One Size Does Not Fit All: Questions to Answer Before Intervening to Change Physician Behavior
The Joint Commission Journal on Quality ImprovementPublished 1 September 1999
Roy M. Poses
Citations35
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TL;DR
Physicians' behavior appears to be resistant to change, and understanding why the behavior should be changed and what caused it may make the process of designing interventions more complicated.
Abstract
Physicians' behavior appears to be resistant to change. Understanding why the behavior should be changed and what caused it may make the process of designing interventions more complicated. The resulting interventions, however, are more likely to be simple and successful.
Keywords
MedicineEconomics, Econometrics and FinanceHealth Professions
Journal of Personality and Social PsychologyUnrealistic optimism about future life events.
4,826 Citations1980Neil D. Weinstein
Journal of Personality and Social PsychologyThe illusion of control.
3,675 Citations1975Ellen J. Langer
JAMAA controlled trial to improve care for seriously ill hospitalized patients. The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators
2,779 Citations1995Alfred F. Connors, Neal V. Dawson +198 more
The phase I observation of SUPPORT confirmed substantial shortcomings in care for seriously ill hospitalized adults and the phase II intervention failed to improve care or patient outcomes.
JAMAChanging physician performance. A systematic review of the effect of continuing medical education strategies
2,602 Citations1995D A Davis
BMJClosing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings
2,337 Citations1998Lisa Bero, Roberto Grilli +4 more
This paper examines systematic reviews of different strategies for the dissemination and implementation of research findings to identify evidence of the effectiveness of different strategies and to assess the quality of the systematic reviews.
JAMAA Controlled Trial to Improve Care for Seriously III Hospitalized Patients
2,284 Citations1995Alfred F. Connors
PubMedNo magic bullets: a systematic review of 102 trials of interventions to improve professional practice.
1,870 Citations1995AD Oxman, M. Thomson +2 more
There are no "magic bullets" for improving the quality of health care, but there are a wide range of interventions available that, if used appropriately, could lead to important improvements in professional practice and patient outcomes.
PubMedEffects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review.
1,690 Citations1998Dereck L. Hunt, R. Brian Haynes +2 more
The CDSSs can enhance clinical performance for drug dosing, preventive care, and other aspects of medical care, but not convincingly for diagnosis.
JAMAChanging Physician Performance
1,690 Citations1995David A. Davis
Widely used CME delivery methods such as conferences have little direct impact on improving professional practice, and more effective methods such as systematic practice-based interventions and outreach visits are seldom used by CME providers.
PubMedTranslating guidelines into practice. A systematic review of theoretic concepts, practical experience and research evidence in the adoption of clinical practice guidelines.
1,227 Citations1997Dave A. Davis, Anne Taylor‐Vaisey
The evidence shows serious deficiencies in the adoption of CPGs in practice and future implementation strategies must overcome this failure through an understanding of the forces and variables influencing practice and through the use of methods that are practice- and community-based rather than didactic.
Organizational Behavior and Human PerformanceDo those who know more also know more about how much they know?
1,086 Citations1977Sarah Lichtenstein, Baruch Fischhoff
JAMAUsers' Guides to the Medical Literature
701 Citations1994Gordon Guyatt
A general internist is asked to see a 65-year-old man with controlled hypertension and a 6-month history of atrial fibrillation resistant to cardioversion, who has no evidence for valvular or coronary heart disease, and who shares concerns about the benefits of long-term anticoagulant therapy.
IEEE Transactions on Systems Man and CyberneticsDirect comparison of the efficacy of intuitive and analytical cognition in expert judgment
572 Citations1987Kenneth R. Hammond, Robert M. Hamm +2 more
Direct comparisons were made of expert highway engineers' use of analytical, quasirational, and intuitive cognition on three different tasks, each displayed in three different ways, showing that the location of the task on the task index induced the expert's cognition to be located at the corresponding region on the cognitive continuum index.
Psychological BulletinEffects of cognitive feedback on performance.
