Rheumatologists' performance in daily practice

Abstract

Objective To assess rheumatologists' performance for 8 rheumatologic conditions and to explore possible explanatory factors. Methods After written informed consent was obtained, 27 rheumatologists (21% of all Dutch rheumatologists) practicing in 16 outpatient departments were each visited by 8 incognito “standardized patients” (SPs). The diagnoses of these 8 cases account for about 23% of all new referred patients in the Netherlands. Results for ordered lab tests as well as real radiographs with corresponding results from a radiologist were simulated. Information from the visits was obtained from the SPs, who completed predefined case‐specific checklists, and by collecting data on resource utilization. Feedback was provided. Results Altogether 254 encounters took place, of which 201 were first visits and 53 were followup visits. SPs were unmasked twice during a visit. There was considerable variation in resource utilization (lab tests and imaging) between cases and between rheumatologists. Mean costs per rheumatologist ranged from US $ 4.67 to $ 65.36 per visit for lab tests and from US $ 33.15 to $ 226.84 per visit for imaging tests. No significant correlations were seen between resource utilization costs and number of years of clinical experience or performance on checklist scores. Rheumatologists with longer experience had lower total item checklist scores (r = −0.47; P < 0.05). Conclusion A considerable variation in resource utilization was found among 27 Dutch rheumatologists. The information obtained is an excellent source for discussion on the appropriateness of care. Arthritis Care Res 45:16–27, 2001. © 2001 by the American College of Rheumatology.

Doctor performance assessment in daily practise: does it help doctors or not? A systematic review

“…The calculated cost per completed appraisal was £771 (€1135) 70 . Video observation was estimated as costing £268 (€394) per doctor and assessment with SPs, which requires at least 6 SP visits, as costing between £3 (€4) and £142 (€209) per visit, depending on the type of case presented 27,37 …”

Radiographic assessment of sacroiliitis by radiologists and rheumatologists: does training improve quality?

“…Recently, a study has assessed the real performances of (Dutch) rheumatologists in daily practice, visited by patients incognito. 18 In particular, a female patient mimicking symptoms suggestive of AS and referred by her general practitioner visited a total of 25 rheumatologists. She brought with her a radiograph from another hospital clearly showing bilateral sacroiliitis.…”

“…After history taking and physical examination, in which nearly all rheumatologists performed spinal mobility tests, more than 50% of the rheumatologists proposed additional radiographic imaging. 18 Evidently, a large group of rheumatologists felt uncertain about interpreting radiographs. Unfortunately, this study does not seem to contribute towards increasing their performance.…”

Place du médecin généraliste dans la prise en charge de la polyarthrite rhumatoïde

“…La multitude des tableaux cliniques rend difficile une prise en charge stéréoty-pée ce qui se retrouve dans les résultats des enquêtes de pratiques. La prise en charge de la polyarthrite rhumatoïde est en effet extrêmement variable : variabilité des diagnostics posés devant une polyarthrite [7], des examens complémen-taires prescrits au début de la polyarthrite [8], des traitements [9][10][11][12][13][14], du suivi [9,[15][16][17][18], de la surveillance du traitement de fond [15,17,19] et de la prise en charge globale [20].…”