Physician practice behavior and practice guidelines: using unannounced standardized patients to gather data.
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.


METHODS
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.


METHODS
Unannounced SPs presented to the office of 32 internists as "real" patients.


METHODS
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.
Krane
N Kevin
NK
Department of Medicine, Tulane University Health Sciences Center, New Orleans, LA 70112-2699, USA. kkrane@tulane.edu
Anderson
Delia
D
Lazarus
Cathy J
CJ
Termini
Michael
M
Bowdish
Bruce
B
Chauvin
Sheila
S
Fonseca
Vivian
V
D001071:Appointments and Schedules; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D007396:Internship and Residency / Q000592:standards; D016544:Patient Simulation; D010817:Physician-Patient Relations; D010820:Physicians / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011364:Professional Practice / Q000592:standards*; D013337:Students, Medical