Script Concordance Testing to Determine Infant Lumbar Puncture Practice Variation

on behalf of the INSPIRE Network

Research output: Contribution to journalArticle

Abstract

Objectives Script concordance testing (SCT) is used to assess clinical decision-making. We explore the use of SCT to (1) quantify practice variations in infant lumbar puncture (LP) and (2) analyze physician's characteristics affecting LP decision making. Methods Using standard SCT processes, a panel of pediatric subspecialty physicians constructed 15 infant LP case vignettes, each with 2 to 4 SCT questions (a total of 47). The vignettes were distributed to pediatric attending physicians and fellows at 10 hospitals within the INSPIRE Network. We determined both raw scores (tendency to perform LP) and SCT scores (agreement with the reference panel) as well as the variation with participant factors. Results Two hundred twenty-six respondents completed all 47 SCT questions. Pediatric emergency medicine physicians tended to select LP more frequently than did general pediatricians, with pediatric emergency medicine physicians showing significantly higher raw scores (20.2 ± 10.2) than general pediatricians (13 ± 15; 95% confidence interval for difference, 1, 13). Concordance with the reference panel varied among subspecialties and by the frequency with which practitioners perform LPs in their practices. Conclusion Script concordance testing questions can be used as a tool to detect subspecialty practice variation. We are able to detect significant practice variation in the self-report of use of LP for infants among different pediatric subspecialties.

Original languageEnglish (US)
Pages (from-to)84-92
Number of pages9
JournalPediatric Emergency Care
Volume34
Issue number2
DOIs
StatePublished - Feb 1 2018

Fingerprint

Spinal Puncture
Physicians
Pediatrics
Self Report
Decision Making
Confidence Intervals

Keywords

  • attending physician
  • clinical practice patterns
  • clinical practice variation
  • lumbar puncture
  • script concordance testing

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

Cite this

Script Concordance Testing to Determine Infant Lumbar Puncture Practice Variation. / on behalf of the INSPIRE Network.

In: Pediatric Emergency Care, Vol. 34, No. 2, 01.02.2018, p. 84-92.

Research output: Contribution to journalArticle

on behalf of the INSPIRE Network. / Script Concordance Testing to Determine Infant Lumbar Puncture Practice Variation. In: Pediatric Emergency Care. 2018 ; Vol. 34, No. 2. pp. 84-92.
@article{1c8d0862754847daafe217c9d2e4adf3,
title = "Script Concordance Testing to Determine Infant Lumbar Puncture Practice Variation",
abstract = "Objectives Script concordance testing (SCT) is used to assess clinical decision-making. We explore the use of SCT to (1) quantify practice variations in infant lumbar puncture (LP) and (2) analyze physician's characteristics affecting LP decision making. Methods Using standard SCT processes, a panel of pediatric subspecialty physicians constructed 15 infant LP case vignettes, each with 2 to 4 SCT questions (a total of 47). The vignettes were distributed to pediatric attending physicians and fellows at 10 hospitals within the INSPIRE Network. We determined both raw scores (tendency to perform LP) and SCT scores (agreement with the reference panel) as well as the variation with participant factors. Results Two hundred twenty-six respondents completed all 47 SCT questions. Pediatric emergency medicine physicians tended to select LP more frequently than did general pediatricians, with pediatric emergency medicine physicians showing significantly higher raw scores (20.2 ± 10.2) than general pediatricians (13 ± 15; 95{\%} confidence interval for difference, 1, 13). Concordance with the reference panel varied among subspecialties and by the frequency with which practitioners perform LPs in their practices. Conclusion Script concordance testing questions can be used as a tool to detect subspecialty practice variation. We are able to detect significant practice variation in the self-report of use of LP for infants among different pediatric subspecialties.",
keywords = "attending physician, clinical practice patterns, clinical practice variation, lumbar puncture, script concordance testing",
author = "{on behalf of the INSPIRE Network} and Chime, {Nnenna Ogochukwu} and Pusic, {Martin V.} and Marc Auerbach and Renuka Mehta and Scherzer, {Daniel J.} and {Van Ittersum}, Wendy and Brett McAninch and Fein, {Daniel M.} and Elizabeth Seelbach and Pavan Zaveri and Jackson, {Jennifer M.} and David Kessler and Chang, {Todd P.}",
year = "2018",
month = "2",
day = "1",
doi = "10.1097/PEC.0000000000000851",
language = "English (US)",
volume = "34",
pages = "84--92",
journal = "Pediatric Emergency Care",
issn = "0749-5161",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Script Concordance Testing to Determine Infant Lumbar Puncture Practice Variation

