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K. Leonard, M. Masatu (2008)
Using the Hawthorne Effect to Examine the Gap between a Doctor's Best Possible Practice and Actual PerformanceHealth Economics
G. Miller, R. Luo, Linxiu Zhang, S. Sylvia, Yaojiang Shi, Patricia Foo, Qiran Zhao, R. Martorell, Alexis Medina, S. Rozelle (2012)
Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trialThe BMJ, 345
Prakarsh Singh (2014)
Performance Pay and Information: Reducing Child Undernutrition in IndiaPublic Goods & Regulation in Health Economics eJournal
T. Wardlaw, Ties Boerma, Colin Mathers (2012)
Levels and trends in child mortality. Report 2012. Estimates developed by the UN Inter-agency Group for Child Mortality Estimation.
Jishnu Das, J. Hammer, K. Leonard (2008)
The Quality of Medical Advice in Low-Income CountriesWorld Bank: Infrastructure (Topic)
(2011)
Mapping Medical Providers in Rural India: Four Key Trends. New Delhi, India: Centre for Policy Research
M. Rao, Krishna Rao, A. Kumar, M. Chatterjee, T. Sundararaman (2011)
Human resources for health in IndiaThe Lancet, 377
P. Gertler, C. Vermeersch (2012)
Using Performance Incentives to Improve Health OutcomesOrganizations & Markets: Motivation & Incentives eJournal
N. Chaudhury, J. Hammer, M. Kremer, K. Muralidharan, F. Rogers (2006)
Missing in action: teacher and health worker absence in developing countries.The journal of economic perspectives : a journal of the American Economic Association, 20 1
Z. Bhutta, Jai Das, N. Walker, A. Rizvi, H. Campbell, I. Rudan, R. Black (2013)
Interventions to address deaths from childhood pneumonia and diarrhoea equitably: what works and at what cost?The Lancet, 381
R. Lozano, M. Naghavi, Kyle Foreman, S. Lim, K. Shibuya, V. Aboyans, J. Abraham, T. Adair, Rakesh Aggarwal, S. Ahn, Mohammad Almazroa, Miriam Alvarado, H. Anderson, Laurie Anderson, Kathryn Andrews, C. Atkinson, L. Baddour, S. Barker-Collo, D. Bartels, Michelle Bell, Emelia Benjamin, D. Bennett, K. Bhalla, B. Bikbov, A. Abdulhak, G. Birbeck, F. Blyth, I. Bolliger, S. Boufous, C. Bucello, M. Burch, P. Burney, J. Carapetis, Honglei Chen, David Chou, S. Chugh, L.E. Coffeng, S. Colan, Samantha Colquhoun, K. Colson, J. Condon, M. Connor, Leslie Cooper, M. Corriere, Monica Cortinovis, Karen Vaccaro, W. Couser, Benjamin Cowie, M. Criqui, M. Cross, Kaustubh Dabhadkar, N. Dahodwala, D. Leo, L. Degenhardt, A. Delossantos, J. Denenberg, D. Jarlais, S. Dharmaratne, E. Dorsey, T. Driscoll, H. Duber, Beth Ebel, P. Erwin, Patricia Espindola, M. Ezzati, V. Feigin, A. Flaxman, M. Forouzanfar, F. Fowkes, R. Franklin, M. Fransen, Michael Freeman, S. Gabriel, E. Gakidou, F. Gaspari, R. Gillum, D. González-Medina, Y. Halasa, D. Haring, James Harrison, Rasmus Havmoeller, Roderick Hay, B. Hoen, Peter Hotez, D. Hoy, K. Jacobsen, S. James, Rashmi Jasrasaria, S. Jayaraman, N. Johns, G. Karthikeyan, N. Kassebaum, A. Keren, J. Khoo, L. Knowlton, O. Kobusingye, A. Koranteng, R. Krishnamurthi, M. Lipnick, S. Lipshultz, Summer Ohno, J. Mabweijano, Michael MacIntyre, Leslie Mallinger, L. March, Guy Marks, Robert Marks, A. Matsumori, R. Matzopoulos, B. Mayosi, J. Mcanulty, M. McDermott, J. Mcgrath, Ziad Memish, G. Mensah, T. Merriman, C. Michaud, Matthew Miller, Ted Miller, C. Mock, A. Mocumbi, A. Mokdad, Andrew Moran, K. Mulholland, M. Nair, L. Naldi, K. Narayan, K. Nasseri, P. Norman, Martin O'Donnell, Saad Omer, K. Ortblad, Richard Osborne, D. Ozgediz, B. Pahari, J. Pandian, A. Rivero, R. Padilla, F. Pérez-Ruiz, N. Perico, D. Phillips, Kelsey Pierce, C. Pope, E. Porrini, F. Pourmalek, M. Raju, D. Ranganathan, Jürgen Rehm, David Rein, G. Remuzzi, F. Rivara, Thomas Roberts, Felipe León, Lisa Rosenfeld, L. Rushton, Ralph Sacco, Joshua Salomon, Uchechukwu Sampson, Ella Sanman, D. Schwebel, M. Seguí-Gómez, Donald Shepard, David Singh, J. Singleton, K. Sliwa, Emma Smith, A. Steer, Jennifer Taylor, Bernadette Thomas, I. Tleyjeh, J. Towbin, T. Truelsen, E. Undurraga, N. Venketasubramanian, L. Vijayakumar, T. Vos, Gregory Wagner, Mengru Wang, Wenzhi Wang, K. Watt, Martin Weinstock, R. Weintraub, J. Wilkinson, A. Woolf, S. Wulf, P. Yeh, Paul Yip, A. Zabetian, Zhi‐Jie Zheng, A. Lopez, C. Murray (2012)
Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010The Lancet, 380
P. Glassman, J. Luck, E. O’Gara, J. Peabody (2000)
Using standardized patients to measure quality: evidence from the literature and a prospective study.The Joint Commission journal on quality improvement, 26 11
A. Kotwani, R. Chaudhury, K. Holloway (2012)
Antibiotic-prescribing practices of primary care prescribers for acute diarrhea in New Delhi, India.Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research, 15 1 Suppl
S. Miller (2006)
Systematic Review: The Relationship Between Clinical Experience and Quality of Health CareYearbook of Plastic and Aesthetic Surgery, 2006
J. Peabody, J. Luck, P. Glassman, S. Jain, Joyce Hansen, Maureen Spell, Martin Lee (2004)
Measuring the Quality of Physician Practice by Using Clinical Vignettes: A Prospective Validation StudyAnnals of Internal Medicine, 141
K. Leonard, M. Masatu (2005)
The use of direct clinician observation and vignettes for health services quality evaluation in developing countries.Social science & medicine, 61 9
P. Basinga, P. Gertler, A. Binagwaho, A. Soucat, Jennifer Sturdy, C. Vermeersch (2011)
Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluationThe Lancet, 377
Jishnu Das (2011)
The Quality of Medical Care in Low-Income Countries: From Providers to MarketsPLoS Medicine, 8
K. Arrow (2004)
Uncertainty and the welfare economics of medical care. 1963.Bulletin of the World Health Organization, 82 2
K. Leonard, M. Masatu (2010)
Professionalism and the know-do gap: exploring intrinsic motivation among health workers in Tanzania.Health economics, 19 12
Jishnu Das, A. Holla, V. Das, M. Mohanan, D. Tabak, Brian Chan (2012)
In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps.Health affairs, 31 12
N. Arora (2010)
Rational use of antibiotics for pneumoniaIndian Pediatrics, 47
Jishnu Das, J. Hammer (2005)
Money for Nothing: The Dire Straits of Medical Practice in Delhi, IndiaWorld Bank Policy Research Working Paper Series
D. You, New Jin, T. Wardlaw (2012)
Levels & Trends in Child Mortality
Jishnu Das, J. Hammer (2005)
Which doctor? Combining vignettes and item response to measure clinical competenceJournal of Development Economics, 78
J. Rethans, F. Sturmans, R. Drop, C. Vleuten (1991)
Assessment of the performance of general practitioners by the use of standardized (simulated) patients.The British journal of general practice : the journal of the Royal College of General Practitioners, 41 344
G. Miller (1990)
The assessment of clinical skills/competence/performanceAcademic Medicine, 65
D. Peters, G. Bloom (2012)
Developing world: Bring order to unregulated health marketsNature, 487
(2014)
Antibiotic resistance—the need for global solutionsBDJ, 216
C. Walker, I. Rudan, Li Liu, H. Nair, E. Theodoratou, Z. Bhutta, K. O'Brien, H. Campbell, R. Black (2013)
Global burden of childhood pneumonia and diarrhoeaLancet (London, England), 381
A. Banerjee, A. Deaton, E. Duflo (2004)
Health care delivery in rural Rajasthan.Framed Field Experiments
J. Rethans, S. Gorter, L. Bokken, Linda Morrison (2007)
Unannounced standardised patients in real practice: a systematic literature reviewMedical Education, 41