476 Citations1989William K. Balzer, Michael E. Doherty +1 more
Annals of Internal MedicineUse of the Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI) To Assist with Triage of Patients with Chest Pain or Other Symptoms Suggestive of Acute Cardiac Ischemia: A Multicenter, Controlled Clinical Trial
356 Citations1998H P Selker, Joni R. Beshansky +17 more
A clinical trial is reported to test the effect of electrocardiogram-based ACI-TIPI on emergency department triage of patients with chest pain or other symptoms suggestive of acute cardiac ischemia and whether its use would reduce unnecessary hospital and CCU admission for emergency department patients without cardiac ischemic disease or with stable angina pectoris while not reducing hospitalization.
BMJEffects of feedback of information on clinical practice: a review.
335 Citations1991Miranda Mugford, Philip Banfield +1 more
It is important that the use of information in the audit process should be critically evaluated, given the cost of information processing and the current emphasis on closing the audit loop in the health services.
Organizational Behavior and Human Decision ProcessesEffects of Procedural and Outcome Accountability on Judgment Quality
329 Citations1996Karen Siegel-Jacobs, J. Frank Yates
Current AnthropologyLikeness and Likelihood in Everyday Thought: Magical Thinking in Judgments About Personality [and Comments and Reply]
311 Citations1977Richard A. Shweder, Joseph B. Casagrande +4 more
International Journal of ForecastingJudgment and Decision Making: An Interdisciplinary Reader
299 Citations2000Paul Goodwin
BMJHuman and Computer-aided Diagnosis of Abdominal Pain: Further Report with Emphasis on Performance of Clinicians
282 Citations1974F T de Dombal, D J Leaper +3 more
It is suggested that while computer-aided diagnosis is a valuable direct adjunct to the clinician dealing with the “acute abdomen,” he may also benefit in the short-term from the constant feedback he receives and from the disciplines and constraints involved in communicating with the computer.
Organizational Behavior and Human Decision ProcessesTwo methods of reducing overconfidence
277 Citations1987Hal R. Arkes, Caryn Christensen +2 more
Organizational Behavior and Human Decision ProcessesThe effect of accountability on susceptibility to decision errors
271 Citations1992Itamar Simonson, P. H. Nye
Organizational Behavior and Human Decision ProcessesExposition Effects on Decision Making: Choice and Confidence in Choice
228 Citations1997Winston R. Sieck, J. Frank Yates
Medical Decision MakingPhysician and Medical Student Bias in Evaluating Diagnostic Information
227 Citations1981Thomas S. Wallsten
Reanalysis of a previously published experiment, in which radiologists evaluated excretory urograms, shows that the radiologists' assessment of the likelihood of a tumor being present was inappropriately influenced by the importance of ruling the tumor out.
Medical Decision MakingThe Psychology of Good Judgment
220 Citations1996Gerd Gigerenzer
The author describes a fast and frugal algorithm, Take The Best, that violates standard principles of rational inference but can be as accurate as sophisticated "optimal" mod els for diagnostic inference.
Annals of Internal MedicineMedical Heuristics: The Silent Adjudicators of Clinical Practice
205 Citations1996Clement J. McDonald
I will identify several specific medical heuristics, examine some of the assumptions that underpin them, and suggest how they might be revised or adjusted on the basis of historical trends, statistical considerations, and common experience.
Medical Decision MakingAvailability, Wishful Thinking, and Physicians' Diagnostic Judgments for Patients with Suspected Bacteremia
190 Citations1991Roy M. Poses, Michele Anthony
Teaching physicians to develop better judgmental strategies may improve the quality of their judgments and hence their patient care, as well as helping them to overcome value bias and wishful thinking.
Medical CareDescribing Health States
183 Citations1984Hilary A. Llewellyn‐Thomas, Heather J. Sutherland +4 more
There is a need to examine systematically the process of obtaining quantitative values before reliance can be placed upon the results of health status index construction, as the results indicate that the type of scenario presented to the rater and the sequence of methods used had a major influence on the results.
JAMAThe accuracy of experienced physicians' probability estimates for patients with sore throats. Implications for decision making
172 Citations1985Roy M. Poses
Organizational Behavior and Human Decision Processes“… Do i love thee? Let me count …” toward an understanding of intuitive and automatic decision making
163 Citations1990Terence R. Mitchell, Lee Roy Beach
Image Theory is proposed as a descriptive theory of decision making which suggests that decisions are made based on the extent to which alternatives fit with images.
