Krane N Kevin, Anderson Delia, Lazarus Cathy J, Termini Michael, Bowdish Bruce, Chauvin Sheila, Fonseca Vivian
Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA 70112-2699, USA.
J Gen Intern Med. 2009 Jan;24(1):53-6. doi: 10.1007/s11606-008-0826-3. Epub 2008 Oct 31.
Measuring actual practice behaviors of physicians, particularly as they relate to established clinical guidelines, is challenging. Standardized patients provide one method of collecting such data.
To demonstrate the use of unannounced standardized patients in gathering data that may address adherence to guidelines in an office setting.
Unannounced standardized patients (SPs) simulating an initial type 2 diabetic visit presented to community offices of 32 internists as "real" patients to record physicians' evaluation and management.
Unannounced SPs presented to the office of 32 internists as "real" patients.
Unannounced SPs, simulating type 2 diabetics, completed a standardized assessment sheet, based on ADA guidelines to record physicians' evaluation and management following an initial visit. Patient charts were also reviewed to determine if evaluation adhered to the guidelines.
Unannounced SPs recorded 56 visits with 32 community internists; all SPs remained undetected. All physicians asked SPs about medications. At least 50% of physicians asked about home blood sugar monitoring, last eye exam, smoking, edema, and told patients to stop smoking. Less than 50% of physicians asked about parasthesias, performed fundoscopy, examined feet, referred the patient to a diabetic educator or ophthalmologist, or gave patients suggestions regarding glucose monitoring or exercise. HbA1c was ordered in 78%, metabolic profiles in 86%, and urinalysis/microalbumin in 41% of patients.
Unannounced standardized patients can successfully collect important data regarding physician practices in community settings. This method may be helpful in assessing physician adherence to established clinical practice guidelines.
衡量医生的实际执业行为，尤其是与既定临床指南相关的行为，具有挑战性。标准化病人提供了一种收集此类数据的方法。
展示使用未事先通知的标准化病人收集数据，这些数据可能有助于了解在门诊环境中对指南的遵循情况。
未事先通知的标准化病人（SPs）模拟2型糖尿病初诊患者，作为“真实”患者前往32位内科医生的社区门诊，以记录医生的评估和管理情况。
未事先通知的标准化病人作为“真实”患者前往32位内科医生的门诊。
未事先通知的标准化病人模拟2型糖尿病患者，根据美国糖尿病协会（ADA）指南完成一份标准化评估表，以记录初诊后医生的评估和管理情况。还查阅了患者病历，以确定评估是否符合指南。
未事先通知的标准化病人记录了与32位社区内科医生的56次就诊；所有标准化病人均未被察觉。所有医生都询问了标准化病人的用药情况。至少50%的医生询问了家庭血糖监测、上次眼科检查、吸烟、水肿情况，并告知患者戒烟。不到50%的医生询问了感觉异常情况、进行了眼底镜检查、检查了足部、将患者转诊给糖尿病教育者或眼科医生，或就血糖监测或运动向患者提供建议。78%的患者进行了糖化血红蛋白（HbA1c）检测，86%的患者进行了代谢指标检测，41%的患者进行了尿液分析/微量白蛋白检测。
未事先通知的标准化病人能够成功收集有关社区环境中医生执业情况的重要数据。这种方法可能有助于评估医生对既定临床实践指南的遵循情况。
