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Techniques to improve physicians' use of diagnostic tests: a new conceptual framework
D H Solomon1, H Hashimoto, L Daltroy
1Department of Medicine, Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Brigham and Women's Hospital, Harvard School of Medicine, Boston, MA 02115, USA. dhsolomon@bics.bwh.harvard.edu
JAMA
|December 24, 1998
Summary
Interventions to improve physician testing practices often claim success, with those targeting multiple behavioral factors showing greater effectiveness. Methodologic limitations exist, but behavioral frameworks aid in understanding successful interventions.
Area of Science:
- Medical Education
- Health Services Research
- Behavioral Science
Background:
- Physicians' diagnostic testing practices are crucial for patient outcomes.
- Evaluating interventions to improve these practices requires robust methodology.
- Behavioral models can help categorize and understand intervention effectiveness.
Purpose of the Study:
- To review literature on interventions improving physicians' testing practices.
- To propose methodological standards for such studies.
- To analyze interventions using the PRECEDE behavioral framework.
Main Methods:
- Searched MEDLINE, EMBASE, HEALTHStar (1966-1998).
- Included 49 studies comparing intervention and control groups.
- Two investigators independently reviewed articles using a data collection form.
Main Results:
- Mean methodologic score was 13/38.
- 76% of interventions reported desired behavior change.
- Interventions targeting multiple behavioral factors (86% success) trended higher than single-factor interventions (62% success).
Conclusions:
- Most reported interventions for physician testing practices claim success.
- Multi-behavioral factor interventions showed a trend toward greater success.
- Behavioral frameworks are useful for interpreting intervention results despite methodological flaws.