Sources of Variation in Physician Adherence with Clinical Guidelines: Results from a Factorial Experiment


Show simple item record McKinlay, J. B. en_US Link, C. L. en_US Freund, K. M. en_US Marceau, L. D. en_US O'Donnell, A. B. en_US Lutfey, K. L. en_US 2012-01-09T20:58:07Z 2012-01-09T20:58:07Z 2007-1-9 en_US
dc.identifier.citation McKinlay, J. B., C. L. Link, K. M. Freund, L. D. Marceau, A. B. O'Donnell, K. L. Lutfey. "Sources of Variation in Physician Adherence with Clinical Guidelines: Results from a Factorial Experiment" Journal of General Internal Medicine 22(3): 289-296. (2007) en_US
dc.identifier.issn 1525-1497 en_US
dc.description.abstract BACKGROUND Health services research has documented the magnitude of health care variations. Few studies focus on provider level sources of variation in clinical decision making-for example, which primary care providers are likely to follow clinical guidelines, with which types of patient. OBJECTIVES To estimate: (1) the extent of primary care provider adherence to practice guidelines and the unconfounded influence of (2) patient attributes and (3) physician characteristics on adherence with clinical practice guidelines. DESIGN In a factorial experiment, primary care providers were shown clinically authentic video vignettes with actors portrayed different "patients" with identical signs of coronary heart disease (CHD). Different types of providers were asked how they would manage the different "patients" with identical CHD symptoms. Measures were taken to protect external validity. RESULTS Adherence to some guidelines is high (over 50% of physicians would follow a third of the recommended actions), yet there is low adherence to many of them (less than 20% would follow another third). Female patients are less likely than males to receive 4 of 5 types of physical examination (p<.03); older patients are less likely to be advised to stop smoking (p<.03). Race and SES of patients had no effect on provider adherence to guidelines. A physicians' level of experience (age) appears to be important with certain patients. CONCLUSIONS Physician adherence with guidelines varies with different types of "patient" and with the length of clinical experience. With this evidence it is possible to appropriately target interventions to reduce health care variations by improving physician adherence with clinical guidelines. en_US
dc.description.sponsorship National Institute on Aging (AG16747) en_US
dc.language.iso en en_US
dc.publisher Springer-Verlag en_US
dc.rights Copyright Society of General Internal Medicine 2007 en_US
dc.subject Clinical decision making en_US
dc.subject Guidelines en_US
dc.subject Disparity en_US
dc.title Sources of Variation in Physician Adherence with Clinical Guidelines: Results from a Factorial Experiment en_US
dc.type article en_US
dc.identifier.doi 10.1007/s11606-006-0075-2 en_US
dc.identifier.pubmedid 17356957 en_US
dc.identifier.pmcid 1824760 en_US

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