Patricia Plaum, Laura N Visser, Bas de Groot, Marlies E B Morsink, Wilma L J M Duijst, Bart G J Candel
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引用次数: 0
Abstract
Background and importance: Various biases can impact decision-making and judgment of case quality in the Emergency Department (ED). Outcome and hindsight bias can lead to wrong retrospective judgment of care quality, and implicit bias can result in unjust treatment differences in the ED based on irrelevant patient characteristics.
Objectives: First, to evaluate the extent to which knowledge of an outcome influences physicians' quality of care assessment. Secondly, to examine whether patients with functional disorders receive different treatment compared to patients with a somatic past medical history.
Design: A web-based cross-sectional study in which physicians received case vignettes with a case description and care provided. Physicians were informed about vignette outcomes in a randomized way (no, good, or bad outcome). Physicians rated quality of care for four case vignettes with different outcomes. Subsequently, they received two more case vignettes. Physicians were informed about the past medical history of the patient in a randomized way (somatic or functional). Physicians made treatment and diagnostic decisions for both cases.
Setting and participants: One hundred ninety-one Dutch emergency physicians (EPs) and general practitioners (GPs) participated.
Outcome measures and analysis: Quality of care was rated on a Likert scale (0-5) and dichotomized as adequate (yes/no). Physicians estimated the likelihood of patients experiencing a bad outcome for hindsight bias. For the second objective, physicians decided on prescribing analgesics and additional diagnostic tests.
Main results: Large differences existed in rated quality of care for three out of four vignettes based on different case outcomes. For example, physicians rated the quality of care as adequate in 44% (95% CI 33-57%) for an abdominal pain case with a bad outcome, compared to 88% (95% CI 78-94%) for a good outcome, and 84% (95% CI 73-91%) for no outcome ( P < 0.01). The estimated likelihood of a bad outcome was higher if physicians received a vignette with a bad patient outcome. Fewer diagnostic tests were performed and fewer opioids were prescribed for patients with a functional disorder.
Conclusion: Outcome, hindsight, and implicit bias significantly influence decision-making and care quality assessment by Dutch EPs and GPs.
背景和重要性：各种偏见会影响急诊科（ED）的决策和对病例质量的判断。结果偏差和事后偏差会导致对护理质量做出错误的回顾性判断，而内隐偏差则会导致在急诊科根据无关的患者特征进行不公正的治疗：首先，评估对结果的了解在多大程度上影响了医生对护理质量的评估。其次，研究功能性障碍患者与有躯体性既往病史的患者相比，是否接受了不同的治疗：设计：一项基于网络的横断面研究，医生会收到包含病例描述和所提供护理的病例小故事。医生以随机方式获知小故事的结果（无结果、好结果或坏结果）。医生对四个不同结果的病例小故事的护理质量进行评分。随后，他们又收到了两个病例小故事。医生以随机方式（躯体或功能）了解病人的既往病史。医生对两个病例做出治疗和诊断决定：结果测量与分析：以李克特量表（0-5）对医疗质量进行评分，并将其二分为适当（是/否）。医生会估计患者出现不良后果的可能性，以防事后诸葛亮。对于第二个目标，医生决定是否开具镇痛药和进行额外的诊断检测：主要结果：根据不同的病例结果，在四个小故事中，有三个小故事的护理质量评分存在很大差异。例如，对于结果不佳的腹痛病例，44%（95% CI 33-57%）的医生将护理质量评为适当，而对于结果良好的病例，88%（95% CI 78-94%）的医生将护理质量评为适当，而对于无结果的病例，84%（95% CI 73-91%）的医生将护理质量评为适当：结果、后见之明和隐性偏见对荷兰急诊医生和全科医生的决策和护理质量评估有重大影响。
期刊介绍：
The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field.
Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community.
Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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