Wave-off: a mechanism for physician-reduced demand

Area of Science:

• Healthcare Operations
• Clinical Decision-Making
• Health Services Research

Background:

• Physicians sometimes implicitly discourage patient revisits to manage high workloads, a phenomenon termed the "wave-off" mechanism.
• This mechanism impacts patient behavior, operational efficiency, and the balance between workload management and patient-centered care.

Purpose of the Study:

• To investigate the relationship between physician workload and patient revisit likelihood.
• To identify physician strategies for modulating patient flow and demand.
• To quantify patient propensity to revisit using a novel metric, Sample Entropy.

Main Methods:

• Analysis of 200,426 outpatient cardiology records.
• Introduction of Sample Entropy to measure patient "stickiness" (revisit propensity).
• Examination of physician behaviors like referrals and prescriptions to understand patient flow modulation.

Main Results:

• Increased physician workload correlated with fewer short-term patient revisits.
• Physicians prescribed more medications and ordered fewer diagnostic tests for "sticky" patients to manage workload.
• These actions reduced immediate workload but may lead to long-term inefficiencies.

Conclusions:

• The "wave-off" mechanism presents a trade-off between short-term workload relief and long-term operational performance.
• Physician-driven demand modulation, including reduced demand, can affect patient care and system efficiency.
• Understanding this phenomenon is crucial for optimizing healthcare delivery and patient outcomes.