The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China.
The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China.
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虚拟患者与突击标准化患者评估在评价初级卫生保健质量方面的一致性：中国7个省份的多中心、横断面试点研究。
DOI：
10.2196/40082
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发表时间：
2022-12-02
影响因子：
7.4
通讯作者：
Liao, Jing
中科院分区：
文献类型：
--
作者：
Zeng, Minrui;Cai, Yiyuan;Cao, Jin;He, Qianyu;Wang, Xiaohui;Lu, Yun;Liang, Huijuan;Xu, Dong;Liao, Jing
关键词：
未经宣布的标准化病人（USP）是初级卫生保健（PHC）质量评估的黄金标准，但有许多限制与高人力和资源成本。虚拟病人（VP）是一种有效的，低成本的软件选项，用于模拟临床场景，并广泛应用于医学教育。VP能否用于PHC质量评价尚不清楚。本研究旨在检查VP和USP对PHC质量评估之间的一致性，并确定影响VP-USP一致性的因素。11个匹配的VP和USP的情况下，设计开发的基础上，临床指南，并实施了一个方便的样本，城市PHC设施在省会城市的7个研究省份。共进行了720次USP访视，在此期间，USP随机选择了符合纳入标准的值班PHC提供者。至少一周后，相同的供应商使用相同的病例条件进行了VP评估。通过一致性相关系数（CCC）（连续性评分）和加权κ（诊断）测量VP-USP一致性。采用多元线性回归确定影响VP-USP一致性的因素。只有146个VP评分与相应的USP评分相匹配。病史的CCC为0.37（95% CI 0.24-0.49）;体格检查为0.27（95% CI 0.12-0.42）;实验室和影像学检查为-0.03（95% CI -0.20至0.14）;治疗为0.22（95% CI 0.07-0.37）。用于诊断的加权κ为0.32（95%CI 0.13-0.52）。多元线性回归模型表明，VP测试的显着影响不同的情况下，测试发生的城市。VP和USP在PHC质量评估方面的一致性较低。这可能反映了“实际知识”的差距。VP测试结果也受到不同案例条件、交互设计和可用性的影响。对VP的修改以及VP-USP一致性低的原因需要进一步研究。
The unannounced standardized patient (USP) is the gold standard for primary health care (PHC) quality assessment but has many restrictions associated with high human and resource costs. Virtual patient (VP) is a valid, low-cost software option for simulating clinical scenarios and is widely used in medical education. It is unclear whether VP can be used to assess the quality of PHC. This study aimed to examine the agreement between VP and USP assessments of PHC quality and to identify factors influencing the VP-USP agreement. Eleven matched VP and USP case designs were developed based on clinical guidelines and were implemented in a convenience sample of urban PHC facilities in the capital cities of the 7 study provinces. A total of 720 USP visits were conducted, during which on-duty PHC providers who met the inclusion criteria were randomly selected by the USPs. The same providers underwent a VP assessment using the same case condition at least a week later. The VP-USP agreement was measured by the concordance correlation coefficient (CCC) for continuity scores and the weighted κ for diagnoses. Multiple linear regression was used to identify factors influencing the VP-USP agreement. Only 146 VP scores were matched with the corresponding USP scores. The CCC for medical history was 0.37 (95% CI 0.24-0.49); for physical examination, 0.27 (95% CI 0.12-0.42); for laboratory and imaging tests, –0.03 (95% CI –0.20 to 0.14); and for treatment, 0.22 (95% CI 0.07-0.37). The weighted κ for diagnosis was 0.32 (95% CI 0.13-0.52). The multiple linear regression model indicated that the VP tests were significantly influenced by the different case conditions and the city where the test took place. There was low agreement between VPs and USPs in PHC quality assessment. This may reflect the “know-do” gap. VP test results were also influenced by different case conditions, interactive design, and usability. Modifications to VPs and the reasons for the low VP-USP agreement require further study.
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影响因子：
7.4
作者：
Fink MC;Reitmeier V;Stadler M;Siebeck M;Fischer F;Fischer MR
通讯作者：
Fischer MR
影响因子：
3
作者：
Ben-Assuli, Ofir;Kumar, Nanda;Shabtai, Itamar
通讯作者：
Shabtai, Itamar
影响因子：
34.3
作者：
Daniels, Benjamin;Kwan, Ada;Pai, Madhukar
通讯作者：
Pai, Madhukar
影响因子：
3
作者：
Deladisma, Adeline M.;Cohen, Marc;Lind, D. Scott
通讯作者：
Lind, D. Scott
影响因子：
3.5
作者：
Kron, Frederick W.;Fetters, Michael D.;Becker, Daniel M.
通讯作者：
Becker, Daniel M.