Family PracticeDecision Making and Prescribing Patterns—a Literature Review
137 Citations1991Colin Bradley
It is argued that further understanding of prescribing behaviour requires a study of the underlying decision making processes and the evidence for the 'drug choice model' is assessed.
Journal of General Internal MedicineEffect of physician profiling on utilization
132 Citations1996E. Andrew Balas, Suzanne Austin Boren +4 more
There is a need for controlled clinical evaluations before subjecting large numbers of physicians to utilization management interventions, as profiling has a statistically significant, but minimal effect on the utilization of clinical procedures.
Medical Decision MakingThe Covariance Decomposition of the Probability Score and Its Use in Evaluating Prognostic Estimates
129 Citations1995Hal R. Arkes, N V Dawson +8 more
The authors suggest that the calculational simplicity of this decomposition, its informative- ness, and the intuitive nature of its components make it a useful tool with which to analyze medical judgment.
JAMATechnology follies. The uncritical acceptance of medical innovation
127 Citations1993David A. Grimes
JAMAThe Accuracy of Experienced Physicians' Probability Estimates for Patients With Sore Throats
127 Citations1985Roy M. Poses
The physicians overestimated the probability of a positive culture for 81% of their patients and their estimates and treatment decisions were strongly associated, limiting the effectiveness of pharyngitis management protocols that require subjective estimates of disease probability.
Medical Decision MakingYou Can Lead a Horse to Water-Improving Physicians' Knowledge of Probabilities May Not Affect Their Decisions
119 Citations1995Roy M. Poses, Randall D. Cebul +1 more
Teaching physicians to make better judgments of disease probability may not alter their treatment decisions and univariable and multi variable analyses showed no major change in the relationships between clinical variables and treatment decisions after the intervention.
Medical CareAssessing Patients?? Utilities
114 Citations1989Albert G. Mulley
Questions of measurement validity need continuing attention and more attention should be paid to validating uses of utility assessments: Can utility assessments distinguish prospectively, among patients who subsequently experience the same health outcome, those for whom it is associated with a high or low level of well-being?
Journal of Behavioral Decision MakingThe Impact of accuracy and effort feedback and goals on adaptive decision behavior
112 Citations1990Elizabeth H. Creyer, James R. Bettman +1 more
The impact of accuracy feedback, effort feedback, and emphasis on either a goal of maximizing accuracy relative to effort or minimizing effort relative to accuracy on decision processes was found to be consistent with the shift in strategies predicted by an effort/accuracy model of strategy selection.
Critical Care MedicineThe answer to “What are my chances, Doctor?” depends on whom is asked
109 Citations1989Roy M. Poses, C. Bekes +2 more
All doctors showed excellent overall discriminating ability, but discriminated less well for postoperative patients, and the need for valid predictive models to aid in decision-making for critically ill patients is underscored.
Annals of Internal MedicineHow Decisions are Reached: Physician and Patient
109 Citations1982Stephen A. Eraker, PETER POLITSER
Behavioral research involving the assessment of values and probabilities may bear on the adequacy of decision analysis and help to better understand patient preferences in clinical decisions.
Organizational Behavior and Human Decision ProcessesGroup vs individual information processing: The effects of outcome feedback on decision making
91 Citations1989R. Scott Tindale
PubMedEffect of physician reminders on preventive care: meta-analysis of randomized clinical trials.
91 Citations1994Suzanne Austin, E. Andrew Balas +2 more
The results of the meta-analyses for cervical cancer screening and tetanus immunizations indicate that physician reminders are an effective information intervention and can improve compliance for these two preventive health care procedures.
Archives of Internal MedicineAre Two (Inexperienced) Heads Better Than One (Experienced) Head?
76 Citations1990Roy M. Poses
This first medical application of this technique suggests that this form of voting by secret ballot may prove useful for health care teams making other judgments and decisions.
JAMATechnology Follies
75 Citations1993David A. Grimes
While some new technologies have clearly improved health and reduced costs, others have not and much, if not most, of contemporary medical practice still lacks a scientific foundation.
Organizational Behavior and Human Decision ProcessesEffects of improved information on the components of skill in weather forecasting
75 Citations1992Thomas R. Stewart, Kenneth Heideman +2 more
Critical Care MedicineEgo bias, reverse ego bias, and physiciansʼ prognostic
62 Citations1991Roy M. Poses, Donna K. McClish +3 more
The critical care attending physicians exhibited reverse ego bias that was mainly a function of their optimism about the overall survival rate for critically ill patients, compared with the house officers who exhibited pessimism about the Overall survival rate.
