ArticleJournal of evaluation in clinical practice2011
The relative contribution of patient, provider and organizational influences to the appropriate diagnosis and management of diabetes mellitus.
Article in Journal of evaluation in clinical practice, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- The Contribution of Patient, Primary Care Physician, and Primary Care Clinic Factors to Good Bone Health Care.The Permanente journal · 2021Trial
- Quality performance and associated factors in Swiss diabetes care - A cross-sectional study.PloS one · 2020Trial
- How the delivery of HIV care in Canada aligns with the Chronic Care Model: A qualitative study.PloS one · 2019Article
- Does a Physician's Attitude toward a Patient with Mental Illness Affect Clinical Management of Diabetes? Results from a Mixed-Method Study.Health services research · 2015Article
- Patient characteristics associated with measurement of routine diabetes care: an observational study.PloS one · 2015Observational
- Variations among primary care physicians in exercise advice, imaging, and analgesics for musculoskeletal pain: results from a factorial experiment.Arthritis care & research · 2014Article
- Characteristics of primary care practices associated with high quality of care.CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2013Article
- An additional cause of health care disparities: the variable clinical decisions of primary care doctors.Journal of evaluation in clinical practice · 2013Article
- Physician styles of decision-making for a complex condition: Type 2 diabetes with co-morbid mental illness.European journal for person centered healthcareArticle
- Adherence with allergen immunotherapy labeling guidelines.The journal of allergy and clinical immunology. In practiceArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
Abstract
objectiveTo estimate the relative contribution of patient attributes, provider characteristics and organizational features of the doctors' workplace to the diagnosis and management of diabetes. RESEARCH DESIGN AND
methodsIn 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.
resultsThis 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.
conclusionAttempts 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 to the area which contributes most to the creation and amplification of variations (organizational influences) may produce better results in terms of reduced variations in health care associated with diabetes.
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