The relative contribution of patient, provider and organizational influences to the appropriate diagnosis and management of diabetes mellitus.
Summary of "The relative contribution of patient, provider and organizational influences to the appropriate diagnosis and management of diabetes mellitus."
Abstract Objective To estimate the relative contribution of patient attributes, provider characteristics and organizational features of the doctors' workplace to the diagnosis and management of diabetes. Research design and methods In a factorial experimental design doctors (n = 192) viewed clinically authentic vignettes of 'patients' presenting with identical signs and symptoms. Doctor subjects were primary care doctors stratified according to gender and level of experience. During an in-person interview scheduled between real patients, doctors were asked how they would diagnosis and manage the vignette 'patients' in clinical practice. Results This study considered the relative contribution of patient, doctor and organizational factors. Taken together patient attributes explained only 4.4% of the variability in diabetes diagnosis. Doctor factors explained only 2.0%. The vast majority of the explained variance in diabetes diagnosis was due to organizational factors (14.3%). Relative contributions combined (patient, provider, organizational factors) explained only 20% of the total variance. Conclusion Attempts to reduce health care variations usually focus on the education/activation of patients, or increased training of doctors. Our findings suggest that shifting quality improvement efforts to the area which contributes most to the creation and amplification of variations (organizational influences) may produce better results in terms of reduced variations in health care associated with diabetes.
Vice President, Media and Communications and Co-Director, Institute for Health Services and Disparities Research, New England Research Institutes, Watertown, Massachusetts, USA.
This article was published in the following journal.
Name: Journal of evaluation in clinical practice
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/20630007
- DOI: http://dx.doi.org/10.1111/j.1365-2753.2010.01489.x
Medical and Biotech [MESH] Definitions
Patient Freedom Of Choice Laws
Laws requiring patients under managed care programs to receive services from the physician or other provider of their choice. Any willing provider laws take many different forms, but they typically prohibit managed-care organizations from having a closed panel of physicians, hospitals, or other providers.
Truthful revealing of information, specifically when the information disclosed is likely to be psychologically painful ("bad news") to the recipient (e.g., revelation to a patient or a patient's family of the patient's diagnosis or prognosis) or embarrassing to the teller (e.g., revelation of medical errors).
The degree to which the individual regards the health care service or product or the manner in which it is delivered by the provider as useful, effective, or beneficial.
Psychotherapeutic technique which emphasizes socioenvironmental and interpersonal influences in the resocialization and rehabilitation of the patient. The setting is usually a hospital unit or ward in which professional and nonprofessional staff interact with the patients.
A method of payment for health services in which an individual or institutional provider is paid a fixed, per capita amount without regard to the actual number or nature of services provided to each patient.
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