tested for the presence of bias in senior medical students. OBJECTIVE: The purpose of the study was to determine whether bias based on race, gender, or socioeconomic status influenced clinical decision-making among medical students. DESIGN: We surveyed seniors at 84 medical schools, who were required to choose between two clinically equivalent management options for a set of cardiac patient vignettes. We examined variations in student recommendations based on patient race, gender, and socioeconomic status. PARTICIPANTS: The study included senior medical students. MAIN MEASURES: We investigated the percentage of students selecting cardiac procedural options for vignette patients, analyzed by patient race, gender, and socioeconomic status. KEY RESULTS: Among 4,603 returned surveys, we found no evidence in the overall sample supporting racial or gender bias in student clinical decision-making. Students were slightly more likely to recommend cardiac procedural options for black (43.9 %) vs. white (42 %, p=.03) patients; there was no difference by patient gender. Patient socioeconomic status was the strongest predictor of student recommendations, with patients described as having the highest socioeconomic status most likely to receive procedural care recommendations (50.3 % vs. 43.2 % for those in the lowest socioeconomic status group, p<.001). Analysis by subgroup, however, showed significant regional geographic variation in the influence of patient race and gender on decision-making. Multilevel analysis showed that white female patients were least likely to receive procedural recommendations. CONCLUSIONS: In the sample as a whole, we found no evidence of racial or gender bias in student clinical decision-making. However, we did find evidence of bias with regard to the influence of patient socioeconomic status, geographic variations, and the influence of interactions b e t w e e n p a t i e n t r ac e a nd g e nd er o n s t u d en t recommendations.

show abstract

Measuring the Quality of Physician Practice by Using Clinical Vignettes: A Prospective Validation Study

Cited by 591 publications

References 49 publications

Psychometric properties and factor structure of the Spanish version of the HC-PAIRS questionnaire

Psychometric properties and factor structure of the Spanish version of the HC-PAIRS questionnaire

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

Racial, Gender, and Socioeconomic Status Bias in Senior Medical Student Clinical Decision-Making: A National Survey

Contact Info

Product

Resources

About