The use of direct clinician observation and vignettes for health services quality evaluation in developing countries

Leonard, Kenneth L.; Masatu, Melkiory C.

doi:10.1016/j.socscimed.2005.03.043

Cited by 97 publications

(80 citation statements)

References 9 publications

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“…Indeed, the increased effort from greater competence looks similar between the groups, however, the deficient effort in public clinics still stands out. The finding that effort and competence are positively correlated is confirmed in the data from Tanzania as well (Leonard and Masatu, 2005).…”

Section: What Do We Learn From Both Testing and Watching Doctors?supporting

confidence: 54%

“…However, whereas doctors in the nongovernment organization sector completed 44 percent of these tasks when observed with their regular patients, doctors in the public sector completed only 36 percent of the same tasks. The items that correspond across the vignette and the direct observation checklist are not the same for Tanzania as they are for India, and therefore the higher percentage of tasks completed should not be interpreted as higher quality (Leonard and Masatu, 2005). However, the numbers illustrate the fact that there are no differences in competence between the public and nongovernment organization sectors in Tanzania, but that there are significant differences in effort.…”

Section: What Do We Learn From Both Testing and Watching Doctors?mentioning

confidence: 99%

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The Quality of Medical Advice in Low-Income Countries

Das

Hammer

Leonard

2008

Journal of Economic Perspectives

336

258

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This paper documents the quality of medical advice in low-income countries. Our evidence on health care quality in low-income countries is drawn primarily from studies in four countries: Tanzania, India, Indonesia, and Paraguay. We provide an overview of recent work that uses two broad approaches: medical vignettes (in which medical providers are presented with hypothetical cases and their responses are compared to a checklist of essential procedures) and direct observation of the doctor-patient interaction These two approaches have proved quite informative. For example, doctors in Tanzania complete less than a quarter of the essential checklist for patients with classic symptoms of malaria, a disease that kills 63,000-96,000 Tanzanians each year. A public-sector doctor in India asks one (and only one) question in the average interaction: "What's wrong with you?" We present systematic evidence in this paper to show that these isolated facts represent common patterns. We find that the quality of care in low-income countries as measured by what doctors know is very low, and that the problem of low competence is compounded due to low effort -- doctors provide lower standards of care for their patients than they know how to provide. We discuss how the properties and correlates of measures based on vignettes and observation may be used to evaluate policy changes. Finally, we outline the agenda in terms of further research and measurement.

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Section: What Do We Learn From Both Testing and Watching Doctors?supporting

confidence: 54%

Section: What Do We Learn From Both Testing and Watching Doctors?mentioning

confidence: 99%

The Quality of Medical Advice in Low-Income Countries

Das

Hammer

Leonard

2008

Journal of Economic Perspectives

336

258

View full text Add to dashboard Cite

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“…Rooney et al announced a report introducing a set of quantifiable indicators used to evaluate healthcare quality in hospitals over time [7]. More recently, researchers have suggested evaluations based on direct clinician observation and perception of patients be used simultaneously to improve the reliability of the data [8]. This is because, in many cases, the opinion of the patient can be affected by certain factors, particularly their own subjective and uninformed cost-benefit analysis, and may not fully reflect the quality of the health care provider [9].…”

Section: Introductionmentioning

confidence: 99%

Psychological and Socio-Economic Factors Affecting Social Sustainability through Impacts on Perceived Health Care Quality and Public Health: The Case of Vietnam

Vuong

et al. 2017

Sustainability

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A study on over 2000 patients has been conducted in Hanoi, Vietnam, to explore the influences of psychological and socio-economic factors on the evaluation of healthcare quality and public health by patients. The findings suggest effective health communication and the status of being married are two elements that have the strongest impact on people's positive perceptions about healthcare quality (β HealthCom = 0.210, β otherMaritalstt = −0.386, p < 0.001). Young unmarried people and the insured tend to be more critical of healthcare quality (β Age = −0.005, p < 0.05; β yesHealthIns = −0.208, p < 0.001). At the same time, a higher BMI and better view of health care quality are linked to negative opinions about community health. These outcomes suggest that in order to maintain collective health as part of social sustainability, the Vietnamese government should pay attention to infrastructure improvement, insurance system reforms, and communication of personal health care knowledge.

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“…Key aspects of the quality of malaria care include the correct assessment, diagnosis, treatment (including drug choice, timing, and dosage), and counseling. Methods to assess outpatient quality of care in resource-limited settings include direct observation of consultations by either conspicuous surveyors 3 -7 or simulated clients 8 ; HW interviews, which might include clinical vignettes 5 ; patient or guardian interviews 9,10 ; and chart abstractions. 6,10 The nature of the inpatient experience, however, makes it more difficult to assess healthcare quality.…”

Section: Introductionmentioning

confidence: 99%

An Evaluation of Methods for Assessing the Quality of Case Management for Inpatients with Malaria in Benin

Mace¹,

Guèye²,

Lynch³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. To improve healthcare quality for hospitalized patients with malaria in Benin, a feasible and valid evaluation method is needed. Because observation of inpatients is challenging, chart abstraction is an attractive option. However, the quality of inpatient charts is unknown. We employed three methods in five hospitals to assess 11 signs of malaria and severe disease: 1) chart abstraction (probability sample of inpatients), 2) chart abstraction compared to interviews of inpatients and health workers (HWs), and 3) abstraction from charts of recently discharged inpatients compared to interviews with HWs. Method 1 showed that of 473 malaria signs (from 43 charts), 178 (38%, 95% confidence interval 24-51%) were documented. Method 2 showed that 96% (45 of 47) of documented signs were valid. Method 3 suggests that 65% (36 of 55) of non-documented signs were assessed (but not documented) by HWs. Chart abstraction was feasible and documented data were valid, but results should be interpreted cautiously in consideration of low levels of documentation.

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The use of direct clinician observation and vignettes for health services quality evaluation in developing countries

Cited by 97 publications

References 9 publications

The Quality of Medical Advice in Low-Income Countries

The Quality of Medical Advice in Low-Income Countries

Psychological and Socio-Economic Factors Affecting Social Sustainability through Impacts on Perceived Health Care Quality and Public Health: The Case of Vietnam

An Evaluation of Methods for Assessing the Quality of Case Management for Inpatients with Malaria in Benin

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