Academic Medicine‘Pseudodiagnosticity’ in an idealized medical problem-solving environment
61 Citations1982Linda Kern, Michael E. Doherty
The pseudodiagnosticity effect is a result from the difficulty of simultaneously evaluating the relevance of a single symptoms in relation to single diagnosis.
IEEE Transactions on Systems Man and CyberneticsUnderstanding contingent choice: a computer simulation approach
61 Citations1990Jessie Payne, Eric J. Johnson +2 more
An approach to investigating contingent decision behavior using an effort/accuracy framework, production system modeling of decision strategies, and Monte Carlo simulation to explore the interactions of task properties with decision heuristics (strategies) is illustrated.
QJMClinical Judgment Analysis
52 Citations1990John Kirwan, D M Chaput de Saintonge +1 more
Clinical judgment analysis offers a method of probing the judgments not just of students and doctors but also of patients who have shown systematic differences in their perceptions of risk and benefit.
The American Journal of MedicineHospitalization decision in febrile intravenous drug users
51 Citations1990Jeffrey H. Samet, Abby Shevitz +2 more
Clinical tests and physician assessments are unable to distinguish occult major illness from minor illness among febrile IVDUs at presentation, and blood culture is best identified by blood culture.
PubMedApplying the acute ischemic heart disease predictive instrument.
49 Citations1987G A Corey, Joel H. Merenstein
A predictive instrument (or index) previously reported to be of value in reducing unnecessary coronary care unit admissions was tested in a randomized study and acceptability to the physician was measured by monitoring utilization in a subsequent nonrandomized phase and by debriefing.
Journal of Cancer EducationOverestimation of test effects in clinical judgment
45 Citations1993Gary H. Lyman, Lodovico Balducci
Physicians and nonphysicians both estimate test performance characteristics accurately but consistently overestimate the effect of positive test results on the probability of disease, and decision making by clinicians could be enhanced by training in the formal methods of decision analysis.
PubMedChanging test ordering behavior. A randomized controlled trial comparing probabilistic reasoning with cost-containment education.
45 Citations1989Frank Davidoff, R Goodspeed +1 more
Acta PsychologicaThe relationship between the probability assessor and the outcomes of an event as a determiner of subjective probability
44 Citations1983Dan Zakay
JAMAThe Comparative Cost-effectiveness of Statistical Decision Rules and Experienced Physicians in Pharyngitis Management
44 Citations1986Randall D. Cebul
While using statistical decision rules may be cost-effective in this setting, their adoption should be consistent with physician and patient priorities.
Medical Decision MakingComparing Methods of Learning Clinical Prediction from Case Simulations
41 Citations1992Thomas G. Tape, Jerry Kripal +1 more
A controlled study of feedback in 60 medical students learning to predict the risk of cardiovascular death based on the presence or absence of five risk factors found the superiority of probability feedback differed from previous findings that cognitive feedback was essential for mastery of multiple-cue-probability learning tasks.
Academic MedicineControlled trial using computerized feedback to improve physiciansʼ diagnostic judgments
33 Citations1992Roy M. Poses, Randall D. Cebul +4 more
The integrated method, based on cognitive psychology, is a promising educational tool that significantly improved the quality of the physicians' judgments as measured by calibration curves and Brier scores, and increased the level of agreement between the Physicians' judgments and those made by the clinical prediction rule.
Medical Decision MakingFeedback and the Illusion of Validity in a Medical Clinic
31 Citations1981James B. Bushyhead, Jay Christensen-Szalanski
It is concluded that incomplete feedback based on an imperfect chest radiograph-ordering decision may perpetuate inefficient chest radiographs ordering patterns.
Organizational Behavior and Human Decision ProcessesEffects of a Relative-Frequency Elicitation Question on Likelihood Judgment Accuracy: The Case of External Correspondence
31 Citations1998Paul C. Price
In three experiments, college students judged the likelihood that they chose the correct alternative for each of 40 two-alternative, general-knowledge items by responding to a relative-frequency elicitation question or to a probability elicitationquestion.
