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Physician practice behavior and practice guidelines: using unannounced standardized patients to gather data.
N Kevin Krane1, Delia Anderson, Cathy J Lazarus
1Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA 70112-2699, USA. kkrane@tulane.edu
Journal of General Internal Medicine
|November 1, 2008
Summary
Unannounced standardized patients successfully gathered data on physician practices for type 2 diabetes care. This method effectively assesses adherence to clinical guidelines in real-world settings.
Area of Science:
- Medical Practice Evaluation
- Clinical Guideline Adherence
- Physician Performance Measurement
Background:
- Assessing physician practice behaviors related to clinical guidelines is difficult.
- Standardized patients offer a viable method for collecting practice behavior data.
Purpose of the Study:
- To demonstrate the utility of unannounced standardized patients in evaluating physician adherence to type 2 diabetes guidelines within office settings.
Main Methods:
- Unannounced standardized patients (SPs) simulated type 2 diabetic visits with 32 internists.
- SPs used a standardized assessment based on American Diabetes Association (ADA) guidelines.
- Physician evaluation and management were recorded, and patient charts were reviewed.
Main Results:
- Unannounced SPs completed 56 visits undetected.
- Physicians frequently inquired about medications (100%) and lifestyle (≥50%).
- Key guideline adherence gaps were noted in foot exams, eye referrals, and patient education.
Conclusions:
- Unannounced standardized patients are effective in collecting practice data in community settings.
- This methodology can be valuable for assessing physician adherence to clinical practice guidelines.
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