ReviewJournal of general internal medicine2014
Directly observed care: can unannounced standardized patients address a gap in performance measurement?
Review in Journal of general internal medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
18 citing papers in PubMed.
- Trial
- Assessing community pharmacists' responses to pregnancy-related nausea and vomiting: A national simulated patient study in Jordan.PloS one · 2025Observational
- Quality in screening and measuring blood pressure in China's primary health care: a national cross-sectional study using unannounced standardized patients.The Lancet regional health. Western Pacific · 2024Article
- Comparison of Primary Care Patients' and Unannounced Standardized Patients' Perceptions of Care.Journal of patient experience · 2023Article
- The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China.Journal of medical Internet research · 2022Article
- Patient-centered quality measurement for opioid use disorder: Development of a taxonomy to address gaps in research and practice.Substance abuse · 2022Review
- Simulation-based education: deceiving learners with good intent.Advances in simulation (London, England) · 2022Article
- Impact of an unannounced standardized veteran program on access to community-based services for veterans experiencing homelessness.Journal of public health (Oxford, England) · 2022Article
- Implementation of a patient-collected audio recording audit & feedback quality improvement program to prevent contextual error: stakeholder perspective.BMC health services research · 2021Article
- Videotaped Unannounced Standardized Patient Encounters to Evaluate Interpersonal and Communication Skills in Emergency Medicine Residents.AEM education and training · 2020Article
- Article
- Application of electronic trigger tools to identify targets for improving diagnostic safety.BMJ quality & safety · 2019Article
- Assessing Residents' Veteran-Centered Care Skills in the Clinical Setting.Journal of graduate medical education · 2018Article
- Increased Rates of Documented Alcohol Counseling in Primary Care: More Counseling or Just More Documentation?Journal of general internal medicine · 2018Article
- Large-Scale Evaluation of Quality of Care in 6 Countries of Eastern Europe and Central Asia Using Clinical Performance and Value Vignettes.Global health, science and practice · 2017Article
- Directly observed care: can unannounced standardized patients address a gap in performance measurement?Journal of general internal medicine · 2014Article
- A Critical Appraisal of AHRQ's "Diagnostic Errors" Report.Missouri medicineReview
- Assessing hormonal contraceptive dispensing and counseling provided by community pharmacists in the United Arab Emirates: a simulated patient study.Pharmacy practiceArticle
Corrections and comments
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Authors and funding
2 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
There are three potential sources of information for evaluating a clinician's performance: documentation, patient report, and directly observed care. Current measures draw on just two of these: data recorded in the medical record and surveys of patients. Neither captures an array of performance characteristics, including clinician attention to symptoms and signs while taking a history or conducting a physical exam, accurate recording in the medical record of information obtained during the encounter, evidence based communication strategies for preventive care counseling, and effective communication behavior. Unannounced Standardized Patients (USPs) have been widely deployed as a research strategy for systematically uncovering significant performance deficits in each of these areas, but have not been adopted for quality improvement. Likely obstacles include concerns about the ethics of sending health professionals sham patients, the technical challenges of the subterfuge, and concerns about the relatively small sample sizes and substantial costs involved. However, the high frequency of significant and remediable performance deficits unmasked by USPs, and the potential to adapt registration and record keeping systems to accommodate their visits, suggest that their selective and purposeful deployment could be a cost effective and powerful strategy for addressing a gap in performance measurement.
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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.