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Changing Physician Behavior: Increasing Challenges for the 1990s

Changing Physician Behavior: Increasing Challenges for the 1990s Abstract Although interest in cost containment is long-standing, it has recently resurged on a national level. This resurgence is partly the result of federal budgetary pressure caused by ever-increasing health care expenditures. However, the resurgence also reflects the combined effects of research from groups of investigators based at Dartmouth College (Hanover, NH) and the Rand Corporation (Santa Monica, Calif). For many years now, Wennberg et al1-3 and others4 have documented large variations in the use of various health care services in different geographic areas without apparent differences in medical need. More recently, Chassin et al5 and Winslow and colleagues6 showed that in up to a third of instances high-cost procedures may be ordered inappropriately. Together these two findings highlight the attractive possibility that more appropriate use of health care services could simultaneously improve quality of care and save money. The major restructuring of Medicare physician payment policy References 1. Wennberg J, Gittelsohn A. Small area variations in health care delivery . Science. 1973;182:1102-1108.Crossref 2. Wennberg J, Freeman JL, Shelton RM, Bubolz TA. Hospital use and mortality among Medicare beneficiaries in Boston and New Haven . N Engl J Med. 1989;321:1168-1173.Crossref 3. Wennberg J, Freeman JL, Culp WJ. Are hospital services rationed in New Haven or over-utilized in Boston? Lancet. 1987;1:1185-1189.Crossref 4. Chassin MR, Brook RH, Park RE, et al. Variations in the use of medical and surgical services by the Medicare population . N Engl J Med. 1986;314:285-290.Crossref 5. Chassin MR, Kosecoff J, Park RE, et al. Does inappropriate use explain geographic variations in the use of health care services? a study of three procedures . JAMA. 1987;258:2533-2537.Crossref 6. Winslow CM, Solomon DH, Chassin MR, Kosecoff J, Merrick NJ, Brook RH. The appropriateness of carotid endarterectomy . N Engl J Med. 1988;319:124. 7. Public Law No. 101-239. The Omnibus Budget Reconciliation Act of 1989. 8. Schectman JM, Elinsky EG, Pawlson LG. Effect of education and feedback on thyroid function testing strategies of primary care clinicians . Arch Intern Med. 1991;151:2163-2166.Crossref 9. Fishbein M, Ajzen I. Belief, Attitude, Intention and Behavior: Introduction to Theory and Research . Reading, Mass: Addison Wesley; 1975. 10. Goldman L. Changing physicians' behavior: the pot and the kettle . N Engl J Med. 1990;322:1524-1525.Crossref 11. Lomas J, Anderson GM, DomnickPierre K, Vayda E, Enkin MW, Hannah WJ. Do practice guidelines guide practice? the effect of a consensus statement on the practice of physicians . N Engl J Med. 1989;321:1306-1311.Crossref 12. Panel of the National Conference on Aspects of Cesarean Birth Indications for Cesarean Section. Final statement of the Panel of the National Consensus Conference on Aspects of Cesarean Birth . Can Med Assoc J. 1986;134:1348-1352. 13. Soumerai SB, Ross-Degnan D, Gortmaker S, Avorn J. Withdrawing payment for nonscientific drug therapy intended and unexpected effects of a large-scale natural experiment . JAMA. 1990;263:831-839.Crossref 14. Soumerai SB, Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decisionmaking . JAMA. 1990;263:549-556.Crossref 15. Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach: a randomized controlled trial of academically based 'detailing.' N Engl J Med . 1983;308:1457-1463.Crossref 16. Lomas J, Enkin M, Anderson GM, Hannah WJ, Vayda E, Singer J. Opinion leaders vs audit and feedback to implement practice guidelines: delivery after cesarean section . JAMA. 1991;265:2202-2207.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Changing Physician Behavior: Increasing Challenges for the 1990s

Archives of Internal Medicine , Volume 151 (11) – Nov 1, 1991

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1991.00400110011003
Publisher site
See Article on Publisher Site

Abstract

Abstract Although interest in cost containment is long-standing, it has recently resurged on a national level. This resurgence is partly the result of federal budgetary pressure caused by ever-increasing health care expenditures. However, the resurgence also reflects the combined effects of research from groups of investigators based at Dartmouth College (Hanover, NH) and the Rand Corporation (Santa Monica, Calif). For many years now, Wennberg et al1-3 and others4 have documented large variations in the use of various health care services in different geographic areas without apparent differences in medical need. More recently, Chassin et al5 and Winslow and colleagues6 showed that in up to a third of instances high-cost procedures may be ordered inappropriately. Together these two findings highlight the attractive possibility that more appropriate use of health care services could simultaneously improve quality of care and save money. The major restructuring of Medicare physician payment policy References 1. Wennberg J, Gittelsohn A. Small area variations in health care delivery . Science. 1973;182:1102-1108.Crossref 2. Wennberg J, Freeman JL, Shelton RM, Bubolz TA. Hospital use and mortality among Medicare beneficiaries in Boston and New Haven . N Engl J Med. 1989;321:1168-1173.Crossref 3. Wennberg J, Freeman JL, Culp WJ. Are hospital services rationed in New Haven or over-utilized in Boston? Lancet. 1987;1:1185-1189.Crossref 4. Chassin MR, Brook RH, Park RE, et al. Variations in the use of medical and surgical services by the Medicare population . N Engl J Med. 1986;314:285-290.Crossref 5. Chassin MR, Kosecoff J, Park RE, et al. Does inappropriate use explain geographic variations in the use of health care services? a study of three procedures . JAMA. 1987;258:2533-2537.Crossref 6. Winslow CM, Solomon DH, Chassin MR, Kosecoff J, Merrick NJ, Brook RH. The appropriateness of carotid endarterectomy . N Engl J Med. 1988;319:124. 7. Public Law No. 101-239. The Omnibus Budget Reconciliation Act of 1989. 8. Schectman JM, Elinsky EG, Pawlson LG. Effect of education and feedback on thyroid function testing strategies of primary care clinicians . Arch Intern Med. 1991;151:2163-2166.Crossref 9. Fishbein M, Ajzen I. Belief, Attitude, Intention and Behavior: Introduction to Theory and Research . Reading, Mass: Addison Wesley; 1975. 10. Goldman L. Changing physicians' behavior: the pot and the kettle . N Engl J Med. 1990;322:1524-1525.Crossref 11. Lomas J, Anderson GM, DomnickPierre K, Vayda E, Enkin MW, Hannah WJ. Do practice guidelines guide practice? the effect of a consensus statement on the practice of physicians . N Engl J Med. 1989;321:1306-1311.Crossref 12. Panel of the National Conference on Aspects of Cesarean Birth Indications for Cesarean Section. Final statement of the Panel of the National Consensus Conference on Aspects of Cesarean Birth . Can Med Assoc J. 1986;134:1348-1352. 13. Soumerai SB, Ross-Degnan D, Gortmaker S, Avorn J. Withdrawing payment for nonscientific drug therapy intended and unexpected effects of a large-scale natural experiment . JAMA. 1990;263:831-839.Crossref 14. Soumerai SB, Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decisionmaking . JAMA. 1990;263:549-556.Crossref 15. Avorn J, Soumerai SB. Improving drug-therapy decisions through educational outreach: a randomized controlled trial of academically based 'detailing.' N Engl J Med . 1983;308:1457-1463.Crossref 16. Lomas J, Enkin M, Anderson GM, Hannah WJ, Vayda E, Singer J. Opinion leaders vs audit and feedback to implement practice guidelines: delivery after cesarean section . JAMA. 1991;265:2202-2207.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1991

References