Comparison of vignettes, standardized patients, and chart abstraction - A prospective validation study of 3 methods for measuring quality
Comparison of vignettes, standardized patients, and chart abstraction - A prospective validation study of 3 methods for measuring quality
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DOI：
10.1001/jama.283.13.1715
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发表时间：
2000-04-05
影响因子：
120.7
通讯作者：
Lee, M
中科院分区：
文献类型：
--
作者：
Peabody, JW;Luck, J;Lee, M
提高卫生保健质量是一个普遍目标，但事实证明，衡量质量是困难和有问题的。一个中心问题是将医生实践与卫生保健系统的其他影响隔离开来。目的验证临床小插曲作为衡量医生能力和实际实践质量的方法。设计前瞻性试验于1997年进行，比较了测量4种常见门诊情况的护理质量的3种方法：(1)标准化患者（SPs）的结构化报告，训练有素的演员在未经通知的情况下向医生诊所提出（黄金标准）；(2)同一次就诊的病历摘录；(3)医生对临床小插曲的反应与SPs的陈述完全一致。在2个退伍军人事务医疗中心设置门诊初级保健诊所。101名普通内科医生、教员和二、三年级住院医师中有98名（97%）同意被随机纳入研究。从该组中，每个地点随机选择10名医生纳入。根据国家指南和地方专家组的明确标准，每种方法共产生160个质量分数（8例x 20名医生），得分定义为正确满足过程标准的百分比，并在3种方法之间进行比较。结果3种方法测量的护理质量范围为76.2% (SPs) ~ 71.0%（小样本）~ 65.6%（图表抽象）。与使用图表抽象相比，使用小片段测量质量始终产生的分数更接近SP分数的金标准。当分数被4个条件分解时，这种模式是稳健的(P
Context Better health care quality is a universal goal, yet measuring quality has proven to be difficult and problematic. A central problem has been isolating physician practices from other effects of the health care system, Objective To validate clinical vignettes as a method for measuring the competence of physicians and the quality of their actual practice.Design Prospective trial conducted in 1997 comparing 3 methods for measuring the quality of care for 4 common outpatient conditions: (1) structured reports by standardized patients (SPs), trained actors who presented unannounced to physicians' clinics (the gold standard); (2) abstraction of medical records for those same visits; and (3) physicians' responses to clinical vignettes that exactly corresponded to the SPs' presentations.Setting Outpatient primary care clinics at 2 Veterans Affairs medical centers.Participants Ninety-eight (97%) of 101 general internal medicine staff physicians, faculty, and second- and third-year residents consented to be randomized for the study. From this group, 10 physicians at each site were randomly selected for inclusion.Main Outcome Measures A total of 160 quality scores (8 cases x 20 physicians) were generated for each method using identical explicit criteria based on national guidelines and local expert panels, Scores were defined as the percentage of process criteria correctly met and were compared among the 3 methods.Results The quality of care, as measured by all 3 methods, ranged from 76.2% (SPs) to 71.0% (vignettes) to 65.6% (chart abstraction). Measuring quality using vignettes consistently produced scores closer to the gold standard of SP scores than using chart abstraction, This pattern was robust when the scores were disaggregated by the 4 conditions (P