Performance on PMPs and performance in practice

Page, Gordon; Fielding, David

doi:10.1097/00001888-198006000-00009

Cited by 29 publications

(70 citation statements)

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“…The number of items per consultation considered by each report ranged from one [13] to 79 [19] (see Table 2). Thirteen reports compared the direct and proxy measures item by item [8-12,14,15,17-22]; seven reports combined the items into summary scores for direct and proxy measures, which were then compared [12-15,17,18]; three reports used both methods [14,15,18]. …”

Section: Resultsmentioning

confidence: 99%

“…Four reports treated different items interchangeably within specific categories: necessary, unnecessary behaviours [12]; assessing symptoms, assessing signs, ordering laboratory tests, delivering treatments, delivering patient education [10]; must do, should do, could do, should not do, must not do actions [14]; taking a history, performing a physical examination, ordering laboratory examinations, giving guidance and advice, delivering medication and therapy, specifying follow-up [17]. …”

Section: Resultsmentioning

confidence: 99%

“…Four reports constructed summary scores, essentially defined as the number of recommended items that were performed, for each consultation, using both the direct and proxy measures [12,14-16]. Two of these reports [14,16] weighted the items to reflect their perceived importance.…”

Section: Resultsmentioning

confidence: 99%

“…Six reports presented sensitivity [9,12,17,19-21], and a further two presented sufficient data to allow calculation of the sensitivity [14,22]. Three reports presented specificity [12,19,20], one report [21] presented the proportion of false positives (1-specificity); and two reports presented sufficient data to allow calculation of the specificity [14,22].…”

Section: Resultsmentioning

confidence: 99%

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Statistical considerations in a systematic review of proxy measures of clinical behaviour

et al. 2010

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BackgroundStudies included in a related systematic review used a variety of statistical methods to summarise clinical behaviour and to compare proxy (or indirect) and direct (observed) methods of measuring it. The objective of the present review was to assess the validity of these statistical methods and make appropriate recommendations.MethodsElectronic bibliographic databases were searched to identify studies meeting specified inclusion criteria. Potentially relevant studies were screened for inclusion independently by two reviewers. This was followed by systematic abstraction and categorization of statistical methods, as well as critical assessment of these methods.ResultsFifteen reports (of 11 studies) met the inclusion criteria. Thirteen analysed individual clinical actions separately and presented a variety of summary statistics: sensitivity was available in eight reports and specificity in six, but four reports treated different actions interchangeably. Seven reports combined several actions into summary measures of behaviour: five reports compared means on direct and proxy measures using analysis of variance or t-tests; four reported the Pearson correlation; none compared direct and proxy measures over the range of their values. Four reports comparing individual items used appropriate statistical methods, but reports that compared summary scores did not.ConclusionsWe recommend sensitivity and positive predictive value as statistics to assess agreement of direct and proxy measures of individual clinical actions. Summary measures should be reliable, repeatable, capture a single underlying aspect of behaviour, and map that construct onto a valid measurement scale. The relationship between the direct and proxy measures should be evaluated over the entire range of the direct measure and describe not only the mean of the proxy measure for any specific value of the direct measure, but also the range of variability of the proxy measure. The evidence about the relationship between direct and proxy methods of assessing clinical behaviour is weak.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Statistical considerations in a systematic review of proxy measures of clinical behaviour

et al. 2010

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“…Repeatedly low correlations were reported both among PMP's (McGuire, 1974;Elstein et al, 1978;Page & Fielding, 1980;Newble et al, 1982), and with concurrent measures (Mura et al, 1976;Lamont & Hennen, 1979). Especially the low correlation among cases, called 'content specificity', raises serious doubt with respect to the content validity of the measures.…”

Section: Clinical Competence Testsmentioning

confidence: 99%

Assessment in a problem-based medical curriculum

Berkel

1990

High Educ

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The problem-based learning curriculum differs from a conventional curriculum with regard to the cumulation of achieved knowledge. Instead of successively ordered topics, the student must learn to solve problems which are related to several topics. It is assumed that by the end of the course the student has mastered the intended goals. Comparisons of problem-based and conventional curricula regarding academic achievement show that differences between curricula-outcomes are very small, if there are any differences at all (Schmidt et aL, 1987). But summative evaluation is not enough. The student and the institute are interested also in the growth of the student during the course. For this purpose a progress test is used.The aim of this paper is to describe how a problem-based curriculum is evaluated. It accents the progress test. Part I. Conventional vs. problem-based medical curricula1.

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Why Do Patients With Atrial Fibrillation Not Receive Warfarin?

Bungard¹,

Ghali²,

Teo³

et al. 2000

Arch Intern Med

530

378

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Atrial fibrillation (AF) is a growing public health problem associated with significant morbidity and mortality. Numerous randomized controlled trials of warfarin have conclusively demonstrated that long-term anticoagulation therapy can reduce the risk for stroke by approximately 68% per year in patients with nonvalvular AF, and even more in patients with valvular AF. However, available data show that of those patients with AF and no contraindication to warfarin therapy, only 15% to 44% are prescribed warfarin. Our literature review has identified patient-, physician-, and health care system-related barriers to warfarin prescription. However, the relative importance of these specific barriers remains unknown. Further work is needed to understand the discrepancy between the randomized controlled trial evidence and clinical practice patterns.

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Performance on PMPs and performance in practice

Cited by 29 publications

References 0 publications

Statistical considerations in a systematic review of proxy measures of clinical behaviour

Statistical considerations in a systematic review of proxy measures of clinical behaviour

Assessment in a problem-based medical curriculum

Why Do Patients With Atrial Fibrillation Not Receive Warfarin?

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