Sources of Variation in Physician Adherence with Clinical Guidelines: Results from a Factorial Experiment
Open accessAbstract
Background Health services research has documented the magnitude of health care variations. Few studies focus on provider level sources of variation in clinical decision making-for example, which primary care providers are likely to follow clinical guidelines, with which types of patient. Objectives To estimate: (1) the extent of primary care provider adherence to practice guidelines and the unconfounded influence of (2) patient attributes and (3) physician characteristics on adherence with clinical practice guidelines. Design In a factorial experiment, primary care providers were shown clinically authentic video vignettes with actors portrayed different "patients" with identical signs of coronary heart disease (CHD). Different types of providers were asked how they would manage the different "patients" with identical CHD symptoms. Measures were taken to protect external validity. Results Adherence to some guidelines is high (over 50% of physicians would follow a third of the recommended actions), yet there is low adherence to many of them (less than 20% would follow another third). Female patients are less likely than males to receive 4 of 5 types of physical examination (p < .03); older patients are less likely to be advised to stop smoking (p < .03). Race and SES of patients had no effect on provider adherence to guidelines. A physicians' level of experience (age) appears to be important with certain patients. Conclusions Physician adherence with guidelines varies with different types of "patient" and with the length of clinical experience. With this evidence it is possible to appropriately target interventions to reduce health care variations by improving physician adherence with clinical guidelines.
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Eight articles appeared to refer to the same data collected in a single cross-country comparison study, and a further two articles analysed the same data.
“eight articles appeared to refer to the same data collected in a single cross-country comparison study [27–32, 34, 35] and a further two articles analysed the same data [45, 47].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [30]
The Methods describe this article’s analysis of a factorial experiment involving 128 Massachusetts physicians and refer readers to McKinlay et al. (2006); the References identify that work as a study of doctors in different countries. Our copy does not establish that this article analysed the same data as the cross-country study or the other articles, so the shared-data attribution is unsupported. (LLM, conf=0.73)
Experimental — accuracy not yet measuredMany assumption studies attempted to make their vignettes as realistic as possible by having them validated by clinicians and by having participants view/read the vignettes as part of a normal day at work.
“many of the assumption studies attempted to make their vignettes as realistic as possible by having them validated by clinicians [25–41] and also by having participants view/read the vignettes as part of a normal day at work [27–36, 39, 41].”
From Implicit bias in healthcare professionals: a systematic review (2017) · cites this paper as [30]
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References 29 · Cited by 117
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- Authors
- McKinlay, J. B., Link, C. L., Freund, K. M., Marceau, L. D., O’Donnell, A. B., & Lutfey, K. L.
- Affiliations
- New England Research Institutes (US)
- Boston University (US)
- Corresponding author
- McKinlay, J. B.
- Venue
- Journal of General Internal Medicine
- Published
- 2007-01-09
- Volume
- 22
- Issue
- 3
- Pages
- 289-296
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC1824760
- OpenAlex
- W1979594378
- Cited by
- 117
- References
- 29
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 5 · 2023: 4 · 2022: 11 · 2021: 5 · 2020: 7 · 2019: 6 · 2018: 3 · 2017: 8 · 2016: 9 · 2015: 1 · 2014: 6 · 2013: 7 · 2012: 5
- FWCI
- 7.92
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- OpenBU (Boston University) (submittedVersion)
- Funders
- New England Research Institutes
- National Institute on Aging (AG 16747, R01AG016747)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- clinical practice guideline adherence, health care variation, primary care physicians, coronary artery disease, patient characteristics, physician characteristics, physician experience, sex differences in care, age differences in care, smoking cessation counseling, physical examination, video vignettes, factorial design
- MeSH terms
- Age Factors, Attitude of Health Personnel, Factor Analysis, Statistical, Female, Humans, Male, Physical Examination, Physicians, Sex Factors, Practice Guidelines as Topic, Guideline Adherence
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