Best Practices: Using Case Vignettes to Train Clinicians and Utilization Reviewers to Make Level-of-Care Decisions

Abstract

Dr. Rosenquist and his colleagues describe how their academically based health maintenance organization joined in training for level-of-care decision making with the external managed behavioral health organization that was providing utilization review and case management decisions. The academic department later took over its own utilization review and in so doing internalized the utilization review function. This development, which is beginning to occur in several states, is an important solution to the "assault" that many providers of care have experienced as a result of the utilization review process. Having taken this step to deal with the realities of 21st-century health care, the authors then seize the opportunity to use their own data to improve decision making within the clinic. This process is how we get to best practices.

The effect of improving task representativeness on capturing nurses’ risk assessment judgements: a comparison of written case simulations and physical simulations

“…Paper cases, whilst relatively easy to administer [10,11,43], may fail to reflect reality and evoke real clinical behavior [44]. Physical simulation, by presenting task information in a way that is perceptually similar to the clinical ecology, allows clinicians to make judgements in settings more similar to their routine clinical environments.…”

“…Clinical judgement analysts typically use paper-based scenarios. While paper cases have the advantage of ease of administration [10,11], their ability to evoke judgements that are similar to clinicians’ responses to actual judgement situations is questionable [12-14]. Format also shapes the cognitive effort invested in processing a task [13]; reflected, for example, in the amount of information subjects use [15-17].…”

The effect of social context on psychiatrists’ judgments of adolescent antisocial behavior

“…Although written case vignettes have been used extensively in studies of clinical decision‐making (Garb, 1998) and training (Rosenquist, Celenda, Briggs, et al, 2000), they have limitations. The information presented lacks the behavioral subtleties observed in personal interviews.…”

Using case vignettes to measure HIV-related stigma among health professionals in China

“…25,26 Case vignettes have been used for measuring physicians' practice patterns and have gained considerable support because of their predictive value of physician behaviour. [27][28][29][30][31] Investigators have found that physicians' responses to cases are a good indication of what they will actually do in a clinical setting. Kelly and colleagues 1 used case vignettes to assess physician attitudes concerning HIV/AIDS.…”