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Feedback reduces test use in a health maintenance organization
JAMA
|March 21, 1986
Summary
Physician feedback on test use reduced blood test and roentgenogram orders by 14.2%. This cost feedback intervention effectively lowered diagnostic test utilization among internists, unlike yield feedback or education alone.
Area of Science:
- Health Services Research
- Clinical Practice Improvement
- Medical Economics
Background:
- Overutilization of diagnostic tests contributes to healthcare costs.
- Variability exists in physician ordering patterns for common blood tests and roentgenograms.
- Effective interventions are needed to optimize test utilization in healthcare settings.
Purpose of the Study:
- To evaluate the impact of three interventions on the rate of use of common diagnostic tests among internists.
- To compare the effectiveness of cost feedback, yield feedback, and educational programs in reducing test utilization.
- To assess the influence of these interventions on the variability of test ordering among physicians.
Main Methods:
- A cross-over design study involving internists in a health maintenance organization.
- Interventions included confidential peer comparison of individual test use rates (cost feedback).
- Other interventions were feedback on abnormal test result rates (yield feedback) and test-specific education.
Main Results:
- Overall use of 12 common blood tests and roentgenograms decreased by 14.2% during the cost feedback period.
- Eleven of the 12 tests showed a reduction in use with cost feedback.
- Yield feedback and educational interventions did not demonstrate a consistent effect on test utilization or variability.
Conclusions:
- Confidential peer comparison of utilization rates (cost feedback) is an effective strategy for reducing diagnostic test use among internists.
- Yield feedback and educational interventions were less effective in modifying physician test ordering behavior.
- Cost feedback also demonstrated a significant reduction in the variability of test ordering among physicians.
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