The Quest to Quantify Quality

Fihn, Stephan D.

doi:10.1001/jama.283.13.1740

Cited by 21 publications

(10 citation statements)

References 11 publications

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“…Although vignettes provide a time- and cost-efficient standardized assessment of clinician practices, vignettes lack the complexity and ambiguity of real-life practice situations (Fihn, 2000). Vignettes may elicit optimized responses from practitioners that do not accurately reflect everyday practice (Leonard & Masatu, 2005).…”

Section: Discussionmentioning

confidence: 99%

“…Vignette methodology has numerous strengths when compared to similar methods to assess practitioner performance in clinical settings (e.g., chart review, standardized patients; Fihn, 2000). Strengths include the ability to craft standardized cases, to alter cases systematically, and to present cases to a large sample of practitioners given relative time and cost effectiveness.…”

Section: Methodsmentioning

confidence: 99%

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Practitioner perceptions of attenuated psychosis syndrome

Jacobs

Kline

Schiffman

2011

Schizophrenia Research

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The “Attenuated Psychosis Syndrome” (APS, sometimes referred to as the “schizophrenia prodrome”) is characterized by subthreshold psychotic-like symptoms and functional decline, and is often associated with significant disability. These symptoms may cause impairment and are of further interest due to their predictive relation to schizophrenia and other psychotic disorders. These symptoms currently are not represented in the diagnostic system for mental health, and it is unclear how they are conceptualized by relevant professionals. The current study surveyed a national sample (n=303) of clinical psychologists, psychiatrists, and general practitioners regarding their clinical appraisal of APS. Practitioners were asked to respond to vignettes representing three conditions: psychosis, subthreshold psychosis (indicating ‘attenuated’ psychosis symptoms), and no psychotic symptoms. Practitioners’ responses suggested that APS is viewed consistently with a DSM-IV-TR defined mental disorder and that most clinicians may diagnose this condition as a full threshold psychotic disorder. Findings tentatively suggest that the inclusion of an attenuated psychosis symptoms category in the forthcoming DSM-5 may be helpful in improving diagnostic reliability and facilitating best practice among community practitioners.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Practitioner perceptions of attenuated psychosis syndrome

Jacobs

Kline

Schiffman

2011

Schizophrenia Research

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“…Vignettes do have intrinsic shortcomings such as lack of the complexity and ambiguity of real-life patients [10, 11, 12]. Only a limited number of vignettes and, thus, a limited number of variables can be entered into a survey to keep the latter within a practical length [13, 14, 15]. However, Peabody et al [15]have shown the validity of case vignettes to measure clinical practice by comparing case vignettes with standard patients and chart abstractions.…”

Section: Discussionmentioning

confidence: 99%

Survey among Surgeons on Surgical Treatment Strategies for Secondary Peritonitis

Lamme

Boermeester²,

Vos³

et al. 2004

Dig Surg

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Background: There is controversy about performing either a planned relaparotomy (PR) or relaparotomy on demand (ROD) in patients with secondary peritonitis. Subjective factors influencing surgeons in decision making for either surgical treatment strategy have never been studied. Methods: All 858 surgeons of the Association of Surgeons of The Netherlands were sent a survey with 16 case vignettes simulating peritonitis patients and evaluating the preference for PR or ROD. Results: Sixty-two percent of surgeons responded to the survey. Of the returned surveys, 407 were eligible for evaluation. The responding surgeons had a slight overall preference for the ROD strategy, as shown by the mean overall preference score of 5.2 (range 3.54–6.52, with a maximal score of 7). Gastrointestinal surgeons and surgeons working in regional and smaller hospitals were significantly more in favour of a ROD strategy than their counterparts. Factors significantly influencing the preference towards PR were ischaemia as aetiology and performing a primary anastomosis; as for ROD, it was small bowel as focus, local extent of contamination and the question whether abdominal closure was possible. However, there was a considerable variability in treatment decisions by surgeons. Conclusion: The majority of responding surgeons would make a choice for a particular treatment strategy based on peritonitis and surgical treatment characteristics. There was a slight overall preference towards the ROD strategy despite the considerable variability per case vignette.

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“…SP as an excellent tool has been used in different domains of medical education for assessment of undergraduates’ and postgraduates’ skills. [6]…”

Section: Introductionmentioning

confidence: 99%

Training and validation of standardized patients for evaluation of general practitioners′ performance in management of obesity and overweight

et al. 2014

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Background:Standardized patient (SP) can serve as a valuable tool to measure the physician performance in actual clinical settings, but it has not been validated for obesity/overweight disorders. This study has been conducted to describe the process of creating reliable and valid SPs for evaluation of general-practitioners’ management of obesity/overweight in Iran.Materials and Methods:A total of 6 obese/overweight volunteers (potential SPs) took part in training. Three scenarios, along with corresponding checklists including 102 items representing different aspects of diagnosis and treatment of obesity/overweight, were developed by an expert group. The SPs were trained using role playing method. During this part, one of the SPs failed. The SPs’ portrayal of their respective scenario was online watched in another room and the checklist filled independently by the physician, research assistant and other SPs. The reliability of the checklist to be used by the SPs was assessed by Cronbach's alpha. The overall inter-rater agreement was calculated by the intraclass correlation coefficient statistic for total scores.Results:The 5 eligible SPs were all women between 20 years and 39 years of age. Inter-rater agreement between the SPs’ total scores was 0.899, value (95% confidence intervals) were 11.8 (0.68-0.98) and P value was <0.001. The Cronbach's alpha for reliability of completed checklists was 0.91.Conclusion:SP could be a powerful instrument for evaluating medical performance of general practitioners in the field of obesity/overweight management. Further research is needed to find the more aspects of training and validation of unannounced SPs in this field.

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The Quest to Quantify Quality

Cited by 21 publications

References 11 publications

Practitioner perceptions of attenuated psychosis syndrome

Practitioner perceptions of attenuated psychosis syndrome

Survey among Surgeons on Surgical Treatment Strategies for Secondary Peritonitis

Training and validation of standardized patients for evaluation of general practitioners′ performance in management of obesity and overweight

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