Journal of General Internal Medicine

, Volume 24, Issue 1, pp 53–56

Physician Practice Behavior and Practice Guidelines: Using Unannounced Standardized Patients to Gather Data

  • N. Kevin Krane
  • Delia Anderson
  • Cathy J. Lazarus
  • Michael Termini
  • Bruce Bowdish
  • Sheila Chauvin
  • Vivian Fonseca
Original Article

DOI: 10.1007/s11606-008-0826-3

Cite this article as:
Krane, N.K., Anderson, D., Lazarus, C.J. et al. J GEN INTERN MED (2009) 24: 53. doi:10.1007/s11606-008-0826-3

Abstract

Background

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.

Objective

To demonstrate the use of unannounced standardized patients in gathering data that may address adherence to guidelines in an office setting.

Design

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.

Participants

Unannounced SPs presented to the office of 32 internists as “real” patients.

Measurements

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.

Results

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.

Conclusions

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.

KEY WORDS

standardized patients practice guidelines 

Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • N. Kevin Krane
    • 1
    • 2
  • Delia Anderson
    • 1
  • Cathy J. Lazarus
    • 1
  • Michael Termini
    • 1
  • Bruce Bowdish
    • 1
  • Sheila Chauvin
    • 1
  • Vivian Fonseca
    • 1
    • 2
  1. 1.Tulane University Health Sciences CenterNew OrleansUSA
  2. 2.Department of MedicineTulane University School of MedicineNew OrleansUSA

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