Mock Report Research Articles

Hidden in Plain Sight: Overlooked Results and Other Errors in Evaluating Online Laboratory Results.

People are increasingly accessing their own laboratory (lab) results online. However, Canadians may be expected to use different systems to access their results, depending upon where they are tested (e.g., community lab vs. hospital), and these results may be displayed differently. This study examined the extent to which participants without medical expertise (N = 25) made errors identifying lab results (i.e., missing or mis-identifying abnormal results) in a mock report. Six participants overlooked each of the flagged values, 20 participants missed an abnormal result that was not flagged, and 2 participants mis-identified a normal value as out of range. We describe potential causes of these errors and the implications for the design of consumer-facing lab results.

Physicians’ perceived usefulness of and satisfaction with test reports for cystic fibrosis (ΔF508) and factor V Leiden

Purpose: We sought to determine whether variation in test-report content for cystic fibrosis (CF ΔF508) and factor V Leiden (fVL) would impact physician-perceived usefulness of and satisfaction with test reports.Methods: A cross-sectional survey of US physicians from specialties likely to order the tests was performed. Physicians received an introductory letter with a clinical scenario, one randomly assigned mock report, and a one-page survey. The analyses evaluated usefulness of and satisfaction with report elements.Results: For CF and fVL, there were significant differences by mock-report version for most of the survey report items (P < 0.05) and for satisfaction (P < 0.0001); results revealed greater usefulness and satisfaction with more comprehensive reports. The three items in CF and fVL reports where physician-perceived usefulness was most highly correlated (R > 0.70) with satisfaction were (1) clinical decision-making information, (2) genetic counseling information, and (3) implications for family members.Conclusion: Opportunities exist to improve the usefulness of genetic test reports in clinical practice.

Design and user experience testing of a polygenic score report: a qualitative study of prospective users

BackgroundPolygenic scores—which quantify inherited risk by integrating information from many common sites of DNA variation—may enable a tailored approach to clinical medicine. However, alongside considerable enthusiasm, we and others have highlighted a lack of standardized approaches for score disclosure. Here, we review the landscape of polygenic score reporting and describe a generalizable approach for development of a polygenic score disclosure tool for coronary artery disease.MethodsWe assembled a working group of clinicians, geneticists, data visualization specialists, and software developers. The group reviewed existing polygenic score reports and then designed a two-page mock report for coronary artery disease. We then conducted a qualitative user-experience study with this report using an interview guide focused on comprehension, experience, and attitudes. Interviews were transcribed and analyzed for themes identification to inform report revision.ResultsReview of nine existing polygenic score reports from commercial and academic groups demonstrated significant heterogeneity, reinforcing the need for additional efforts to study and standardize score disclosure. Using a newly developed mock score report, we conducted interviews with ten adult individuals (50% females, 70% without prior genetic testing experience, age range 20–70 years) recruited via an online platform. We identified three themes from interviews: (1) visual elements, such as color and simple graphics, enable participants to interpret, relate to, and contextualize their polygenic score, (2) word-based descriptions of risk and polygenic scores presented as percentiles were the best recognized and understood, (3) participants had varying levels of interest in understanding complex genomic information and therefore would benefit from additional resources that can adapt to their individual needs in real time. In response to user feedback, colors used for communicating risk were modified to minimize unintended color associations and odds ratios were removed. All 10 participants expressed interest in receiving a polygenic score report based on their personal genomic information.ConclusionsOur findings describe a generalizable approach to develop a polygenic score report understandable by potential patients. Although additional studies are needed across a wider spectrum of patient populations, these results are likely to inform ongoing efforts related to polygenic score disclosure within clinical practice.

Understanding and interpretation of a variant of uncertain significance (VUS) genetic test result by pediatric providers who do not specialize in genetics.

The advancement of genetic testing technologies has allowed for better diagnosis and management of patients, but also results in more variants of uncertain significance (VUSs) due to the increased number of genes being analyzed. There are more genetic tests available and more providers who do not specialize in genetics ordering genetic testing, but few studies examining how providers who do not specialize in genetics interpret VUSs. This study surveyed pediatric providers at a midwestern pediatric care center who do not specialize in genetics about their understanding of a mock genetic test report with a VUS result and whether their understanding of the result was associated with experience ordering genetic tests. Participants' preferences about content of the report and steps taken to understand the result were also examined. Of the 51 participants, 33% correctly answered both knowledge questions about the VUS result: one asking them to interpret the result and one asking them how they would explain the result to the patient. There was no association between answering both knowledge questions correctly and types of previous genetic tests ordered (p>.1 for 8 types of genetic tests), having received a genetic test report with a VUS result (p=.58), having referred patients to a genetics professional (p=.74), or feeling comfortable discussing a positive, negative, or VUS genetic test result (p>.4). This suggests that having previous experience ordering genetic tests does not contribute to the participants' knowledge about a variant of uncertain significance. Most participants reported that the amount of information in each section of the mock report was adequate. Participants were likely to reference multiple resources to better understand a VUS result, including published literature (82%), gene-specific databases (67%), and colleagues (63%). While these results cannot be generalized to all institutions, institutions can use the two knowledge questions to determine participants' understanding of genetic test results. This will help healthcare institutions determine methods that will best aide their providers who order genetic testing but do not specialize in genetics in learning more about the genetic testing process and better utilize results to improve patient care.

Usability of Reports Generated by a Computerised Dose Prediction Software.

