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Diagnostic certainty as a source of medical practice variation in coronary heart disease: results from a cross-national experiment of clinical decision making
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Lutfey, Karen E., Link, Carol L., Marceau, Lisa D., Grant, Richard W., Adams, Ann, Arber, Sora, Siegrist, Johannes, Boente, Markus, von dem Knesebeck, Olaf and McKinlay, John B.. (2009) Diagnostic certainty as a source of medical practice variation in coronary heart disease: results from a cross-national experiment of clinical decision making. Medical Decision Making, Vol.29 (No.5). pp. 606-618. ISSN 0272-989X
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Official URL: http://dx.doi.org/10.1177/0272989X09331811
Abstract
The authors examined physician diagnostic certainty as one reason for cross-notional 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 core 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.
| Item Type: | Journal Article |
|---|---|
| Subjects: | H Social Sciences > HV Social pathology. Social and public welfare R Medicine |
| Divisions: | Faculty of Medicine > Warwick Medical School > Mental Health and Wellbeing Faculty of Medicine > Warwick Medical School |
| Journal or Publication Title: | Medical Decision Making |
| Publisher: | Sage Publications, Inc. |
| ISSN: | 0272-989X |
| Official Date: | September 2009 |
| Volume: | Vol.29 |
| Number: | No.5 |
| Number of Pages: | 13 |
| Page Range: | pp. 606-618 |
| Identification Number: | 10.1177/0272989X09331811 |
| Status: | Peer Reviewed |
| Publication Status: | Published |
| Access rights to Published version: | Restricted or Subscription Access |
| URI: | http://wrap.warwick.ac.uk/id/eprint/17157 |
Data sourced from Thomson Reuters' Web of Knowledge
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