Study finds computer vignette to be effective way to measure quality of physician practice

A new measurement tool called the computerized clinical vignette can help clinicians and policymakers assess and improve the quality of physician practice while potentially reducing costs, according to a study led by a researcher at the San Francisco VA Medical Center (SFVAMC).

The vignette -- which presents a simulated patient visit to the doctor via computer -- is an accurate, inexpensive, and efficient way to measure how well physicians handle their clinical practice, the study concludes. Research findings are published in the November 16 issue of Annals of Internal Medicine.

"As we investigate the quality of clinical practice, we know there's a tremendous need for improvement," says study leader John W. Peabody, MD, PhD, a staff physician at SFVAMC and an associate professor of epidemiology, biostatistics, and medicine at the University of California, San Francisco.

In order to improve care and control costs, he adds, "We need to give physicians a very precise estimate of where their strengths and weaknesses are. But in medicine, we don't get a lot of feedback. And in order to change that, we need a new measurement method."

At present, the most common measurement system is medical record abstraction, a summary of a doctor's patient care records. However, such records proved inaccurate 43 percent of the time when measuring the accuracy of the doctor's diagnosis in another study, also led by Peabody and just published in the November 2004 issue of the journal Medical Care. Based on the findings, Peabody notes that "the paper trail is probably not a very representative way to assess what happens during a doctor visit."

The gold standard for measuring physician performance is through the standardized patient -- a trained actor with a simulated illness who visits a doctor unannounced and records the doctor's actions immediately after the visit. This method is relatively accurate, but expensive and complicated to u

Contact: Corinna Kaarlela
University of California - San Francisco

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