Abstract
Objective. To identify clinical hypotheses and information gaps underlying disagreement about the use of upper gastrointestinal endoscopy (EGD) for the diagnosis of gastroesophageal reflux disease (GERD), and to design a registry study to test these hypotheses. Design and setting. Structured group discussions with community-based practicing gastroenterologists. Results. Thirty-three gastroenterologists from 17 sites discussed a set of clinical scenarios concerning the use of EGD in GERD patients with different clinical histories. Clinicians identified patient characteristics and outcome variables missing from the original problem formulation. Using decision tables, the combinations of patient characteristics that provoked disagreement among clinicians were determined. The resulting decision tables specified which characteristics and outcome variables should be measured to test competing clinical theories of when to use EGD in patients with GERD. Subsequently, the clinicians conducted a practice-based study measuring uncertain variables associated with disagreement about the need for EGD in specific clinical situations. Conclusion. A structured, but flexible, approach to group discussion may help identify factors that are important in decision making and the hypotheses that should he addressed in resolving variations in practice styles. Technology assessors can use these methods to identify variables underlying clinicians' concerns about the clinical validity of recommendations about practice. This experience with eliciting patient characteristics and uncertain variables underscores the importance of involving practicing clinicians in the process and could be a useful model for problem formulation in guideline development and in community-based research.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 315-323 |
| Number of pages | 9 |
| Journal | Medical Decision Making |
| Volume | 17 |
| Issue number | 3 |
| DOIs | |
| State | Published - 1997 |
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Keywords
- Decision-support techniques
- Endoscopy
- Gastroesophageal reflux
- Gastrointestinal
- Physician practice patterns
- Practice guidelines
ASJC Scopus subject areas
- Public Health, Environmental and Occupational Health
- Health Informatics
- Health Information Management
- Nursing(all)
Cite this
Community-based research - A framework for problem formulation : The case of upper endoscopy for gastroesophageal reflux disease. / Helfand, Mark; Oehlke, Megan A.; Lieberman, David.
In: Medical Decision Making, Vol. 17, No. 3, 1997, p. 315-323.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Community-based research - A framework for problem formulation
T2 - The case of upper endoscopy for gastroesophageal reflux disease
AU - Helfand, Mark
AU - Oehlke, Megan A.
AU - Lieberman, David
PY - 1997
Y1 - 1997
N2 - Objective. To identify clinical hypotheses and information gaps underlying disagreement about the use of upper gastrointestinal endoscopy (EGD) for the diagnosis of gastroesophageal reflux disease (GERD), and to design a registry study to test these hypotheses. Design and setting. Structured group discussions with community-based practicing gastroenterologists. Results. Thirty-three gastroenterologists from 17 sites discussed a set of clinical scenarios concerning the use of EGD in GERD patients with different clinical histories. Clinicians identified patient characteristics and outcome variables missing from the original problem formulation. Using decision tables, the combinations of patient characteristics that provoked disagreement among clinicians were determined. The resulting decision tables specified which characteristics and outcome variables should be measured to test competing clinical theories of when to use EGD in patients with GERD. Subsequently, the clinicians conducted a practice-based study measuring uncertain variables associated with disagreement about the need for EGD in specific clinical situations. Conclusion. A structured, but flexible, approach to group discussion may help identify factors that are important in decision making and the hypotheses that should he addressed in resolving variations in practice styles. Technology assessors can use these methods to identify variables underlying clinicians' concerns about the clinical validity of recommendations about practice. This experience with eliciting patient characteristics and uncertain variables underscores the importance of involving practicing clinicians in the process and could be a useful model for problem formulation in guideline development and in community-based research.
AB - Objective. To identify clinical hypotheses and information gaps underlying disagreement about the use of upper gastrointestinal endoscopy (EGD) for the diagnosis of gastroesophageal reflux disease (GERD), and to design a registry study to test these hypotheses. Design and setting. Structured group discussions with community-based practicing gastroenterologists. Results. Thirty-three gastroenterologists from 17 sites discussed a set of clinical scenarios concerning the use of EGD in GERD patients with different clinical histories. Clinicians identified patient characteristics and outcome variables missing from the original problem formulation. Using decision tables, the combinations of patient characteristics that provoked disagreement among clinicians were determined. The resulting decision tables specified which characteristics and outcome variables should be measured to test competing clinical theories of when to use EGD in patients with GERD. Subsequently, the clinicians conducted a practice-based study measuring uncertain variables associated with disagreement about the need for EGD in specific clinical situations. Conclusion. A structured, but flexible, approach to group discussion may help identify factors that are important in decision making and the hypotheses that should he addressed in resolving variations in practice styles. Technology assessors can use these methods to identify variables underlying clinicians' concerns about the clinical validity of recommendations about practice. This experience with eliciting patient characteristics and uncertain variables underscores the importance of involving practicing clinicians in the process and could be a useful model for problem formulation in guideline development and in community-based research.
KW - Decision-support techniques
KW - Endoscopy
KW - Gastroesophageal reflux
KW - Gastrointestinal
KW - Physician practice patterns
KW - Practice guidelines
UR - http://www.scopus.com/inward/record.url?scp=0030927175&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030927175&partnerID=8YFLogxK
U2 - 10.1177/0272989X9701700308
DO - 10.1177/0272989X9701700308
M3 - Article
C2 - 9219192
AN - SCOPUS:0030927175
VL - 17
SP - 315
EP - 323
JO - Medical decision making : an international journal of the Society for Medical Decision Making
JF - Medical decision making : an international journal of the Society for Medical Decision Making
SN - 0272-989X
IS - 3
ER -