John W Peabody

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CONTEXT Better health care quality is a universal goal, yet measuring quality has proven to be difficult and problematic. A central problem has been isolating physician practices from other effects of the health care system. OBJECTIVE To validate clinical vignettes as a method for measuring the competence of physicians and the quality of their actual(More)
BACKGROUND Worldwide efforts are under way to improve the quality of clinical practice. Most quality measurements, however, are poorly validated, expensive, and difficult to compare among sites. OBJECTIVE To validate whether vignettes accurately measure the quality of clinical practice by using a comparison with standardized patients (the gold standard(More)
PURPOSE Despite widespread reliance on chart abstraction for quality measurement, concerns persist about its reliability and validity. We prospectively evaluated the validity of chart abstraction by directly comparing it with the gold standard of reports by standardized patients. SUBJECTS AND METHODS Twenty randomly selected general internal medicine(More)
OBJECTIVE To determine how accurately preventive care reported in the medical record reflects actual physician practice or competence. DESIGN Scoring criteria based on national guidelines were developed for 7 separate items of preventive care. The preventive care provided by randomly selected physicians was measured prospectively for each of the 7 items.(More)
Review of the world literature to the end of 1971 has provided data on 838 cases of esophageal leiomyomata, including our own 19 surgically removed lesions. Although esophageal leiomyoma is the most common of the benign tumors of the esophagus, it is still rare compared with carcinoma. It occurs in more men than women, by a ratio of 1.9 to 1. Over 50% of(More)
OBJECTIVE Because little is known about its effects on cognitive function among children in less-developed countries, we determined the impact of lead exposure from other nutritional determinants of cognitive ability. STUDY DESIGN Data were from a cross-sectional population-based stratified random sample of 877 children (age 6 months-5 years)(More)
Solid fuels are a major source of indoor air pollution, but in less developed countries the short-term health effects of indoor air pollution are poorly understood. The authors conducted a large cross-sectional study of rural Chinese households to determine associations between individual health status and domestic cooking as a source of indoor air(More)
The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We(More)
Legislation to control tobacco use in developing countries has lagged behind the dramatic rise in tobacco consumption. India, the third largest grower of tobacco in the world, amassed 1.7 million disability-adjusted life years (DALYs) in 1990 due to disease and injury attributable to tobacco use in a population where 65% of the men and 38% of the women(More)
OBJECTIVE To examine whether delays in seeking care are associated with worse health outcomes or increased treatment costs in children, and then assess whether insurance coverage reduces these delays. STUDY DESIGN We use data on 4070 children younger than 5 years from the Quality Improvement Demonstration Study, a randomized controlled experiment(More)