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Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making

Lutfey, KE, Link, C, Marceau, C, Grant, RW, Adams, A, Arber, S, Siegrist, J, Bonte. M, , von dem Knesebeck, O and McKinlay, J (2009) Diagnostic Certainty as a Source of Medical Practice Variation in Coronary Heart Disease: Results from a Cross-National Experiment of Clinical Decision Making Medical Decision Making, 29 (5). pp. 606-618.

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Abstract

The authors examined physician diagnostic certainty as one reason for cross-national medical practice variation. Data are from a factorial experiment conducted in the United States, the United Kingdom, and Germany, estimating 384 generalist physicians’ diagnostic and treatment decisions for videotaped vignettes of actor patients depicting a presentation consistent with coronary heart disease (CHD). Despite identical vignette presentations, the authors observed significant differences across health care systems, with US physicians being the most certain and German physicians the least certain (P < 0.0001). Physicians were least certain of a CHD diagnoses when patients were younger and female (P < 0.0086), and there was additional variation by health care system (as represented by country) depending on patient age (P < 0.0100) and race (P < 0.0021). Certainty was positively correlated with several clinical actions, including test ordering, prescriptions, referrals to specialists, and time to follow-up.

Item Type: Article
Divisions : Faculty of Arts and Social Sciences > Department of Sociology
Authors :
AuthorsEmailORCID
Lutfey, KEUNSPECIFIEDUNSPECIFIED
Link, CUNSPECIFIEDUNSPECIFIED
Marceau, CUNSPECIFIEDUNSPECIFIED
Grant, RWUNSPECIFIEDUNSPECIFIED
Adams, AUNSPECIFIEDUNSPECIFIED
Arber, SUNSPECIFIEDUNSPECIFIED
Siegrist, JUNSPECIFIEDUNSPECIFIED
Bonte. M, UNSPECIFIEDUNSPECIFIED
von dem Knesebeck, OUNSPECIFIEDUNSPECIFIED
McKinlay, JUNSPECIFIEDUNSPECIFIED
Date : 2009
Identification Number : 10.1177/0272989X09331811
Related URLs :
Additional Information : Published in Medical Decision Making, 29(5), 2009. Copyright 2009 Sage Publications
Depositing User : Symplectic Elements
Date Deposited : 31 Jan 2013 11:05
Last Modified : 23 Sep 2013 19:18
URI: http://epubs.surrey.ac.uk/id/eprint/293563

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