K. Leonard, M. Masatu, Alexandre Vialou (2007)
Getting Doctors to Do Their BestThe Journal of Human Resources, XLII
M. Chopra, E. Mason, J. Borrazzo, H. Campbell, I. Rudan, Li Liu, R. Black, Z. Bhutta (2013)
Ending of preventable deaths from pneumonia and diarrhoea: an achievable goalThe Lancet, 381
Grant Miller, Kimberly Babiarz (2013)
Pay-for-Performance Incentives in Low- and Middle-Income Country Health ProgramsNBER Working Paper Series
H. Johnston, R. Ved, N. Lyall, K. Agarwal (2003)
Where do rural women obtain postabortion care? The case of Uttar Pradesh, India.International family planning perspectives, 29 4
Rajn Kumar (2011)
GOVERNMENT OF NATIONAL CAPITAL TERRITORY OF DELHI
ImportanceIn rural India, as in many developing countries, childhood mortality remains high and the quality of health care available is low. Improving care in such settings, where most health care practitioners do not have formal training, requires an assessment of the practitioners’ knowledge of appropriate care and the actual care delivered (the know-do gap). ObjectiveTo assess the knowledge of local health care practitioners and the quality of care provided by them for childhood diarrhea and pneumonia in rural Bihar, India. Design, Setting, and ParticipantsWe conducted an observational, cross-sectional study of the knowledge and practice of 340 health care practitioners concerning the diagnosis and treatment of childhood diarrhea and pneumonia in Bihar, India, from June 29 through September 8, 2012. We used data from vignette interviews and unannounced standardized patients (SPs). Main Outcomes and MeasuresFor SPs and vignettes, practitioner performance was measured using the numbers of key diagnostic questions asked and examinations conducted. The know-do gap was calculated by comparing fractions of practitioners asking key diagnostic questions on each method. Multivariable regressions examined the relation among diagnostic performance, prescription of potentially harmful treatments, and the practitioners’ characteristics. We also examined correct treatment recommended by practitioners with both methods. ResultsPractitioners asked a mean of 2.9 diagnostic questions and suggested a mean of 0.3 examinations in the diarrhea vignette; mean numbers were 1.4 and 0.8, respectively, for the pneumonia vignette. Although oral rehydration salts, the correct treatment for diarrhea, are commonly available, only 3.5% of practitioners offered them in the diarrhea vignette. With SPs, no practitioner offered the correct treatment for diarrhea, and 13.0% of practitioners offered the correct treatment for pneumonia. Diarrhea treatment has a large know-do gap; practitioners asked diagnostic questions more frequently in vignettes than for SPs. Although only 20.9% of practitioners prescribed treatments that were potentially harmful in the diarrhea vignettes, 71.9% offered them to SPs (P < .001). Unqualified practitioners were more likely to prescribe potentially harmful treatments for diarrhea (adjusted odds ratio, 5.11 [95% CI, 1.24-21.13]). Higher knowledge scores were associated with better performance for treating diarrhea but not pneumonia. Conclusions and RelevancePractitioners performed poorly with vignettes and SPs, with large know-do gaps, especially for childhood diarrhea. Efforts to improve health care for major causes of childhood mortality should emphasize strategies that encourage pediatric health care practitioners to diagnose and manage these conditions correctly through better monitoring and incentives in addition to practitioner training initiatives.
JAMA Pediatrics – American Medical Association
Published: Apr 1, 2015
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