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BMJ. 2002 Sep 28;325(7366):679.

Using standardised patients to measure physicians' practice: validation study using audio recordings.

Author information

  • 1Veterans Administration, Greater Los Angeles Healthcare System, 11 301 Wilshire Blvd, Los Angeles, CA 90073, USA.

Abstract

OBJECTIVE:

To assess the validity of standardised patients to measure the quality of physicians' practice.

DESIGN:

Validation study of standardised patients' assessments. Physicians saw unannounced standardised patients presenting with common outpatient conditions. The standardised patients covertly tape recorded their visit and completed a checklist of quality criteria immediately afterwards. Their assessments were compared against independent assessments of the recordings by a trained medical records abstractor.

SETTING:

Four general internal medicine primary care clinics in California.

PARTICIPANTS:

144 randomly selected consenting physicians.

MAIN OUTCOME MEASURES:

Rates of agreement between the patients' assessments and independent assessment.

RESULTS:

40 visits, one per standardised patient, were recorded. The overall rate of agreement between the standardised patients' checklists and the independent assessment of the audio transcripts was 91% (kappa=0.81). Disaggregating the data by medical condition, site, level of physicians' training, and domain (stage of the consultation) gave similar rates of agreement. Sensitivity of the standardised patients' assessments was 95%, and specificity was 85%. The area under the receiver operator characteristic curve was 90%.

CONCLUSIONS:

Standardised patients' assessments seem to be a valid measure of the quality of physicians' care for a variety of common medical conditions in actual outpatient settings. Properly trained standardised patients compare well with independent assessment of recordings of the consultations and may justify their use as a "gold standard" in comparing the quality of care across sites or evaluating data obtained from other sources, such as medical records and clinical vignettes.

Comment in

PMID:
12351358
[PubMed - indexed for MEDLINE]
PMCID:
PMC126653
Free PMC Article

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