Weiner Saul J, Schwartz Alan, Yudkowsky Rachel, Schiff Gordon D, Weaver Frances M, Goldberg Julie, Weiss Kevin B
Department of Medicine, University of Illinois at Chicago, Chicago, Illinois 60612, USA.
Med Decis Making. 2007 Nov-Dec;27(6):726-34. doi: 10.1177/0272989X07306113. Epub 2007 Sep 26.
Clinical decision making requires 2 distinct cognitive skills: the ability to classify patients' conditions into diagnostic and management categories that permit the application of research evidence and the ability to individualize or-more specifically-to contextualize care for patients whose circumstances and needs require variation from the standard approach to care. The purpose of this study was to develop and test a methodology for measuring physicians' performance at contextualizing care and compare it to their performance at planning biomedically appropriate care.
First, the authors drafted 3 cases, each with 4 variations, 3 of which are embedded with biomedical and/or contextual information that is essential to planning care. Once the cases were validated as instruments for assessing physician performance, 54 internal medicine residents were then presented with opportunities to make these preidentified biomedical or contextual errors, and data were collected on information elicitation and error making.
The case validation process was successful in that, in the final iteration, the physicians who received the contextual variant of cases proposed an alternate plan of care to those who received the baseline variant 100% of the time. The subsequent piloting of these validated cases unmasked previously unmeasured differences in physician performance at contextualizing care. The findings, which reflect the performance characteristics of the study population, are presented.
This pilot study demonstrates a methodology for measuring physician performance at contextualizing care and illustrates the contribution of such information to an overall assessment of physician practice.
临床决策需要两种不同的认知技能：将患者病情分类到可应用研究证据的诊断和管理类别中的能力，以及针对情况和需求需要偏离标准护理方法的患者进行个性化护理（更具体地说，是情境化护理）的能力。本研究的目的是开发并测试一种衡量医生情境化护理表现的方法，并将其与医生规划生物医学上适当护理的表现进行比较。
首先，作者起草了3个病例，每个病例有4种变体，其中3种嵌入了规划护理所必需的生物医学和/或情境信息。一旦这些病例被验证为评估医生表现的工具，54名内科住院医师就有机会犯这些预先确定的生物医学或情境错误，并收集有关信息获取和犯错的数据。
病例验证过程是成功的，因为在最后一轮中，收到病例情境变体的医生100%的时间都比收到基线变体的医生提出了不同的护理计划。随后对这些经过验证的病例进行的试点揭示了医生在情境化护理方面以前未被测量到的表现差异。呈现了反映研究人群表现特征的研究结果。
这项试点研究展示了一种衡量医生情境化护理表现的方法，并说明了此类信息对医生实践总体评估的贡献。
