Diagnostic Management by Gatekeepers Is Not Cost Effective for Neuro-ophthalmology

Dillon, Edward; Sergott, Robert C.; Savino, Peter J.; Bosley, Thomas M.

doi:10.1016/s0161-6420(94)31127-4

Cited by 24 publications

(15 citation statements)

References 8 publications

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“…If this were the case, the apparent cost savings associated with low referral rates may mask poorer quality of care and even greater costs, both human and administrative, of avoidable morbidity. 81 Prescribing activity of physicians has also come under the spotlight in health policy reforms and drug review assessments. [13][14][15][16][17][18][19][20][82][83][84] Annual expenditures for prescription drugs have increased substantially, [85][86][87] and drug-related illness is now claimed to be the sixth leading cause of mortality in the United States.…”

Section: Implications For Population Health and Health Care System Pomentioning

confidence: 99%

Association Between Licensing Examination Scores and Resource Use and Quality of Care in Primary Care Practice

Tamblyn

Abrahamowicz²,

Brailovsky³

et al. 1998

JAMA

142

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Context.-Clinical competence is a determinant of the quality of care delivered, and may be associated with use of health care resources by primary care physicians. Clinical competence is assumed to be assessed by licensing examinations, yet there is a paucity of information on whether scores achieved predict subsequent practice. Objective.-To determine if licensing examination scores were associated with selected aspects of quality of care and resource use in initial primary care practice. Design.-Prospective cohort study of recently licensed family physicians, followed up for the first 18 months of practice. Setting.-The Québec health care system. Participants.-A total of 614 family physicians who passed the licensing examination between 1991 and 1993 and entered fee-for-service practice in Québec. Main Outcome Measures.-All patients seen by physicians were identified by the universal health insurance board and all health services provided to these patients were retrieved for the 18 months prior to (baseline) and after (follow-up) the physicians' entry into practice. Medical service and prescription claims files were used to measure rates of resource use (specialty consultation, symptom-relief prescribing compared with disease-specific prescribing) and quality of care (inappropriate prescribing, mammography screening). Baseline data were used to adjust for differences in practice population. Results.-Study physicians saw a total of 1 116 389 patients, of whom 113 535 (10.2%) were elderly and 83 391 (7.5%) were women aged 50 to 69 years. Physicians with higher licensing examination scores referred more of their patients for consultation (3.8/1000 patients per SD increase in score; 95% confidence interval [CI], 1.2-7.0; P = .005), prescribed to elderly patients fewer inappropriate medications (−2.7/1000 patients per SD increase in score; 95% CI, −4.8 to −0.7; P = .009) and more disease-specific medications relative to symptom-relief medications (3.9/1000 patients per SD increase in score; 95% CI, 0.3 to 7.4; P = .03), and referred more women aged 50 to 69 years (6.6/1000 patients per SD increase in score; 95% CI, 1.2-11.9; P = .02) for mammography screening. If patients of physicians with the lowest scores had experienced the same rates of consultation, prescribing, and screening as patients of physicians with the highest scores, an additional 3027 patients would have been referred, 179 fewer elderly patients would have been prescribed symptom-relief medication, 912 more elderly patients would have been prescribed disease-specific medication, 189 fewer patients would have received inappropriate medication, and 121 more women would have received mammography screening. Conclusions.-Licensing examination scores are significant predictors of consultation, prescribing, and mammography screening rates in initial primary care practice.

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Section: Implications For Population Health and Health Care System Pomentioning

confidence: 99%

Association Between Licensing Examination Scores and Resource Use and Quality of Care in Primary Care Practice

Tamblyn

Abrahamowicz²,

Brailovsky³

et al. 1998

JAMA

142

View full text Add to dashboard Cite

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“…Rao et al (2) investigated neuroimaging utilization rates in the United States and observed a 36% increase in tests performed in 5 years, from 13,987 neuroimaging tests per 100,000 Medicare patients in 1993 to 19,431 tests per 100,000 patients in 1998. Health care costs have also escalated during this time, which is partly attributed to growth in medical technology (1,4). Health care costs have also escalated during this time, which is partly attributed to growth in medical technology (1,4).…”

mentioning

confidence: 99%

The Diagnostic and Economic Yield of Neuroimaging in Neuro-ophthalmology

Mehta

Loevner

Mikityansky

et al. 2012

Journal of Neuro-Ophthalmology

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“…Gatekeeping and utilization review strategies are based on the idea that reducing patient access to specialists and specialized services reduces the opportunity for further medical resource use and may protect patients from overtreatment. 7 Although previous studies have examined the influence of specialty differences on the quality and costs of care, 8–16 we could not locate any studies of the influence of utilization review methods or denial of specialty referral on patient satisfaction with care.…”

mentioning

confidence: 99%

The influence of gatekeeping and utilization review on patient satisfaction

et al. 1999

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OBJECTIVE:To examine the influence of utilization review and denial of specialty referrals on patient satisfaction with overall medical care, willingness to recommend one's physician group to a friend, and desire to disenroll from the health plan. DESIGN: MEASUREMENTS AND MAIN RESULTS:Our main measures were how groups conducted utilization review for specialty referrals and tests, patient-reported denial of specialty referrals, and patient satisfaction with overall medical care. Patients in groups that required preauthorization for access to many types of specialists were significantly ( p Յ .001) less satisfied than patients in groups that had few preauthorization requirements, even after adjusting for patient and other group characteristics. Patients who had wanted to see a specialist in the previous year but did not see one were significantly less satisfied than those who had wanted to see a specialist and actually saw one ( p Ͻ .001). In addition, patients who did not see a specialist when desired were more likely to want to disenroll from the health plan than patients who saw the specialist (40% vs 18%, p Յ .001) and more likely not to recommend their group to a friend (38% vs 13%, p Յ .001). CONCLUSIONS:Policies that limited direct access to specialists, and especially denial of patient-desired referrals, were associated with significantly lower patient satisfaction, increased desire to disenroll, and lower likelihood of recommending the group to a friend. Health plans and physician groups need to take these factors into account when designing strategies to reduce specialty care use.

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Diagnostic Management by Gatekeepers Is Not Cost Effective for Neuro-ophthalmology

Cited by 24 publications

References 8 publications

Association Between Licensing Examination Scores and Resource Use and Quality of Care in Primary Care Practice

Association Between Licensing Examination Scores and Resource Use and Quality of Care in Primary Care Practice

The Diagnostic and Economic Yield of Neuroimaging in Neuro-ophthalmology

The influence of gatekeeping and utilization review on patient satisfaction

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