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dc.contributor.authorMcKinlay, J. B.en_US
dc.contributor.authorLink, C. L.en_US
dc.contributor.authorFreund, K. M.en_US
dc.contributor.authorMarceau, L. D.en_US
dc.contributor.authorO'Donnell, A. B.en_US
dc.contributor.authorLutfey, K. L.en_US
dc.date.accessioned2012-01-09T20:58:07Z
dc.date.available2012-01-09T20:58:07Z
dc.date.issued2007-1-9en_US
dc.identifier.citationMcKinlay, 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.issn1525-1497en_US
dc.identifier.urihttp://hdl.handle.net/2144/2933
dc.description.abstractBACKGROUND 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.sponsorshipNational Institute on Aging (AG16747)en_US
dc.language.isoenen_US
dc.publisherSpringer-Verlagen_US
dc.rightsCopyright Society of General Internal Medicine 2007en_US
dc.subjectClinical decision makingen_US
dc.subjectGuidelinesen_US
dc.subjectDisparityen_US
dc.titleSources of Variation in Physician Adherence with Clinical Guidelines: Results from a Factorial Experimenten_US
dc.typearticleen_US
dc.identifier.doi10.1007/s11606-006-0075-2en_US
dc.identifier.pubmedid17356957en_US
dc.identifier.pmcid1824760en_US


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