Pham Thao, Roy Carine, Mariette Xavier, Lioté Fréderic, Durieux Pierre, Ravaud Philippe
Department of Rheumatology, CHU Conception, 13005 Marseille, France.
BMC Health Serv Res. 2009 Jul 28;9:128. doi: 10.1186/1472-6963-9-128.
Clinical vignettes have been used widely to compare quality of clinical care and to assess variation in practice, but the effect of different response formats has not been extensively evaluated. Our objective was to compare three clinical vignette-based survey response formats - open-ended questionnaire (A), closed-ended (multiple-choice) questionnaire with deceptive response items mixed with correct items (B), and closed-ended questionnaire with only correct items (C) - in rheumatologists' pre-treatment assessment for tumor-necrosis-factor (TNF) blocker therapy.
Prospective randomized study.
Rheumatologists attending the 2004 French Society of Rheumatology meeting. Physicians were given a vignette describing the history of a fictitious woman with active rheumatoid arthritis, who was a candidate for therapy with TNF blocking agents, and then were randomized to receive questionnaire A, B, or C, each containing the same four questions but with different response formats, that asked about their pretreatment assessment.
Long (recommended items) and short (mandatory items) checklists were developed for pretreatment assessment for TNF-blocker therapy, and scores were expressed on the basis of responses to questionnaires A, B, and C as the percentage of respondents correctly choosing explicit items on these checklists.
Comparison of the selected items using pairwise Chi-square tests with Bonferonni correction for variables with statistically significant differences.
Data for all surveys distributed (114 As, 118 Bs, and 118 Cs) were complete and available for analysis. The percentage of questionnaire A, B, and C respondents for whom data was correctly complete for the short checklist was 50.4%, 84.0% and 95.0%, respectively, and was 0%, 5.0% and 5.9%, respectively, for the long version. As an example, 65.8%, 85.7% and 95.8% of the respondents of A, B, and C questionnaires, respectively, correctly identified the need for tuberculin skin test (p < 0.0001).
In evaluating clinical practice with use of a clinical vignette, a multiple-choice format rather than an open-ended format overestimates physician performance. The insertion of deceptive response items mixed with correct items in closed-ended (multiple-choice) questionnaire failed to avoid this overestimation.
临床病例已被广泛用于比较临床护理质量和评估实践差异，但不同回答格式的影响尚未得到广泛评估。我们的目的是比较三种基于临床病例的调查回答格式——开放式问卷（A）、带有与正确选项混合的欺骗性回答选项的封闭式（多项选择）问卷（B）和仅包含正确选项的封闭式问卷（C）——在风湿病学家对肿瘤坏死因子（TNF）阻滞剂治疗的治疗前评估中的应用。
前瞻性随机研究。
参加2004年法国风湿病学会会议的风湿病学家。给医生提供了一个描述一名患有活动性类风湿关节炎的虚构女性病史的病例，该女性是TNF阻滞剂治疗的候选者，然后将他们随机分为接受问卷A、B或C，每份问卷包含相同的四个问题，但回答格式不同，这些问题询问他们的治疗前评估。
制定了用于TNF阻滞剂治疗前评估的长（推荐项目）和短（必填项目）清单，并根据对问卷A、B和C的回答，将得分表示为在这些清单上正确选择明确项目的受访者的百分比。
使用成对卡方检验对选定项目进行比较，并对具有统计学显著差异的变量进行Bonferonni校正。
所有调查的数据（114份A问卷、118份B问卷和118份C问卷）均完整且可供分析。对于短清单，问卷A、B和C中数据正确完整的受访者百分比分别为50.4%、84.0%和95.0%，对于长版本分别为0%、5.0%和5.9%。例如，问卷A、B和C的受访者中，分别有65.8%、85.7%和95.8%正确识别了结核菌素皮肤试验的必要性（p<0.0001）。
在使用临床病例评估临床实践时，多项选择格式而非开放式格式高估了医生的表现。在封闭式（多项选择）问卷中插入与正确选项混合的欺骗性回答选项并不能避免这种高估。
