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Are there valid proxy measures of clinical behaviour? A systematic review.

Hrisos S, Eccles MP, Francis JJ, Dickinson HO, Kaner EF, Beyer F, Johnston M - Implement Sci (2009)

Bottom Line: Some direct measures failed to meet our validity criteria.The evidence for clinician self-report was inconclusive.Further research is needed to better establish the methods of development, application, and analysis for a range of both direct and proxy measures of behaviour.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK. susan.hrisos@ncl.ac.uk

ABSTRACT

Background: Accurate measures of health professionals' clinical practice are critically important to guide health policy decisions, as well as for professional self-evaluation and for research-based investigation of clinical practice and process of care. It is often not feasible or ethical to measure behaviour through direct observation, and rigorous behavioural measures are difficult and costly to use. The aim of this review was to identify the current evidence relating to the relationships between proxy measures and direct measures of clinical behaviour. In particular, the accuracy of medical record review, clinician self-reported and patient-reported behaviour was assessed relative to directly observed behaviour.

Methods: We searched: PsycINFO; MEDLINE; EMBASE; CINAHL; Cochrane Central Register of Controlled Trials; science/social science citation index; Current contents (social & behavioural med/clinical med); ISI conference proceedings; and Index to Theses.

Inclusion criteria: empirical, quantitative studies; and examining clinical behaviours. An independent, direct measure of behaviour (by standardised patient, other trained observer or by video/audio recording) was considered the 'gold standard' for comparison. Proxy measures of behaviour included: retrospective self-report; patient-report; or chart-review. All titles, abstracts, and full text articles retrieved by electronic searching were screened for inclusion and abstracted independently by two reviewers. Disagreements were resolved by discussion with a third reviewer where necessary.

Results: Fifteen reports originating from 11 studies met the inclusion criteria. The method of direct measurement was by standardised patient in six reports, trained observer in three reports, and audio/video recording in six reports. Multiple proxy measures of behaviour were compared in five of 15 reports. Only four of 15 reports used appropriate statistical methods to compare measures. Some direct measures failed to meet our validity criteria. The accuracy of patient report and chart review as proxy measures varied considerably across a wide range of clinical actions. The evidence for clinician self-report was inconclusive.

Conclusion: Valid measures of clinical behaviour are of fundamental importance to accurately identify gaps in care delivery, improve quality of care, and ultimately to improve patient care. However, the evidence base for three commonly used proxy measures of clinicians' behaviour is very limited. Further research is needed to better establish the methods of development, application, and analysis for a range of both direct and proxy measures of behaviour.

No MeSH data available.


Identification of included references (QUORUM diagram).
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Related In: Results  -  Collection

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Figure 1: Identification of included references (QUORUM diagram).

Mentions: The search strategy identified 5,260 references (Figure 1). The titles and abstracts of these references were screened independently by two reviewers. Ten papers were retrieved for full text review and their reference lists screened for other potential papers. A further 102 papers were identified from the reference lists of retrieved papers, their abstracts were again reviewed independently by two reviewers, and 41 of these were retrieved for full text review. Fifteen papers, based on comparisons from eleven separate source studies, fulfilled the inclusion criteria and their data were abstracted [5-19]. As papers reporting different findings from the same study [5,6,10,12,14,18] present different data and, with the exception of two [10,18], used different methods of analysis, we have considered them as 15 separate reports for the purpose of this review.


Are there valid proxy measures of clinical behaviour? A systematic review.

Hrisos S, Eccles MP, Francis JJ, Dickinson HO, Kaner EF, Beyer F, Johnston M - Implement Sci (2009)

Identification of included references (QUORUM diagram).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2713194&req=5

Figure 1: Identification of included references (QUORUM diagram).
Mentions: The search strategy identified 5,260 references (Figure 1). The titles and abstracts of these references were screened independently by two reviewers. Ten papers were retrieved for full text review and their reference lists screened for other potential papers. A further 102 papers were identified from the reference lists of retrieved papers, their abstracts were again reviewed independently by two reviewers, and 41 of these were retrieved for full text review. Fifteen papers, based on comparisons from eleven separate source studies, fulfilled the inclusion criteria and their data were abstracted [5-19]. As papers reporting different findings from the same study [5,6,10,12,14,18] present different data and, with the exception of two [10,18], used different methods of analysis, we have considered them as 15 separate reports for the purpose of this review.

Bottom Line: Some direct measures failed to meet our validity criteria.The evidence for clinician self-report was inconclusive.Further research is needed to better establish the methods of development, application, and analysis for a range of both direct and proxy measures of behaviour.

View Article: PubMed Central - HTML - PubMed

Affiliation: Institute of Health and Society, Newcastle University, 21 Claremont Place, Newcastle upon Tyne, NE2 4AA, UK. susan.hrisos@ncl.ac.uk

ABSTRACT

Background: Accurate measures of health professionals' clinical practice are critically important to guide health policy decisions, as well as for professional self-evaluation and for research-based investigation of clinical practice and process of care. It is often not feasible or ethical to measure behaviour through direct observation, and rigorous behavioural measures are difficult and costly to use. The aim of this review was to identify the current evidence relating to the relationships between proxy measures and direct measures of clinical behaviour. In particular, the accuracy of medical record review, clinician self-reported and patient-reported behaviour was assessed relative to directly observed behaviour.

Methods: We searched: PsycINFO; MEDLINE; EMBASE; CINAHL; Cochrane Central Register of Controlled Trials; science/social science citation index; Current contents (social & behavioural med/clinical med); ISI conference proceedings; and Index to Theses.

Inclusion criteria: empirical, quantitative studies; and examining clinical behaviours. An independent, direct measure of behaviour (by standardised patient, other trained observer or by video/audio recording) was considered the 'gold standard' for comparison. Proxy measures of behaviour included: retrospective self-report; patient-report; or chart-review. All titles, abstracts, and full text articles retrieved by electronic searching were screened for inclusion and abstracted independently by two reviewers. Disagreements were resolved by discussion with a third reviewer where necessary.

Results: Fifteen reports originating from 11 studies met the inclusion criteria. The method of direct measurement was by standardised patient in six reports, trained observer in three reports, and audio/video recording in six reports. Multiple proxy measures of behaviour were compared in five of 15 reports. Only four of 15 reports used appropriate statistical methods to compare measures. Some direct measures failed to meet our validity criteria. The accuracy of patient report and chart review as proxy measures varied considerably across a wide range of clinical actions. The evidence for clinician self-report was inconclusive.

Conclusion: Valid measures of clinical behaviour are of fundamental importance to accurately identify gaps in care delivery, improve quality of care, and ultimately to improve patient care. However, the evidence base for three commonly used proxy measures of clinicians' behaviour is very limited. Further research is needed to better establish the methods of development, application, and analysis for a range of both direct and proxy measures of behaviour.

No MeSH data available.