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 physicianʼs 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)
JournalPediatric Emergency Care
DOIs
StateAccepted/In press - Sep 23 2016

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Spinal Puncture
Physicians
Pediatrics
Self Report
Decision Making
Confidence Intervals

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, 23.09.2016.

Research output: Contribution to journalArticle

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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 physicianʼs 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.",
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 = "2016",
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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.

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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 physicianʼs 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 physicianʼs 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.

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