The relative contribution of patient, provider and organizational influences to the appropriate diagnosis and management of diabetes mellitus.

Journal of Evaluation in Clinical Practice
Lisa D MarceauCarol Link

Abstract

To estimate the relative contribution of patient attributes, provider characteristics and organizational features of the doctors' workplace to the diagnosis and management of diabetes. 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. 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. 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 t...Continue Reading

References

Aug 3, 2002·Journal of the National Medical Association·Alan Nelson
Jun 27, 2003·The New England Journal of Medicine·Elizabeth A McGlynnEve A Kerr
Feb 5, 2004·Social Science & Medicine·Johannes SiegristRichard Peter
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Jun 22, 2006·Managed Care Interface·Chris M Kozma
Jan 10, 2008·Diabetes Care·UNKNOWN American Diabetes Association

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Citations

Jul 24, 2013·CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne·Marie-Dominique BeaulieuNatalyia Dragieva
Feb 26, 2014·The Journal of Allergy and Clinical Immunology. in Practice·Matthew Greenhawt, Julie Wang
Dec 12, 2012·Journal of Evaluation in Clinical Practice·John McKinlayLisa Marceau
Jan 23, 2015·The Journal of Allergy and Clinical Immunology. in Practice·Marilyn KaramMatthew Greenhawt

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