Can Vignettes Be Used to Improve Practice & Outcome

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT00122148
Recruitment Status : Terminated
First Posted : July 21, 2005
Last Update Posted : February 8, 2010
Information provided by:
VA Office of Research and Development

July 18, 2005
July 21, 2005
February 8, 2010
September 2005
Not Provided
Disease-specific patient care indicators, comparing results at six months.
Same as current
Complete list of historical versions of study NCT00122148 on Archive Site
Not Provided
Not Provided
Not Provided
Not Provided
Can Vignettes Be Used to Improve Practice & Outcome
Can Vignettes be Used to Improve Practice and Outcomes?
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
  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.
Not Applicable
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Behavioral: Feedback on provision of care
Intervention: Behavioral: Feedback on provision of care
Peabody JW, Luck J, Jain S, Bertenthal D, Glassman P. Assessing the accuracy of administrative data in health information systems. Med Care. 2004 Nov;42(11):1066-72.

*   Includes publications given by the data provider as well as publications identified by Identifier (NCT Number) in Medline.
Not Provided
June 2006
Not Provided

Inclusion Criteria:

Physician at SF VAMC with panel of primary care patients

Exclusion Criteria:

Sexes Eligible for Study: All
Child, Adult, Older Adult
Contact information is only displayed when the study is recruiting subjects
United States
IIR 01-189
Not Provided
Not Provided
Jain, Sharad - Principal Investigator, Department of Veterans Affairs
VA Office of Research and Development
Not Provided
Principal Investigator: Sharad Jain, MD San Francisco
VA Office of Research and Development
August 2006

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP