ArticleMedical decision making : an international journal of the Society for Medical Decision Making
Diagnostic certainty as a source of medical practice variation in coronary heart disease: results from a cross-national experiment of clinical decision making.
Article in Medical decision making : an international journal of the Society for Medical Decision Making. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 1 of them a synthesis that pooled it.
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Who cites it
17 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Implicit bias in healthcare professionals: a systematic review.BMC medical ethics · 2017Pooled it
- Implicit Gender Bias and the Use of Cardiovascular Tests Among Cardiologists.Journal of the American Heart Association · 2017Trial
- Physician clinical information technology and health care disparities.Medical care research and review : MCRR · 2009Trial
- Implementing strategies to reduce the number of urgent low-value cranial CT for non-trauma reasons-where do we start fighting the hydra?European radiology · 2024Article
- Audit and feedback to reduce unwarranted clinical variation at scale: a realist study of implementation strategy mechanisms.Implementation science : IS · 2023Article
- The use of experimental vignette studies to identify drivers of variations in the delivery of health care: a scoping review.BMC medical research methodology · 2021Article
- Unwarranted clinical variation in health care: Definitions and proposal of an analytic framework.Journal of evaluation in clinical practice · 2020Review
- Article
- Tracing the decision-making process of physicians with a Decision Process Matrix.BMC medical informatics and decision making · 2016Article
- Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science: A Scientific Statement From the American Heart Association.Circulation · 2016Review
- Contextualizing Disparities: The Case for Comparative Research on Social Inequalities in Health.Research in the sociology of health care · 2013Article
- Gendered uncertainty and variation in physicians' decisions for coronary heart disease: the double-edged sword of "atypical symptoms".Journal of health and social behavior · 2012Article
- The effect of imaging on the clinical management of breast pain.Journal of general internal medicine · 2012Article
- Diagnosis and management of depression in 3 countries: results from a clinical vignette factorial experiment.The primary care companion for CNS disorders · 2011Article
- Physician cognitive processing as a source of diagnostic and treatment disparities in coronary heart disease: results of a factorial priming experiment.Journal of health and social behavior · 2010Article
- Coronary atherosclerosis imaging by CT to improve clinical outcomes.Journal of cardiovascular computed tomographyReview
- Computer-assisted Medical Decision-making System for Diagnosis of Urticaria.MDM policy & practiceArticle
Corrections and comments
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Authors and funding
10 authors at 6 institutions in 3 countries.
Funding
Abstract
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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.