Address correspondence to John W. Peabody, M.D., Ph.D., Institute for Global Health, University of California, San Francisco, 74 New Montgomery, Suite 508, San Francisco, CA 94105. Dr. Peabody is also with the Department of Epidemiology and Biostatistics, University of California, San Francisco, the San Francisco Veterans Affairs Medical Center, the Department of Health Services, University of California, Los Angeles School of Public Health, and RAND. F. Tozija, M.D., Ph.D., is with the Cathedra of Social Medicine Medical Faculty, University of Cyril and Methodius, Skopje, Macedonia. J. A. Muñoz, Ph.D., is with Escuela Superior de Economía y Negocios, San Salvador, El Salvador. R. J. Nordyke, Ph.D., is with Zynx and Department of Health Services, University of California, Los Angeles School of Public Health. J. Luck, M.B.A., Ph.D., is with the Department of Health Services, University of California, Los Angeles School of Public Health and Veterans Affairs Greater Los Angeles Health Care System.
Using Vignettes to Compare the Quality of Clinical Care Variation in Economically Divergent Countries
Version of Record online: 11 NOV 2004
Health Services Research
Volume 39, Issue 6p2, pages 1951–1970, December 2004
How to Cite
Peabody, J. W., Tozija, F., Muñoz, J. A., Nordyke, R. J. and Luck, J. (2004), Using Vignettes to Compare the Quality of Clinical Care Variation in Economically Divergent Countries. Health Services Research, 39: 1951–1970. doi: 10.1111/j.1475-6773.2004.00327.x
- Issue online: 11 NOV 2004
- Version of Record online: 11 NOV 2004
- quality indicators;
- health care;
- quality of health care;
- cross-national comparative study;
- clinical vignettes
Objective. To determine whether clinical vignettes can measure variations in the quality of clinical care in two economically divergent countries.
Data Source/Study Setting. Primary data collected between February 1997 and February 1998 at two Veterans Affairs facilities in the United States and four government-run outpatient facilities in Macedonia.
Study Design. Randomly selected, eligible Macedonian and U.S. physicians (>97 percent participation rate) completed vignettes for four common outpatient conditions. Responses were judged against a master list of explicit quality criteria and scored as percent correct.
Data Collection/ Extraction. An ANOVA model and two-tailed t-tests were used to compare overall scores by case, study site, and country.
Principal Findings. The mean score for U.S. physicians was 67 percent (+/−11 percent) compared to 48 percent (+/−11 percent) for Macedonian physicians. The quality of clinical practice, which emphasizes basic skills, varied greatly in both sites, but more so in Macedonia. However, the top Macedonian physicians in all sites approached or—in one case—exceeded the median score in the U.S. sites.
Conclusions. Vignettes are a useful method for making cross-national comparisons of the quality of care provided in very different settings. The vignette measurements revealed that some physicians in Macedonia performed at a standard comparable to that of their counterparts in the United States, despite the disparity of the two health systems. We infer that in poorer countries, policy that promotes improvements in the quality of clinical practice—not just structural inputs—could lead to rapid improvements in health.