Clinical Decisions with Older Patients: 3rd Experiment

老年患者的临床决策：第三次实验

• 批准号: 7060483
• 负责人: John B McKinlay
• 金额: $ 31.18万
• 依托单位: NEW ENGLAND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2000
• 资助国家: 美国
• 起止时间: 2000-06-01 至 2009-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7060483
• 关键词: British Isles; Germany; United States; age difference; aging; behavioral /social science research tag; cardiovascular disorder diagnosis; clinical research; cognition; coronary disorder; decision making; depression; epidemiology; gender difference; health care policy; health services research tag; human subject; mental disorder diagnosis; patient care management; patient care personnel attitude; primary care physician

DESCRIPTION (provided by applicant): Using an experimental factorial design we have recently demonstrated significant differences between primary care providers in the US and the UK in the clinical management of common medical problems of the elderly (coronary heart disease and depression). These differences are highly significant (most p<.001 ) and unconfounded by patient attributes or physician characteristics. This Competing Continuation will determine whether these exciting health care system differences in clinical decision-making (CDM) are sustained in a third, quite different system (Germany's federalized and corporatized system). Research on health system contributions to variations in CDM obviously requires inclusion of several systems for comparative purposes. Replication of our experiment in a different national setting (Germany) will add scientific confidence to recent findings of system differences in the US and the UK. This research represents a paradigm shift in studies of CDM, by moving the focus from patient attributes (prescriptive CDM) and provider characteristics (descriptive CDM) to a more sociological "third generation" approach (health care system contributions) and to "fourth generation" studies of underlying cognitive (and reasoning) processes. Novel use of a classical experimental (factorial) design (as opposed to observational data) permits unconfounded estimation of different effects. It builds cost-efficiently on work already completed on time and within budget. It has policy implications at the level of patient care, provider training and the organization and financing of medical care. It offers a new explanation for observed international variations in disease rates. The most recent issue of AJPH (February 2003) highlights the urgent need for comparative analyses of different health systems in order to provide policy lessons for the rapidly changing US health care system.

描述（由申请人提供）：使用实验阶乘设计，我们最近在美国和英国的初级保健提供者之间在老年人常见医学问题（冠心病和抑郁症）的临床管理方面存在显着差异。这些差异是非常显着的（大多数p <.001），并且与患者属性或医师特征无关。这种竞争的延续将决定这些令人兴奋的临床决策中这些令人兴奋的医疗保健系统差异（CDM）是否在第三个完全不同的系统（德国的联邦化和公司化系统）中持续下去。卫生系统对CDM变化的贡献的研究显然需要包含几个用于比较目的的系统。在不同的国家环境（德国）中复制我们的实验将使科学信心对美国和英国的系统差异的最新发现。 这项研究代表了CDM研究的范式转移，通过将重点从患者属性（规范性CDM）和提供者特征（描述性CDM）转移到更社会学的“第三代”方法（卫生保健系统贡献）以及对潜在认知（和推理）过程的“第四代”研究。经典实验（阶乘）设计（与观察数据相反）的新颖使用允许对不同效果的无共同估计。它在已经按时和预算范围内完成的工作中建立了成本效益。它在患者护理，提供者培训以及医疗服务的组织和融资方面具有政策影响。它为观察到的国际疾病率差异提供了新的解释。最近的AJPH（2003年2月）的最新一期强调，迫切需要对不同卫生系统进行比较分析，以便为快速变化的美国卫生保健系统提供政策课程。

项目成果

Talking about smoking in primary care medical practice--results of experimental studies from the US, UK and Germany.

谈论初级保健医疗实践中的吸烟——美国、英国和德国的实验研究结果。

• DOI: 10.1016/j.pec.2012.04.011
• 发表时间: 2012
• 期刊: Patient education and counseling
• 影响因子: 3.5
• 作者: vondemKnesebeck,Olaf;Hoehne,Anke;Link,Carol;Marceau,Lisa;Adams,Ann;Roland,Martin;Campbell,Stephen;Siegrist,Johannes;McKinlay,John
• 通讯作者: McKinlay,John

Country differences in the diagnosis and management of coronary heart disease - a comparison between the US, the UK and Germany.

• DOI: 10.1186/1472-6963-8-198
• 发表时间: 2008-09-29
• 期刊: BMC health services research
• 影响因子: 2.8
• 作者: von dem Knesebeck O;Bönte M;Siegrist J;Marceau L;Link C;Arber S;Adams A;McKinlay J
• 通讯作者: McKinlay J

Diagnostic certainty as a source of medical practice variation in coronary heart disease: results from a cross-national experiment of clinical decision making.

诊断确定性是冠心病医疗实践变异的一个来源：临床决策跨国实验的结果。

• DOI: 10.1177/0272989x09331811
• 发表时间: 2009
• 期刊: Medical decision making : an international journal of the Society for Medical Decision Making
• 作者: Lutfey,KarenE;Link,CarolL;Marceau,LisaD;Grant,RichardW;Adams,Ann;Arber,Sara;Siegrist,Johannes;Bönte,Markus;vondemKnesebeck,Olaf;McKinlay,JohnB
• 通讯作者: McKinlay,JohnB

[Diagnosis and therapy of depression in the elderly--influence of patient and physician characteristics].

[老年抑郁症的诊断和治疗——患者和医生特征的影响]。

• DOI: 10.1055/s-0029-1202270
• 发表时间: 2010
• 期刊: Psychotherapie, Psychosomatik, medizinische Psychologie
• 作者: Knesebeck,Olafvondem;Bönte,Markus;Siegrist,Johannes;Marceau,Lisa;Link,Carol;McKinlay,John
• 通讯作者: McKinlay,John

Influence of patient characteristics on doctors' questioning and lifestyle advice for coronary heart disease: a UK/US video experiment.

患者特征对冠心病医生询问和生活方式建议的影响：英国/美国视频实验。

• 发表时间: 2004
• 期刊: The British journal of general practice : the journal of the Royal College of General Practitioners.
• 作者: Arber,Sara;McKinlay,John;Adams,Ann;Marceau,Lisa;Link,Carol;O'Donnell,Amy
• 通讯作者: O'Donnell,Amy