Grants and Research Committee Research Annotation, September 2011

By Cate Nicholas

Welcome ASPE News readers to the first monthly article review by the ASPE Grants and Research Committee. Each month one of our committee members will choose an article from the 2011 literature and write up an annotation for the membership.  Each article will expand our database and hopefully increase the ease at which you can access this information.

This month featured article looks at Unannounced Standardized Patient (USP) Methodology in: Siminoff, L.A, Rogers, H.L, Waller, A.C., Harris-Haywood, S., Epstein, R.M., Borrell , Carrio, F., Gliva-McConvey, G. & Longo, D. R. (2011). The advantages and challenges of unannounced standardized patient methodology to assess healthcare communication. Patient Education and Counseling, 82,318-324.

The authors of this month’s article state, “As Health Reform in the US begins to focus on, among other issues, patient centered care, there will be a need for more studies that examine the critical nature of physician-patient communication. Thus the need for more rigorous studies that employ the use of USP’s will grow.”   This article reviews the steps needed to design a successful USP program; not a task for the faint-hearted!   If you are interested in learning more, I recommend reading the article in full.

The eight authors from five US Schools of Medicine, and one from Spain, are collaborators on an ongoing NIH grant looking to understand how and whether physician-patient communication is affected by patient race and gender.   In order to capture real time communication between patients and their physicians, they have chosen to use USP methodology.  This is a review paper discussing the advantages, disadvantages and strategies to overcome barriers to implementing a USP study providing examples from their ongoing work.  The review paper goes step by step through the process of USP logistical challenges including:  USP selections, training, creating an identity, detection prevention, responding to practice and physician phone calls to USPs, obtaining audio recording of the visit while undercover, electronic registration system and insurance issues, updating, inactivating and deleting electronic medical records, and the role of office manager as confederates.

The study currently underway is examining physician-patient communication during a primary care visit and if that communication is affected by race and gender by simulating a 47-year old patient presenting a common set of symptoms to a general internist or family practitioner.  Each MD will see at least 2 USPs, each of a different gender and race (white male and African American female or vice versa). The initial visit occurs 4 months after consent and the second visit occurs 3 months after the first. Each visit is audio recorded and the medical chart is obtained to assess differential diagnosis and treatment recommendations.  To date, 39 USPs have been to 25 different primary care MDs at 19 different practices over a 5 month period with only one know detection.  The USPs performances have been rated as “believable, convincing, and able to maintain role”.  Using six questions related to authenticity of USP performance from the Maastricht Assessment of Simulated Patient Scale, the USPs were rated as appearing authentic and answering questions in a natural manner.  The authors discussed ongoing quality improvement as part of the process, stressing the importance of communication among the USPs and the study coordinator.  Careful advance planning, working closely with the office confederates, debriefing the MDs and providing feedback are critical.

I think this paper will be very helpful to those who are considering using an USP program or for those who have used one and had difficulty.  I appreciated the combination of describing methods with application to their own study.  I look forward to the final report on their findings as I have an interest in gender and communication in healthcare.

I recommend this article as well:
Rethans et al. (2007). Unannounced standardized patients in real practice: a systematic literature review. Medical Education, Jun, 41 (6): 537-49.

Comments?  Join the discussion below!

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