The main strength of the study was its the use of millions of electronic medical records from hundreds of general practices (using the same information clinicians used for providing care for the patients, thereby minimising observer effects) to construct relevant quality indicators and evaluate the effect of withdrawal of incentives.
Cycloplegic autorefraction was obtained before the study entry by the same clinician using the same instrument and measurement protocol.
These settings were as close as possible to those previously chosen by the responsible clinician, using the same driving pressure; if the patient was put on PSV mode, then the set respiratory rate during the study was set to reach the same total minute ventilation.
Clinical diagnosis was made according to ICD-10; an independent clinician using the same criteria reviewed all diagnoses.
Demographic and clinical information (including cardinal symptoms and their duration: fever, night sweat, weight loss, poor appetite, weakness, cough, and blood in sputum as well as information on nodes such as number, size, and consistency) was collected from each patient through an interview with a clinician using the same questionnaire in all health centres.
Planning for repeated measurement with feedback using the same instruments was left to the clinicians, with about 30 days in between as a guideline.
A mere 16-60 % of the clinicians mentioned repeatedly using the same measurement during a clinical episode [ 1, 11, 13].
However, the vignette analysis found that, regardless of professional group or setting, clinicians made similar case assessments, using the same case factors and weighing them similarly.
A random effects model was conducted using the same adjustment factors as above except substituting gender mix with clinician gender.
This document also included the clinician's judgment of the patient's global QoL using the same scale as the EORTC questionnaire.
