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

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  • 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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  • Leonard, Kenneth L. & Masatu, Melkiory C., 2005. "The use of direct clinician observation and vignettes for health services quality evaluation in developing countries," Social Science & Medicine, Elsevier, vol. 61(9), pages 1944-1951, November.
    • Handle: RePEc:eee:socmed:v:61:y:2005:i:9:p:1944-1951
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    1. Kalf, Annette J. H. & Spruijt-Metz, Donna, 1996. "Variation in diagnoses: Influence of specialists' training on selecting and ranking relevant information in geriatric case vignettes," Social Science & Medicine, Elsevier, vol. 42(5), pages 705-712, March.
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    3. Kenneth L. Leonard & Gilbert R. Mliga & Damen Haile Mariam, 2002. "Bypassing Health Centres in Tanzania: Revealed Preferences for Quality," Journal of African Economies, Centre for the Study of African Economies, vol. 11(4), pages 441-471, December.
    4. Das, Jishnu & Hammer, Jeffrey, 2004. "Which doctor? Combining vignettes and item response to measure doctor quality," Policy Research Working Paper Series 3301, The World Bank.
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    Cited by:

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    3. 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.
    4. Das,Jishnu & Holla,Alaka & Mohpal,Aakash & Muralidharan,Karthik, 2015. "Quality and accountability in healthcare delivery : audit evidence from primary care providers in India," Policy Research Working Paper Series 7334, The World Bank.
    5. Leonard, Kenneth L. & Masatu, Melkiory C., 2010. "Using the Hawthorne effect to examine the gap between a doctor's best possible practice and actual performance," Journal of Development Economics, Elsevier, vol. 93(2), pages 226-234, November.
    6. 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.
    7. Jishnu Das & Alaka Holla & Aakash Mohpal & Karthik Muralidharan, 2016. "Quality and Accountability in Health Care Delivery: Audit-Study Evidence from Primary Care in India," American Economic Review, American Economic Association, vol. 106(12), pages 3765-3799, December.
    8. 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.
    9. Christophe Lemiére & Gaute Torsvik & Ottar Mæstad & Christopher H. Herbst & Kenneth L. Leonard, 2013. "Evaluating the Impact of Results-Based Financing on Health Worker Performance: Theory, Tools and Variables to Inform an Impact Evaluation," Health, Nutrition and Population (HNP) Discussion Paper Series 98269, The World Bank.
    10. Asadi-Aliabadi, Mehran & Karimi, Seyed M & Tehrani-Banihashemi, Arash & Mirbaha-Hashemi, Fariba & Janani, Leila & Babaee, Ebrahim & Nojomi, Marzieh & Moradi-Lakeh, Maziar, 2022. "Effectiveness of pay for performance to non-physician health care providers: A systematic review," Health Policy, Elsevier, vol. 126(7), pages 592-602.
    11. World Bank & Oxford Policy Management, 2015. "Health Worker Survey in Timor-Leste," World Bank Publications - Reports 23879, The World Bank Group.
    12. 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.
    13. Banuri, Sheheryar & de Walque, Damien & Keefer, Philip & Haidara, Ousmane Diadie & Robyn, Paul Jacob & Ye, Maurice, 2018. "The use of video vignettes to measure health worker knowledge. Evidence from Burkina Faso," Social Science & Medicine, Elsevier, vol. 213(C), pages 173-180.
    14. Rao, Krishna D. & Sheffel, Ashley, 2018. "Quality of clinical care and bypassing of primary health centers in India," Social Science & Medicine, Elsevier, vol. 207(C), pages 80-88.
    15. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
    16. Leonard, Kenneth L. & Masatu, Melkiory C., 2008. "Professionalism, Latent Professionalism and Organizational Demands for Health Care Quality in a Developing Country," Working Papers 42883, University of Maryland, Department of Agricultural and Resource Economics.
    17. Adrien Allorant & Nancy Fullman & Hannah H. Leslie & Moussa Sarr & Daouda Gueye & Eliudi Eliakimu & Jon Wakefield & Joseph L. Dieleman & David Pigott & Nancy Puttkammer & Robert C. Reiner, 2023. "A small area model to assess temporal trends and sub-national disparities in healthcare quality," Nature Communications, Nature, vol. 14(1), pages 1-13, December.
    18. Glick, Peter, 2009. "How reliable are surveys of client satisfaction with healthcare services? Evidence from matched facility and household data in Madagascar," Social Science & Medicine, Elsevier, vol. 68(2), pages 368-379, January.
    19. Anna D Gage & Margaret E Kruk & Tsinuel Girma & Ephrem T Lemango, 2018. "The know-do gap in sick child care in Ethiopia," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-10, December.
    20. 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.
    21. Rao, Krishna D. & Mehta, Akriti & Noonan, Caitlin & Peters, Michael A. & Perry, Henry, 2024. "Voting with their feet: Primary care provider choice and its implications for public sector primary care services in India," Social Science & Medicine, Elsevier, vol. 340(C).

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