Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making
The authors examined physician diagnostic certainty as one reason for cross-national medical practice variation. Data are from a factorial experiment conducted in the United States, the United Kingdom, and Germany, estimating 384 generalist physicians’ diagnostic and treatment decisions for videotap...
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| Veröffentlicht in: | Medical decision making 2009-09, Vol.29 (5), p.606-618 |
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| container_title | Medical decision making |
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| creator | Lutfey, Karen E. Link, Carol L. Marceau, Lisa D. Grant, Richard W. Adams, Ann Arber, Sara Siegrist, Johannes Bönte, Markus von dem Knesebeck, Olaf McKinlay, John B. |
| description | The authors examined physician diagnostic certainty as one reason for cross-national medical practice variation. Data are from a factorial experiment conducted in the United States, the United Kingdom, and Germany, estimating 384 generalist physicians’ diagnostic and treatment decisions for videotaped vignettes of actor patients depicting a presentation consistent with coronary heart disease (CHD). Despite identical vignette presentations, the authors observed significant differences across health care systems, with US physicians being the most certain and German physicians the least certain (P < 0.0001). Physicians were least certain of a CHD diagnoses when patients were younger and female (P < 0.0086), and there was additional variation by health care system (as represented by country) depending on patient age (P < 0.0100) and race (P < 0.0021). Certainty was positively correlated with several clinical actions, including test ordering, prescriptions, referrals to specialists, and time to follow-up. |
| doi_str_mv | 10.1177/0272989X09331811 |
| format | Article |
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Physicians were least certain of a CHD diagnoses when patients were younger and female (P < 0.0086), and there was additional variation by health care system (as represented by country) depending on patient age (P < 0.0100) and race (P < 0.0021). 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Data are from a factorial experiment conducted in the United States, the United Kingdom, and Germany, estimating 384 generalist physicians’ diagnostic and treatment decisions for videotaped vignettes of actor patients depicting a presentation consistent with coronary heart disease (CHD). Despite identical vignette presentations, the authors observed significant differences across health care systems, with US physicians being the most certain and German physicians the least certain (P < 0.0001). Physicians were least certain of a CHD diagnoses when patients were younger and female (P < 0.0086), and there was additional variation by health care system (as represented by country) depending on patient age (P < 0.0100) and race (P < 0.0021). Certainty was positively correlated with several clinical actions, including test ordering, prescriptions, referrals to specialists, and time to follow-up.</description><subject>Aged</subject><subject>Coronary Disease - diagnosis</subject><subject>Decision Making</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Practice Patterns, Physicians</subject><subject>Uncertainty</subject><issn>0272-989X</issn><issn>1552-681X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kUtvEzEUhS0EoqGwZ4W8YzXg18Q2CyQ0KRSpBcRL3Vl3HDu4TOzUnkH0z_Bb8TQRL4mVF_fc7xzfg9BDSp5QKuVTwiTTSl8QzTlVlN5CC9q2rFkqenEbLeZxM8-P0L1SLgmhQitxFx1RLSSRVC_Qj1WATUxlDBZ3Lo8Q4niNoWDAH9KUrcPJ43O3DhYG_C6DrUKHP0MOMIYUcYi4SzlFyNf41EEe8SoUB8U9w-9dmYaxYJ_TtuK6nEpp3tysVdbJ953LYeviODt0Q4g3FitnQ5nB5_A1xM19dMfDUNyDw3uMPr08-didNmdvX73uXpw1VnA-NqCXDLhc014576lbCwUgFeOcSdDet4pyslz3hAjpQRHetq3vGVuKXlvNFT9Gz_fc3dRv3drWWBkGs6sJ689MgmD-nsTwxWzSN8Nl24pWVMDjAyCnq8mV0WxDsW4YILo0FSM5F4QzRqqS7JV2Pkh2_pcLJWZu1fzbal159Ge63wuHGqug2QsKbJy5rMXVE5f_A38C1FmtUQ</recordid><startdate>20090901</startdate><enddate>20090901</enddate><creator>Lutfey, Karen E.</creator><creator>Link, Carol L.</creator><creator>Marceau, Lisa D.</creator><creator>Grant, Richard W.</creator><creator>Adams, Ann</creator><creator>Arber, Sara</creator><creator>Siegrist, Johannes</creator><creator>Bönte, Markus</creator><creator>von dem Knesebeck, Olaf</creator><creator>McKinlay, John B.</creator><general>SAGE Publications</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20090901</creationdate><title>Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making</title><author>Lutfey, Karen E. ; Link, Carol L. ; Marceau, Lisa D. ; Grant, Richard W. ; Adams, Ann ; Arber, Sara ; Siegrist, Johannes ; Bönte, Markus ; von dem Knesebeck, Olaf ; McKinlay, John B.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c433t-a962a37d1b8eff1ed48aa7823327a9ff581306db0047fa803555fb2264b9c9383</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Aged</topic><topic>Coronary Disease - diagnosis</topic><topic>Decision Making</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Practice Patterns, Physicians</topic><topic>Uncertainty</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lutfey, Karen E.</creatorcontrib><creatorcontrib>Link, Carol L.</creatorcontrib><creatorcontrib>Marceau, Lisa D.</creatorcontrib><creatorcontrib>Grant, Richard W.</creatorcontrib><creatorcontrib>Adams, Ann</creatorcontrib><creatorcontrib>Arber, Sara</creatorcontrib><creatorcontrib>Siegrist, Johannes</creatorcontrib><creatorcontrib>Bönte, Markus</creatorcontrib><creatorcontrib>von dem Knesebeck, Olaf</creatorcontrib><creatorcontrib>McKinlay, John B.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Medical decision making</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lutfey, Karen E.</au><au>Link, Carol L.</au><au>Marceau, Lisa D.</au><au>Grant, Richard W.</au><au>Adams, Ann</au><au>Arber, Sara</au><au>Siegrist, Johannes</au><au>Bönte, Markus</au><au>von dem Knesebeck, Olaf</au><au>McKinlay, John B.</au><au>Bossuyt, Patrick M. 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| source | MEDLINE; SAGE Complete |
| subjects | Aged Coronary Disease - diagnosis Decision Making Female Humans Male Middle Aged Practice Patterns, Physicians Uncertainty |
| title | Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making |
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