Study finds computer vignette to be effective way to measure quality of physicia...( in all five domains of patient care a...),Health

"What makes this study so unusual is that we rarely have the opportunity to define the case when we're evaluating the quality of care," notes Peabody. "By having the standardized patients, we could say with complete certainty that we were making identical comparisons between these three measurement methods."

Peabody and his team developed the vignette method over the course of eight years of research. He says this method would be easy to implement nationwide for several reasons: physicians are familiar with the format because it looks like a patient case they might see in their clinic; it's inexpensive because physicians can sit down, complete the steps on a computerized screen and generate a score very quickly; computerization allows doctors to complete vignettes anywhere, over the web and at home; and there is a minimal time requirement, such as twice a year for one hour.

Vignettes turn out to be a very precise way of measuring an individual doctor's strengths and weaknesses, according to Peabody. A doctor "may have strength in taking a history, but order too many unnecessary tests. Similarly, because we give different cases, it allows us to say that you're particularly good at taking care of a patient with depression, but you're struggling a bit with a patient who has congestive heart failure."

Peabody says this level of accuracy led researchers to a striking finding: the differences in quality of care between institutions were not nearly as great as the differences within institutions.

Within a particular clinic, "it's usually not the case that there are a couple of bad doctors driving down the overall quality of care, but more that some doctors are having trouble with certain cases or with certain aspects of clinical care
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Contact: Corinna Kaarlela
ckaarlela@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
15-Nov-2004