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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

Brief Summary:
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 or disease Intervention/treatment Phase
Healthy Behavioral: Feedback on provision of care Not Applicable

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.

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Study Type : Interventional  (Clinical Trial)
Allocation: Randomized
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Official Title: Can Vignettes be Used to Improve Practice and Outcomes?
Study Start Date : September 2005
Actual Study Completion Date : June 2006

Arm Intervention/treatment
1 Behavioral: Feedback on provision of care

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

Information from the National Library of Medicine

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

Inclusion Criteria:

Physician at SF VAMC with panel of primary care patients

Exclusion Criteria:


Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT00122148

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United States, California
San Francisco
San Francisco, California, United States, 94121-1598
Sponsors and Collaborators
US Department of Veterans Affairs
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Principal Investigator: Sharad Jain, MD San Francisco
Publications of Results:
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Responsible Party: Jain, Sharad - Principal Investigator, Department of Veterans Affairs Identifier: NCT00122148    
Other Study ID Numbers: IIR 01-189
First Posted: July 21, 2005    Key Record Dates
Last Update Posted: February 8, 2010
Last Verified: August 2006
Keywords provided by VA Office of Research and Development:
Quality of health care