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Anchoring Vignettes as a Method to Address Implicit Gender Bias in Patient Experience Scores - 20/08/21

Doi : 10.1016/j.annemergmed.2021.04.017 
Diane Kuhn, MD, PhD a, , Hannah Goldberg, MD b, Nikita Salker c, Jonathan Hurst c, Kinjal Sethuraman, MD, MPH b
a Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 
b Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD 
c University of Maryland School of Medicine, Baltimore, MD 

Corresponding Author.

Abstract

Study objective

Patient experience metrics have become increasingly important in evaluations of health care organizations and physician performance. Although such measures have been touted as a way to make objective comparisons of performance, they are subject to many of the same biases as other survey instruments, including gender bias.

Methods

A total of 320 surveys were conducted between February and October 2020. Surveys included vignettes describing different scenarios, and respondents were asked to rate the vignette physician in each scenario on 1 of 3 themes: listening, time, or courtesy. Three vignettes per theme were used. Half of the surveys used a male physician and half used a female physician. Using tests of difference, we compared the ratings of male and female vignette physicians. We also used a statistical technique known as anchoring vignettes to show how respondents’ ratings of vignette physicians related to their ratings of their own physicians.

Results

In all 9 vignette scenarios, the male vignette physician was rated more highly than the female vignette physician. These differences were statistically significant in 2 of 9 scenarios. Male vignette physicians were given more top-box ratings than female vignette physicians. Anchoring vignettes showed a statistically nonsignificant association between vignette ratings and ratings of respondents’ own physicians.

Conclusion

Our findings revealed a pattern of higher ratings of male vignette physicians when compared to female vignette physicians, which may translate to ratings of patients’ own physicians. These findings suggest that current methods to evaluate patients’ experiences with their own physicians may disadvantage female physicians.

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Esquema


 Please see page 389 for the Editor’s Capsule Summary of this article.
 Supervising editor: Donald M. Yealy, MD. Specific detailed information about possible conflict of interest for individual editors is available at editors.
 Author contributions: DK conceived the study. DK, HG, and KS designed the trial. DK and KS obtained research funding. DK, HG, NS, and JH supervised the conduct of the trial and data collection. DK was responsible for statistical design and data analysis. DK and HG drafted the manuscript, and all authors contributed to its revision. DK takes responsibility for the manuscript as a whole.
 All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. This study was supported through a grant from the Gender Equity in Medicine Research Foundation.
 Readers: click on the link to go directly to a survey in which you can provide RLT3WY5 to Annals on this particular article.
 A podcast for this article is available at www.annemergmed.com.


© 2021  American College of Emergency Physicians. Publicado por Elsevier Masson SAS. Todos los derechos reservados.
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Vol 78 - N° 3

P. 388-396 - septembre 2021 Regresar al número
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