Medical CareChanging Test Ordering Behavior
28 Citations1989Frank Davidoff, Ronald B. Goodspeed +1 more
The probabilities group ordered fewer tests than the placebo group at all hospitals, but differences were greatest in the community hospital, and teaching about probabilistic reasoning improves the efficiency of test ordering.
JAMACost Savings Using a Stepped-Care Prescribing Protocol for Nonsteroidal Anti-inflammatory Drugs
27 Citations1996David L. Jones
For drugs with similar benefits and adverse effects, a "stepped formulary" approach requiring an initial trial of one of the less expensive agents can maintain physician prescribing choices and satisfaction while lowering costs.
Archives of Internal MedicineImpact of a Cardiology Data Bank on Physicians' Prognostic Estimates
24 Citations1981Lee Goldman
To determine whether physicians would be influenced by the prognostic information in a large coronary artery disease data bank, cardiology faculty and fellows made initial estimates of the prognoses of their patients and then made revised final estimates after seeing the outcome of matched patients from the data bank.
Medical Decision MakingAssessing Physicians Estimates of the Probability of Coronary Artery Disease
22 Citations1992Kevin A. Schulman, José J. Escarce +5 more
It is concluded that physicians make consistent errors in the use of probability estimates, and the quality of these estimates depends on patient characteristics such as type of chest pain and true likelihood of disease.
Medical CarePhysicians' Judgments of the Risks of Cardiac Procedures
22 Citations1997Roy M. Poses, Donna K. McClish +9 more
Cardiologists more frequently made accurate judgments of the rates of morbidity and death due to cardiac catheterization than did the other internists; otherInternists more frequentlymade accurate judgments for the ratesof morbidity due to Swan-Ganz catheterized.
Medical Decision MakingHow Did the Acute Ischemic Heart Disease Predictiue Instrument Reduce Unnecessary Coronary Care Unit Admissions?
20 Citations1988Robert Mcnutt, Harry P. Selker
The hypothesis that the mechanism by which the predictive instrument reduces unnecessary CCU admissions is by downward correction of physicians' overly-high suspicions of acute cardiac ischemia into a threshold range for which CCU admission is considered unnecessary is supported.
Methods of Information in MedicineEffects of Prevalence and Test Diagnosticity upon Clinical Judgments of Probability
18 Citations1983J. Balla, Arthur S. Elstein +1 more
The process of revising diagnostic probabilities was studied to examine the relative influence of prior probability and test diagnosticity at various levels of clinical experience and showed a slightly increasing reliance on prior probability with increasing experience.
RadiologyInformal Use of Decision Theory To Improve Radiological Patient Management
12 Citations1978Dennis G. Fryback, John R. Thornbury
Six radiologists reviewed 50 urograms to determine whether arteriography or needle aspiration should be recommended for evaluation of a space-occupying renal lesion and found that even informal, non-numerical application of decision theory resulted in improved outcomes.
Journal of Behavioral Decision MakingThe effects of statistical training on choice heuristics in choice under uncertainty
12 Citations1996David E. Hansen, James G. Helgeson
Journal of General Internal MedicineMoney and mission? Addressing the barriers to evidence-based medicine
10 Citations1999Roy M. Poses
The study by McAlister and colleagues suggests that EBM advocates still have to contest with three in particular: Physicians remain uncomfortable with the quantitative approach to medical practice; even those who accept this approach in principle have few opportunities to learn about it in detail; and physicians are often frustrated when the EBM process does not discover strong enough evidence to let them make decisions with confidence.
Academic MedicineModification of decision-making behavior of third-year medical students
8 Citations1982C T Spiegel, Bianca Kemp +3 more
An experimental program attempted both to construct an educational approach that included aspects of such expenditures and to measure the effectiveness of the approach, with members of the experimental group scoring significantly better in their ability to determine diagnoses, make patient-management decisions, and choose essential diagnostic procedures.
Archives of Internal MedicineThe Use of Follow-up Chest Roentgenograms Among Hospitalized Patients
6 Citations1989Dan R. Berlowitz
Using receiver operating characteristic curves, it is shown that physicians have difficulty in predicting which roentgenograms will show important changes and when these tests are likely to be of benefit.
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