Thursday, May 07, 2015

Over testing by hospitalists

For years hospitalists have been promoted, despite evidence to the contrary, as the ultimate drivers of efficiency and cost savings in health care. This promotion ranges from unproven claims that the hospitalist model delivers equal quality but at lower cost compared to the traditional model to more grandiose ideas. But a new study in the Annals of Internal Medicine reports survey data from 2011, when the hospitalist movement had matured well into its second decade, indicating rampant over testing by hospitalists. From the paper:

Design: National survey of practice patterns for 2 common clinical vignettes: preoperative evaluation and syncope. Respondents were randomly selected and randomly provided 1 of 4 versions of each vignette. Each version contained identical clinical information but varied in factors that could change physician behavior. Respondents were asked to identify what they believed most hospitalists at their institution would recommend in each vignette.

Setting: Mailed survey conducted from June through October 2011...

Results: 68% (1020 of 1500) of hospitalists responded. They reported overuse in 52% to 65% of the preoperative evaluation vignettes and 82% to 85% of the syncope vignettes.

More than that, the responses indicated that the hospitalists ordered these tests despite knowing they were not recommended in the guidelines, patient satisfaction pressure being cited as a big driver.

According to a related piece inToday's Hospitalist, positive cost incentives were not found to be responsible:

Dr. Kachalia points to another interesting result: The study shows that even in settings in which physicians have little to no financial incentive, they still overuse tests.

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