Physician Use of Services for the Hospitalized Patient: A Review, with Implications for Cost Containment

Myers, Lois P.; Schroeder, Steven A.

doi:10.2307/3349738

Cited by 60 publications

(10 citation statements)

References 61 publications

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“…Of the factors identified as influencing physicians to order medical services [17,19], a belief that patient care will be improved is thought to be the most common and important reason for increased use of services. In the patient cases in this study, however, referral for tests was not related to an expectation of medical benefit.…”

Section: Discussionmentioning

confidence: 99%

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Rationale for Physicians' Decisions to Refer Obese Patients

Rovner¹,

Rothert²,

Holmes³

et al. 1985

Med Decis Making

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Health care costs are an increasing burden upon American society. Referral of patients to a specialist generates additional cost. We studied the reasons behind decisions to refer patients with uncomplicated obesity to endocrinologists. Obesity may be viewed as a paradigm of diseases with relatively well-known etiology, low morbidity and mortality, chronicity, and poor outcome from standard therapy. In addition, it is a disease that is rarely curable by medical intervention, requiring behavioral change. Physicians have little direct experience in the differential diagnosis of endocrine disease, because of its low prevalence. We studied the referral decisions of 45 physicians in three medical specialties. Clinical decision making was studied using a standard set of 24 carefully structured case reports of obese women, all without obvious endocrine disease cues on history or physical. In these cases the patients' desire to be seen by endocrinologists was the major factor in the decision to refer. Referrals were not made primarily to rule out suspected endocrine disorder or because of concern for increased risk of morbidity.

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Section: Discussionmentioning

confidence: 99%

“…In our study, physicians in all specialties used the patient's insistence upon referral as the primary cue to refer. Studies involving other services, particular laboratory tests or drug usage, have also identified patient demand as a major factor that may influence the physician to order particular services [17,19].…”

Section: Discussionmentioning

confidence: 99%

Rationale for Physicians' Decisions to Refer Obese Patients

Rovner¹,

Rothert²,

Holmes³

et al. 1985

Med Decis Making

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show abstract

“…The efficacy of self-generated data and/or external review/audit in improving the performance of professional bureaucracies has been documented (e.g., Burns et al, 1982; M. Levine, 1980Levine, , 1986Mazmanian & Sabatier, 1983, pp. 175-217;Myers & Schroeder, 1981). This is not to say that evaluation studies are bias-free in the sense that there is no conscious attempt to distort the actual state of functioning of the organization, either in a favorable or an unfavorable manner.…”

Section: 'Market Grouping Is the Grouping Of Units On The Basis Of Fimentioning

confidence: 99%

Change processes in the professional bureaucracy

Cheng¹

1990

J. Community Psychol.

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The limits of organizational change often make effective implementation of policies difficult. This article examines how change can be accomplished in the professional bureaucracy. Examples in community mental health and compensatory education are employed to illustrate the points discussed. It is concluded that because professionals function independently and their work cannot be easily replaced, change in the professional bureaucracy would inevitably involve (a) replacing existing staff with people sympathetic to the change or (b) convincing and motivating existing staff to implement the change. Except for crisis situations in which the leadership can take advantage to organize for change, other strategies seem to be secondary to these requirements.

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“…[1][2][3][4][5][6][7] Repeat investigations are a common cause of unnecessary requests. In one study 30% of the patients had a normal biochemical profile on admission; nevertheless most of these patients received two additional profiles during their hospital stay.…”

Section: Overuse Of Investigationsmentioning

confidence: 99%

Improving laboratory usage: a review

Young

1988

Postgraduate Medical Journal

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Summary:Influencing the ordering of laboratory investigations, and in particular reducing unnecessary ones, is a vital concern to many hospitals. An account of the reasons why control is necessary is presented. The different methods evaluated are reviewed, including rationing, form design, resource management (budget control), education, protocols and decision support systems, incentives, feedback and case note appraisal.Methods of controlling the requesting of investigations are likely to be ineffective unless they take place in the correct environment. Elements of this include correct attitude and commitment by senior staff, a long term strategy, and different approaches for different groups of doctors.

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Physician Use of Services for the Hospitalized Patient: A Review, with Implications for Cost Containment

Cited by 60 publications

References 61 publications

Rationale for Physicians' Decisions to Refer Obese Patients

Rationale for Physicians' Decisions to Refer Obese Patients

Change processes in the professional bureaucracy

Improving laboratory usage: a review

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