The Use of Clinical Vignettes To Measure the Quality of Health Care FREE

The ability to measure the quality of health care is important for efforts to improve care. One common way to measure the quality of health care provided by doctors is to review what the doctor writes in the medical chart. This is easy to do but is often inaccurate because doctors do not always write down everything they think about or do. A second way uses standardized patients; these are people who are trained to act like patients and observe whether the doctor asks the right questions, examines the most important parts of the body, and orders the right tests and treatments. Standardized patients provide very accurate measures of quality but are expensive to use. A third method, clinical vignettes, might solve some of these problems. With clinical vignettes, doctors are asked questions about what they would ask or do for a hypothetical patient. Doctors' responses to the questions might provide information similar to that provided by standardized patients at a cheaper cost. However, the accuracy of clinical vignettes for measuring quality needs to be determined.

To see whether clinical vignettes accurately measure the quality of health care provided by doctors.

116 doctors at 2 Veterans Affairs and 2 private medical centers in California; 40 doctors were trainees in internal medicine training programs.

Over the course of a year, the doctors completed 8 clinical vignettes that simulated patients with common diseases. At different times in the same year, the doctors saw 8 standardized patients with the same diseases. The information about quality from the clinical vignettes was compared with that gathered by standardized patients and from a review of what the doctors wrote in the medical record about those patients.

Compared with standardized patients, clinical vignettes more clearly reflected quality of care than did the medical record review.

Clinical vignettes provide no information about whether a doctor's decisions actually improve the health of patients. The important decisions they assess in one visit might really take place over many visits. Also, the vignettes provide no information about other important aspects of high-quality health care, such as a doctor's concern for patients.

Clinical vignettes may be an accurate, inexpensive way to measure the quality of care provided by doctors for common diseases. They have limitations, however, and should not be the only tool used to measure quality.