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Physician Practice Variation in Assignment of Return Interval
Karen B. DeSalvo, MD, MPH;
Bruce E. Bowdish, PhD;
Alys S. Alper, MD, MPH;
David M. Grossman, MD;
William W. Merrill, MD
Arch Intern Med. 2000;160:205-208.
Background Recent shifts in reimbursement toward capitation makes appointment availability a significant resource and stimulates us to understand primary care physician (hereafter referred to as "provider") behavior concerning appointment assignment. The results of prior studies suggest significant provider variability in this area.
Objective To examine the influences on assigning patient revisit intervals in the ambulatory setting.
Methods Survey regarding general care issues of hypothetical diabetic and hypertensive patients seen in an ambulatory setting was given to 62 providers in the Internal Medicine Program at the Tulane University Internal Medicine Residency Program and outpatient clinics, New Orleans, La. Measurements evaluated included survey responses for demographics (sex, year of birth, year of graduation from medical school, and level of training) and practice style (decision to change therapy, order tests, and recommended return appointment interval in weeks) variables.
Results The response rate was 89% (56 providers). Most respondents were men (n = 39). Wide variation was noted in assignment of reappointment interval with mean return intervals for the scenarios ranging from 2.2 to 20.5 weeks. Significant influences on provider practice included patient stability (P<.001), the decision to change therapy (P = .001), and the decision to order tests (P = .001). All correlated with an earlier return appointment. Some providers exhibited test-ordering tendencies across scenarios. Sex was a significant provider independent variable and was not influenced by other study variables. Female providers assigned earlier reappointment intervals for their patients.
Conclusions Wide variation exists among practitioners with similar training background and practice setting. As expected, patient stability was a major determinant of assigned return interval. Test-ordering behaviors may consume appointments inappropriately and may be a productive area for efforts to reduce provider variability. The influence of the provider's sex on scheduling follow-up appointments warrants further investigation.
From the Department of Medicine (Drs DeSalvo, Alper, Grossman, and Merrill) and the Office of Educational Resources (Dr Bowdish), Tulane University School of Medicine, and the New Orleans Veterans Affairs Medical Center (Drs Grossman and Merrill), New Orleans, La.
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