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The use of direct clinician observation and vignettes for health services quality evaluation in developing countries

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Author Info

  • Leonard, Kenneth L.
  • Masatu, Melkiory C.

Abstract

This paper reports the results of a comparison between two different methods of examining quality in outpatient services in a developing country. Data from rural and urban Tanzania are used to compare the measures of quality collected by direct clinician observation (DCO) (where clinicians are observed in the course of their normal consultations) and vignettes (unblind case studies with an actor). The vignettes are shown to exhibit a strong connection between the inputs provided during consultation (rational history taking, physical examination and health education) and the ability of the clinician to properly diagnose the presented illness. However, the inputs provided in vignettes are not well correlated with the inputs provided in DCO, suggesting that the inputs provided in the vignette are not well correlated with the inputs that would be provided in an actual consultation. We conclude that since vignettes do not appear to be measuring what would be provided in an actual consultation they are not a good measure of quality. Instead, we suggest that vignettes and DCO be used simultaneously. We show how the scores obtained using vignettes in conjunction with DCO can be used to improve the reliability of DCO and therefore our estimates of actual clinician quality.

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Bibliographic Info

Article provided by Elsevier in its journal Social Science & Medicine.

Volume (Year): 61 (2005)
Issue (Month): 9 (November)
Pages: 1944-1951

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Handle: RePEc:eee:socmed:v:61:y:2005:i:9:p:1944-1951

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Related research

Keywords: Direct clinician observation Vignettes Health services quality Tanzania;

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Citations

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Cited by:
  1. Jishnu Das & Jeffrey Hammer & Kenneth Leonard, 2008. "The Quality of Medical Advice in Low-Income Countries," Journal of Economic Perspectives, American Economic Association, vol. 22(2), pages 93-114, Spring.
  2. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
  3. Leonard, Kenneth L., 2009. "The cost of imperfect agency in health care: Evidence from rural Cameroun," Journal of Development Economics, Elsevier, vol. 88(2), pages 282-291, March.
  4. Jack, William & Lewis, Maureen, 2009. "Health investments and economic growth : macroeconomic evidence and microeconomic foundations," Policy Research Working Paper Series 4877, The World Bank.
  5. Leonard, Kenneth L. & Masatu, Melkiory C., 2008. "Moving from the lab to the field: Exploring scrutiny and duration effects in lab experiments," Economics Letters, Elsevier, vol. 100(2), pages 284-287, August.
  6. Rao, Krishna D. & Sundararaman, T. & Bhatnagar, Aarushi & Gupta, Garima & Kokho, Puni & Jain, Kamlesh, 2013. "Which doctor for primary health care? Quality of care and non-physician clinicians in India," Social Science & Medicine, Elsevier, vol. 84(C), pages 30-34.
  7. Leonard, Kenneth L., 2008. "Is patient satisfaction sensitive to changes in the quality of care? An exploitation of the Hawthorne effect," Journal of Health Economics, Elsevier, vol. 27(2), pages 444-459, March.

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