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The effects of group size on test ordering for hypertensive patients
Insights
Physicians in large group practices order twice as many diagnostic tests for hypertensive patients compared to those in small groups or solo practices. This leads to significantly higher testing costs for patients in larger group settings.
Area of Science:
- Health Services Research
- Medical Practice Management
- Health Economics
Background:
- Increasing trend of physicians moving from solo to group practice settings.
- Potential impact of practice organization on healthcare utilization and costs.
- Need to understand factors influencing diagnostic test ordering for ambulatory patients.
Purpose of the Study:
- To investigate the association between group practice size and the number of diagnostic tests ordered for hypertensive patients.
- To compare testing frequency and associated costs between physicians in large group, small group, and solo practices.
- To identify specific tests whose utilization is influenced by practice size.
Main Methods:
- Retrospective study of 351 hypertensive patients' records.
- Data collected from 30 internists in solo and group private practices.
- Multiple regression analysis to assess the impact of group size on test ordering, controlling for patient and physician factors.
Main Results:
- Patients in large group practices received twice as many tests (6.4/patient/year) compared to small groups (3.5) or solo practices (3.3).
- Testing charges were nearly double for patients in large groups ($123) versus small groups ($58) or solo practices ($71).
- Large group practices were associated with increased use of electrocardiography, blood counts, urinalysis, and chest radiography, independent of other factors.
Conclusions:
- Membership in a large group practice is associated with increased diagnostic test ordering for hypertensive patients.
- The observed increase in testing may be attributed to physician/patient self-selection or organizational properties of large group practices.
- Findings suggest practice organization significantly influences healthcare resource utilization and patient costs.
Abstract:
There has been a tremendous increase in the number of patients receiving care from physicians in group practice rather than in solo practice. To determine whether group size influences the number of tests ordered for ambulatory patients, we studied the records of 351 hypertensive patients cared for by 30 internists in group or solo private practice. Patients of physicians who were members of large groups received twice as many tests (6.4 per patient per year) as patients of physicians in small groups (3.5) or in solo practice (3.3) (P less than 0.001). The charges for testing were also nearly double for patients of physicians in large groups ($123 vs. $58 and $71, P less than 0.01). A multiple regression analysis of individual tests showed that large group practices were associated with increased use of electrocardiography (P less than 0.001), blood counts (P less than 0.01), urinalysis (P less than 0.05), and chest radiography (P less than 0.05). These effects were independent of the patient's age and sex, the year the physician graduated from medical school, and the availability of testing machinery at the practice site. These findings suggest that membership in a large group practice is associated with increased test ordering for hypertensive patients. This may be due to self-selection of particular types of physicians or patients, or to a property of the organizational structure itself.