This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Veloski, J. Articles by Nash, D. B. Search for Related Content PubMed PubMed Citation Articles by Veloski, J. Articles by Nash, D. B. Social Bookmarking                         What's this?

Clinical Vignette-Based Surveys: A Tool for Assessing Physician Practice Variation

Center for Research in Medical Education and Health Care, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, jon.veloski{at}jefferson.edu

Stephen Tai

Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

Adam S. Evans

Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

David B. Nash, MD, MBA

Department of Health Policy, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania

Clinical vignette-based surveys have been used for more than 30 years to measure variation in physicians’ approaches to the diagnosis and treatment of patients with similar health problems. Vignettes offer advantages over medical record reviews, analysis of claims data, and standardized patients. A vignette-based survey can be completed more quickly than a record review or standardized patient program. Research has shown that vignette-based surveys produce better measures of quality of care than medical record reviews when used to measure differential diagnosis, selection of tests, and treatment decisions. Although standardized patients are preferred when measuring communication and physical examination skills, vignettes are more cost-effective than standardized patients when assessing clinical physicians’ decision making. Vignettes offer better opportunities to isolate physicians’ decision making and to control case-mix variation than do analyses of claims data sets. Clinical vignette-based surveys are simple and economical tools that can be used to characterize physicians’ practice variation.

Key Words: practice variation • physician performance • clinical vignettes • quality of care • clinical decision making • selection of tests • treatment decisions

American Journal of Medical Quality, Vol. 20, No. 3, 151-157 (2005)
DOI: 10.1177/1062860605274520


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				M. Geirsson, G. Hensing, and F. Spak Does Gender Matter? A Vignette Study of General Practitioners' Management Skills in Handling Patients with Alcohol-Related Problems Alcohol Alcohol., November 1, 2009; 44(6): 620 - 625. [Abstract] [Full Text] [PDF]

				K. E. Lutfey, C. L. Link, L. D. Marceau, R. W. Grant, A. Adams, S. Arber, J. Siegrist, M. Bonte, O. von dem Knesebeck, and J. B. McKinlay Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making Med Decis Making, September 1, 2009; 29(5): 606 - 618. [Abstract] [PDF]

				K. R. Archer, E. J. MacKenzie, M. J. Bosse, A. N. Pollak, and L. H. Riley III Factors Associated With Surgeon Referral for Physical Therapy in Patients With Traumatic Lower-Extremity Injury: Results of a National Survey of Orthopedic Trauma Surgeons Physical Therapy, September 1, 2009; 89(9): 893 - 905. [Abstract] [Full Text] [PDF]

				R. Shackelton, C. Link, L. Marceau, and J. McKinlay Does the culture of a medical practice affect the clinical management of diabetes by primary care providers? J Health Serv Res Policy, April 1, 2009; 14(2): 96 - 103. [Abstract] [Full Text] [PDF]

				S. J. Lee, S. Joffe, A. S. Artz, R. E. Champlin, S. M. Davies, M. Jagasia, N. A. Kernan, F. R. Loberiza Jr, R. J. Soiffer, and M. Eapen Individual Physician Practice Variation in Hematopoietic Cell Transplantation J. Clin. Oncol., May 1, 2008; 26(13): 2162 - 2170. [Abstract] [Full Text] [PDF]

				S. L. Barber, P. J. Gertler, and P. Harimurti Differences In Access To High-Quality Outpatient Care In Indonesia Health Aff., May 1, 2007; 26(3): w352 - w366. [Abstract] [Full Text] [PDF]

				S. L. Barber, P. J. Gertler, and P. Harimurti The Contribution Of Human Resources For Health To The Quality Of Care In Indonesia Health Aff., May 1, 2007; 26(3): w367 - w379. [Abstract] [Full Text] [PDF]

				P. Werner Family Physicians' Recommendations for the Treatment of Alzheimer's Disease American Journal of Alzheimer's Disease and Other Dementias, January 1, 2007; 21(6): 403 - 410. [Abstract] [PDF]