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Can Vignettes Be Used to Improve Practice & Outcome

This study has been terminated.
Information provided by:
VA Office of Research and Development Identifier:
First received: July 18, 2005
Last updated: February 4, 2010
Last verified: August 2006
This is a pilot study to first measure the cross-sectional relationship between variations in physicians� vignette scores and aggregated scores of individual physicians� patient health outcomes; and second to (longitudinally) determine whether feedback of vignette scores improves physicians� clinical performance as measured by vignettes

Condition Intervention
Healthy Behavioral: Feedback on provision of care

Study Type: Interventional
Study Design: Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: Open Label
Official Title: Can Vignettes be Used to Improve Practice and Outcomes?

Further study details as provided by VA Office of Research and Development:

Primary Outcome Measures:
  • Disease-specific patient care indicators, comparing results at six months.

Study Start Date: September 2005
Study Completion Date: June 2006
Arms Assigned Interventions
1 Behavioral: Feedback on provision of care

Detailed Description:
  1. Study Design: Physicians will complete computerized vignettes for four conditions � diabetes, coronary artery diseases (CAD), chronic obstructive pulmonary disease (COPD), and depression. We will collect retrospective outcomes data and develop composite outcome measures for on two conditions, Diabetes and CAD. For the longitudinal analysis, only vignette data will be collected and fed back to providers. Feedback will consist of specific data on vignette outcome scores for the individual physicians and for the sites overall.
  2. Site Selection: Primary care clinics at 2 VAMCs
  3. Study Population and Sampling: We will enroll primary care physicians at 2 VAMCs. 30 consenting physicians will be prospectively randomized into two groups. One group will receive feedback of their vignette scores, and the other group will serve as control, receiving no feedback.
  4. Variables and Measurement Instruments: Computerized vignettes measuring clinical practice completed by the physicians for diabetes, CAD, COPD, and Depression and a composite health outcome measures from the medical records of these physicians� patients with diabetes and CAD.
  5. Data Collection Strategy and Timeline: Vignettes will be administered to all physicians at baseline, with feedback of scores 3 months later and readministration of vignettes 9 months thereafter to measure the trend in improvement. The composite outcome data will only be collected at baseline only.
  6. Data Analysis: The statistical analysis will compare the effects within the context of an analysis of covariance (ANCOVA) model. The analyte is the quality of care physicians give to patients with four common conditions. The relationship between vignette scores and patient outcomes will be modeled accounting for clustering effects. The prospective experimental design will be used to quantify possible differences between the intervention and control groups. The data will be analyzed using a three-way crossed, one-way nested ANCOVA model where the covariate is the baseline vignette score. This model can be used to look at case effects, by domain, level of training, and by site.

Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

Physician at SF VAMC with panel of primary care patients

Exclusion Criteria:

  Contacts and Locations
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Please refer to this study by its identifier: NCT00122148

United States, California
San Francisco
San Francisco, California, United States, 94121-1598
Sponsors and Collaborators
VA Office of Research and Development
Principal Investigator: Sharad Jain, MD San Francisco
  More Information

Responsible Party: Jain, Sharad - Principal Investigator, Department of Veterans Affairs Identifier: NCT00122148     History of Changes
Other Study ID Numbers: IIR 01-189
Study First Received: July 18, 2005
Last Updated: February 4, 2010

Keywords provided by VA Office of Research and Development:
Quality of health care
Feedback processed this record on June 22, 2017