Determinants of Medical Practice Variation Among Primary Care Physicians: Protocol for a Three Phase Study

Abstract

Background One of the greatest challenges of modern health systems is the choice and use of resources needed to diagnose and treat patients. Medical practice variation (MPV) is a broad term which entails the differences between health care providers inclusive of both the overuse and underuse. In this paper, we describe a 3-phase research protocol examining MPV in primary care. Objective We aim to identify the potential targets for behavioral modification interventions to reduce the variation in practice patterns and thus improve health care, decrease costs, and prevent disparities in care. Methods The first phase will delineate the variation in primary care practice over a wide range of services and long follow-up period (2003-2017), the second will examine the 3 determinants of variation (ie, patient, physician, and clinic characteristics), and attempt to derive the unexplained variance. In the third phase, we will assess a novel component that might contribute to the previously unexplained variance - the physicians’ personal behavioral characteristics (such as risk aversion, fear of malpractice, stress from uncertainty, empathy, and burnout). Results This work was supported by the research grant from Israel National Institute for Health Policy Research (Grant No. 2014/134). Soroka University Medical Center Institutional Ethics Committee has approved the updated version of the study protocol (SOR-14-0063) in February 2019. All relevant data for phases 1 and 2, including patient, physician, and clinic, were collected from the Clalit Health Services data set in 2019 and are currently being analyzed. The evaluation of the individual physician characteristics (eg, risk aversion) by the face-to-face questionnaires was started on 2018 and remains in progress. We intend to publish the results during 2020-2021. Conclusions Based on the results of our study, we aim to propose a list of potential targets for focused behavioral intervention. Identifying new targets for such an intervention can potentially lead to a decrease in the unwarranted variation in the medical practice. We suggest that such an intervention will result in optimization of the health system, improvement of health outcomes, reduction of disparities in care and savings in cost. International Registered Report Identifier (IRRID) DERR1-10.2196/18673

Unravelling the determinants of medical practice variation in referrals among primary care physicians: insights from a retrospective cohort study in Southern Israel

“…We chose HSs that involve clinical scenarios with discretionary decisions where the physician has the freedom of action to decide whether to use them. 11 The referrals are divided into five domains: ► Four imaging tests: bone scintigraphy, CT of the brain and spine, X-ray of the chest (CXR) and MRI. ► A composite of cardiac tests: 24-hour Holter electrocardiography, stress test and echocardiography.…”

“…The annual referral rates were calculated as the number of referrals per year divided by the total number of insured patients under the physician’s care, and then multiplied by 1000 to standardise the rates per 1000 patients. We chose HSs that involve clinical scenarios with discretionary decisions where the physician has the freedom of action to decide whether to use them 11. The referrals are divided into five domains:…”

“…We chose HSs that involve clinical scenarios with discretionary decisions where the physician has the freedom of action to decide whether to use them. 11 The referrals are divided into five domains:…”

“…Medical practice variation (MPV) is associated with poor health outcomes, increased costs, disparities in care and burden on medical systems 1 2. Unwarranted MPV is the type of variation that cannot be explained by patient illness or preferences 3.…”

Successful Implementation of Single Urine Polymerase Chain Reaction Test for Evaluating Suspected Cytomegalovirus Infection in Neonates

“…Previous studies suggest unwarranted practice variation and excessive use of diagnostic modalities are key contributors to health care inefficiency and waste. [16][17][18] Going from 3 to 1 specimen has reduced waste on many levels. Laboratory testing, from collection to processing, involves resources Fig.…”