AU - on behalf of the INSPIRE Network

AU - Chime, Nnenna Ogochukwu

AU - Pusic, Martin V.

AU - Auerbach, Marc

AU - Mehta, Renuka

AU - Scherzer, Daniel J.

AU - Van Ittersum, Wendy

AU - McAninch, Brett

AU - Fein, Daniel M.

AU - Seelbach, Elizabeth

AU - Zaveri, Pavan

AU - Jackson, Jennifer M.

AU - Kessler, David

AU - Chang, Todd P.

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Objectives Script concordance testing (SCT) is used to assess clinical decision-making. We explore the use of SCT to (1) quantify practice variations in infant lumbar puncture (LP) and (2) analyze physician's characteristics affecting LP decision making. Methods Using standard SCT processes, a panel of pediatric subspecialty physicians constructed 15 infant LP case vignettes, each with 2 to 4 SCT questions (a total of 47). The vignettes were distributed to pediatric attending physicians and fellows at 10 hospitals within the INSPIRE Network. We determined both raw scores (tendency to perform LP) and SCT scores (agreement with the reference panel) as well as the variation with participant factors. Results Two hundred twenty-six respondents completed all 47 SCT questions. Pediatric emergency medicine physicians tended to select LP more frequently than did general pediatricians, with pediatric emergency medicine physicians showing significantly higher raw scores (20.2 ± 10.2) than general pediatricians (13 ± 15; 95% confidence interval for difference, 1, 13). Concordance with the reference panel varied among subspecialties and by the frequency with which practitioners perform LPs in their practices. Conclusion Script concordance testing questions can be used as a tool to detect subspecialty practice variation. We are able to detect significant practice variation in the self-report of use of LP for infants among different pediatric subspecialties.

AB - Objectives Script concordance testing (SCT) is used to assess clinical decision-making. We explore the use of SCT to (1) quantify practice variations in infant lumbar puncture (LP) and (2) analyze physician's characteristics affecting LP decision making. Methods Using standard SCT processes, a panel of pediatric subspecialty physicians constructed 15 infant LP case vignettes, each with 2 to 4 SCT questions (a total of 47). The vignettes were distributed to pediatric attending physicians and fellows at 10 hospitals within the INSPIRE Network. We determined both raw scores (tendency to perform LP) and SCT scores (agreement with the reference panel) as well as the variation with participant factors. Results Two hundred twenty-six respondents completed all 47 SCT questions. Pediatric emergency medicine physicians tended to select LP more frequently than did general pediatricians, with pediatric emergency medicine physicians showing significantly higher raw scores (20.2 ± 10.2) than general pediatricians (13 ± 15; 95% confidence interval for difference, 1, 13). Concordance with the reference panel varied among subspecialties and by the frequency with which practitioners perform LPs in their practices. Conclusion Script concordance testing questions can be used as a tool to detect subspecialty practice variation. We are able to detect significant practice variation in the self-report of use of LP for infants among different pediatric subspecialties.

KW - attending physician

KW - clinical practice patterns

KW - clinical practice variation

KW - lumbar puncture

KW - script concordance testing

UR - http://www.scopus.com/inward/record.url?scp=84988712006&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84988712006&partnerID=8YFLogxK

U2 - 10.1097/PEC.0000000000000851

DO - 10.1097/PEC.0000000000000851

M3 - Article

C2 - 27668921

AN - SCOPUS:84988712006

VL - 34

SP - 84

EP - 92

JO - Pediatric Emergency Care

JF - Pediatric Emergency Care

SN - 0749-5161

IS - 2

ER -