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.
Affiliation
Vice President, Media and Communications and Co-Director, Institute for Health Services and Disparities Research, New England Research Institutes, Watertown, Massachusetts, USA.
Journal Details
This article was published in the following journal.
Name: Journal of evaluation in clinical practice
ISSN: 1365-2753
Pages:
Links
- 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.
Truth Disclosure
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).
Patient Satisfaction
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.
Therapeutic Community
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.
Capitation Fee
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.
PubMed Articles
In parallel to market-like reforms in Swedish primary care, the gathering and compilation of comparative information about providers, for example through survey tools, has been improved. Such informat...
BACKGROUND: As health-care organizations endeavor to improve their quality of care, there is a growing recognition of the importance of establishing a culture of patient safety. The main objective of...
Provider and Systems Factors in Diabetes Quality of Care.
A gap exists in knowledge and the observed frequency with which patients with diabetes actually receive treatment for optimal cardiovascular risk reduction. Many interventions to improve quality of ca...
The Patient-Provider Relationship in Chronic Pain.
The relationship between patient and provider has long been the subject of study within the psychotherapy literature, with the available data suggesting a modest, but reliable, association between the...
Organizational determinants of patient-centered fertility care: a multilevel analysis.
OBJECTIVE: To identify organizational determinants of positive patient experiences with fertility care, with the goal of improving patient centeredness of care. DESIGN: Cross-sectional survey. SETTING...
Clinical Trials
Improving Practice Patterns for the Treatment of Hypertension
To improve the quality of hypertension care in our facility, while concurrently, examining the relative contribution of each aspect of a multi-factorial intervention designed to improve hy...
Effectiveness of a Observational Unit at St. Olavs Hospital
The trial is designed to evaluate the effectiveness of a newly established Observational unit at St. Olavs Hospital in terms of readmission rates, compared to the provision of care in norm...
Quality Improvement of Patient-Provider Communication For Colorectal Cancer Screening
The immediate objective of this proposal is to assess the effectiveness of a multi-faceted intervention to improve patient-provider communication about colorectal cancer screening in impro...
The Provider and Organization in Asthma Guidelines
The purpose of this study is to examine the interaction between the personal attributes of clinicians and the organizations in which they work and the effect of interventions on their abil...
Patient Profiling and Provider Feedback to Reduce Adverse Drug Events
Adverse drug events (ADE) present a unique focus for error reduction. Computerized provider order entry, with embedded clinical decision support, has great promise in reducing medication e...