Computerised dose prediction software assist clinicians in undertaking therapeutic drug monitoring by providing individualised dosing recommendations, typically communicated to prescribers in the form of a report. These software are highly sophisticated and accurate in predicting individualised dosage regimens, but if the information contained in the report is not understood by prescribers, the benefits of the software are not achieved. In this study, we set out to assess the perceived usability of a report generated from a dose prediction system. Fifteen prescribers were presented with a mock report and asked a number of questions to elicit their views of the report's content and design. Overall, we found that the mock report was effective in communicating the recommended dose of a drug, but this recommendation was presented alongside information that was not understood or was unlikely to be utilised by prescribers. In particular, the aspects of the report viewed negatively by end-users largely related to a lack of familiarity with the pharmacological terminology used in the report, which hindered understanding and caused confusion. Involving prescribers early on in the process of designing decision support systems is likely to result in systems and outputs that are more useful, usable and accessible to users.

G172(P) Safeguarding training – Are we doing enough? What do paediatric trainees want?

AimThis project was undertaken to assess whether adequate training is being delivered to the trainees in our deanery and to identify what trainees expected from the programme.MethodsAll paediatric trainees from...

Advancing the use of community pharmacy quality measures: A qualitative study

To describe consumers' ability to interpret pharmacy quality measures data presented in a report card, to examine the tools that consumers require to interpret the information available in a pharmacy quality report card, and to determine whether pharmacy quality measures influence consumers' choice of a pharmacy. Qualitative study. Three semistructured focus groups conducted in a private meeting space at a public library in Sioux Falls, SD, from April 2011 to May 2011. 29 laypeople. Participants' skills interpreting and using pharmacy quality information were examined based on mock report cards containing the Pharmacy Quality Alliance (PQA) quality measures. Consumer perceptions of pharmacy quality data. Participants reported difficulty understanding quality measures because of knowledge deficits. They wanted supportive resources on drug class of their medications to help them understand the measures. Participants had different opinions on whether their pharmacies should be compared with other pharmacies based on specific quality measures. For example, they favored the use of drug-drug interactions as a quality measure for comparing pharmacies, while medication adherence was deemed of limited use for comparison. Participants stated that pharmacy report cards would be useful information but would not prompt a change in pharmacy. However, participants perceived that this information would be useful in selecting a new pharmacy. The results suggest that consumers require simplification of PQA quality measures and supportive resources to interpret the measures. Consumers may favor certain quality measures based on their perception of the role of the pharmacist. Education is required before full use of this quality-of-care information can be realized.

Fishing, Commitment, and Communication: A Proposal for Comprehensive Nonbinding Research Registration

Social scientists generally enjoy substantial latitude in selecting measures and models for hypothesis testing. Coupled with publication and related biases, this latitude raises the concern that researchers may intentionally or unintentionally select models that yield positive findings, leading to an unreliable body of published research. To combat this “fishing” problem in medical studies, leading journals now require preregistration of designs that emphasize the prior identification of dependent and independent variables. However, we demonstrate here that even with this level of advanced specification, the scope for fishing is considerable when there is latitude over selection of covariates, subgroups, and other elements of an analysis plan. These concerns could be addressed through the use of a form of comprehensive registration. We experiment with such an approach in the context of an ongoing field experiment for which we drafted a complete “mock report” of findings using fake data on treatment assignment. We describe the advantages and disadvantages of this form of registration and propose that a comprehensive but nonbinding approach be adopted as a first step to combat fishing by social scientists. Likely effects of comprehensive but nonbinding registration are discussed, the principal advantage being communication rather than commitment, in particular that it generates a clear distinction between exploratory analyses and genuine tests.

Applying critical social work in direct practice with families

ABSTRACTThis paper seeks to further discourse concerning the implications of critical social work for direct practice with families and children. It presents and discusses a hypothetical example of how a social worker in a social care agency in Israel can incorporate critical social work notions into an official social work report. The paper begins by presenting key concepts in critical social work, their manifestations in practice and their implications for official social work reports. It then presents a mock report informed by critical social work ideas and discusses its structure and contents. The mock report provides an example of how abstract notions central to critical social work can be actualized. The paper thus offers practitioners the opportunity for a richer discourse on the contribution of critical social work to direct practice with families and children.

Public Reporting of 30-Day Mortality for Patients Hospitalized With Acute Myocardial Infarction and Heart Failure

For cardiac care, the Centers for Medicare M how often smokers are counseled to quit; how rapidly hospitals provide reperfusion therapy for patients with an ST-segment elevation myocardial infarction; and how often the ejection fraction is measured for patients with heart failure. All of these measures assess care that is strongly recommended by guidelines. The measures include only those patients who should receive this care and are reported at the hospital level simply as percentages. The performance on these measures should ideally be 100%, and the rates have improved markedly over time. ; View this table: Table. Acute Myocardial Infarction and Heart Failure Process-of-Care Measures On June 21, 2007, CMS expanded the measures to include outcomes and posted information on its “Hospital Compare” website1 regarding hospital-specific 30-day mortality rates for patients with acute myocardial infarction and heart failure. These measures used administrative claims data and were validated against measures using medical record data; the measures were approved by the National Quality Forum.2,3 In 2007, the publicly reported information was limited to describing hospitals as having rates that were higher, lower, or no different than the national average. Hospitals received information about their rates, their patients, and comparisons with other hospitals in their state and with the nation. This year, CMS is expanding the publicly available information. For acute myocardial infarction, heart failure, and now pneumonia, CMS will post the calculated risk-standardized 30-day mortality rates (RSMRs) and the 95% interval estimates for each hospital that treated Medicare patients with these conditions; hospital volume for each condition also will be posted. As …