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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. doi:10.1177/0272989X09331811

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Official URL: http://dx.doi.org/10.1177/0272989X09331811

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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 > Health Sciences > 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
Dates:
DateEvent
September 2009Published
Volume: Vol.29
Number: No.5
Number of Pages: 13
Page Range: pp. 606-618
DOI: 10.1177/0272989X09331811
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Restricted or Subscription Access

Data sourced from Thomson Reuters' Web of Knowledge

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