A method for selecting criteria to evaluate medical care.

Area of Science:

• Medical research
• Health services research
• Clinical practice guidelines

Background:

• Assessing medical care quality requires understanding physician process criteria.
• Existing methods for eliciting these criteria may have limitations.

Purpose of the Study:

• To evaluate a questionnaire method for gathering physician opinions on clinical actions for infant respiratory infections.
• To assess the reliability and validity of this questionnaire method by comparing opinions to recorded practice.

Main Methods:

• National samples of family physicians, pediatricians, and pediatric infectious disease specialists received questionnaires.
• Questionnaires presented 125 clinical scenarios regarding infant respiratory infections.
• Physician opinions were compared to their medical records for a subset of participants.

Main Results:

• A majority of surveyed physicians favored most clinical actions, with few opposed.
• Opinions on specific diagnostic tests and treatments varied significantly by clinical situation.
• Physician opinions showed stability over one year, particularly for favored actions.
• Only 55% of actions favored in questionnaires were reflected in corresponding medical records.

Conclusions:

• The questionnaire method is a feasible, specific, and reliable tool for identifying clinical opinions.
• Significant discordance exists between physician-expressed opinions and documented clinical practice.
• Further research is needed to bridge the gap between perceived and actual medical care.