Intervening to Prevent Contextual Errors in Medical Decision Making
This study will assess whether a medical education intervention improves the quality of medical decision making in the care of patients with complex psychosocial -- or contextual -- needs that are essential to address when planning their care. A group of internal medicine residents will be randomly assigned to participate in the seminar and practicum and then they, along with a control group that has not participated, will be assessed for the quality of their clinical decision making and its impact on patient care.
We plan to enroll 144 internal medicine residents at 2 VA hospitals, Jesse Brown and Hines, in a randomized controlled design. Half will participate in a 4 hour seminar series that is integrated into their ambulatory curriculum. Each month a total of 8 residents will participate. Following the intervention there will be 3 levels of assessment: (1) All participants, intervention and control, will participate in a brief exercise interviewing 4 standardized patients (SPs). Note that we will separately be enlisting the assistance of 8 attending physicians to assist with case development for these SPs. (2) The research team will subsequently enroll 3 real patients from each physician's practice with "red flags" such as poor adherence, or missed visits, suggestive of contextual issues that need to be addressed. Physicians will be scored on their performance at identifying the underlying contextual factors that account for these red flags and on formulating an appropriate plan of care. (3) The coders will prospectively define successful vs. unsuccessful outcomes for each case. At the follow up visit data will be collected on whether the desired outcome was achieved. The analysis will compare the skills, performance and outcomes of the intervention compared with the control group to determine the efficacy of training residents to individualize care.
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Health Services Research
Seminar and Practicum on Contextualizing Care
Jesse Brown VAMC
Department of Veterans Affairs
Results (where available)
- Source: http://clinicaltrials.gov/show/NCT00856557
- Information obtained from ClinicalTrials.gov on July 15, 2010
Medical and Biotech [MESH] Definitions
Encouraging consumer behaviors most likely to optimize health potentials (physical and psychosocial) through health information, preventive programs, and access to medical care.
Progressive Patient Care
Organization of medical and nursing care according to the degree of illness and care requirements in the hospital. The elements are intensive care, intermediate care, self-care, long-term care, and organized home care.
Medical care provided after the regular practice schedule of the physicians. Usually it is designed to deliver 24-hour-a-day and 365-day-a-year patient care coverage for emergencies, triage, pediatric care, or hospice care.
Episode Of Care
An interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient), thus serving as one measure of health care provided.
The relating of causes to the effects they produce. Causes are termed necessary when they must always precede an effect and sufficient when they initiate or produce an effect. Any of several factors may be associated with the potential disease causation or outcome, including predisposing factors, enabling factors, precipitating factors, reinforcing factors, and risk factors.
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