Abstract
Objective: To develop a reliable measure of physician attitudes postulated to influence resource utilization.
Design: Statements related to attitudes that may influence resource use were culled from the literature and informal discussions with physicians.
Setting: Academic medical center.
Participants: All faculty and housestaff in internal medicine, pediatrics, family medicine, and surgery at an academic medical center were surveyed. The response rate was 59% (n=428).
Results: Exploratory factor analysis of all internal medicine surveys revealed four prominent domains. These closely corresponded with our a-priori hypothesized domains and were interpreted as cost-consciousness, discomfort with uncertainty, fear of malpractice, and annoyance with utilization review. A replication of the analysis using 25 survey items and conducted on the remainder of the data (surgeons, pediatricians, and family practitioners) revealed a similar four-factor solution. Scales were constructed for each of the four domains. Cronbach’s alpha ranged from 0.66 to 0.88. Discomfort from uncertainty and fear of malpractice were moderately correlated (r=0.42); other scale-scale correlations were modest. Of the four attitude measures, only cost-consciousness was associated with lower self-estimates of resource use. Both annoyance with utilization review and fear of malpractice increased as the proportion of time spent in patient care increased.
Conclusions: Although various physician attitudes and beliefs have been hypothesized to influence health services resource use, reliable and valid measures for most of these have not been developed. The authors developed a 19-item survey instrument designed to measure these attitudes reliably. The four scales developed in this study may help identify physician attitudes that are important determinants of physician decision making and help foster a better understanding of physicians’ reactions and acculturation to different practice environments.
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References
McMahon LF Jr, Newbold R. Variation in resource use within diagnosis-related groups: the effect of severity of illness and physician practice. Med Care. 1986;24:388–97.
Connell FA, Blide LA, Hanken MA. Clinical correlates of small area variations in population-based admission rates for diabetes. Med Care. 1984;22:939–49.
Wennberg J, Gittelsohn A. Variations in medical care among small areas. Sci Am. 1982;246:120–34.
Schroeder SA, Kenders K, Cooper JK, Piemme TE. Use of laboratory tests and pharmaceuticals: variation among physicians and effect of cost audit on subsequent use. JAMA. 1973;225:969–73.
Daniels M, Schroeder SA. Variation among physicians in use of laboratory tests. II. Relation to clinical productivity and outcomes of care. Med Care. 1977;15:482–7.
Stockwell H, Vayda E. Variations in surgery in Ontario. Med Care. 1979;17:390–6.
Roos LL Jr, Roos NP. Assessing existing technologies: the Manitoba study of common surgical procedures. Med Care. 1983;21:454–62.
Beland F. Utilization of health services as events: an exploratory study. Health Serv Res. 1988;23:295–310.
Greenfield S, Nelson EC, Zubkoff M, et al. Variations in resource use among medical specialties and systems of care. JAMA. 1992;267:1624–30.
McPherson K, Wennberg JE, Hovind OB, Clifford P. Small-area variations in the use of common surgical procedures: an international comparison of New England, England, and Norway. N Engl J Med. 1982;307:1310–4.
Katz SJ, Larson EB, LoGerfo JP. Trends in the utilization of mammography in Washington state and British Columbia: relation to stage of diagnosis and mortality. Med Care. 1992;30:320–8.
Hlatky MA, Lee KL, Botvinick EH, Brundage BH. Diagnostic test use in different practice settings: a controlled comparison. Arch Intern Med. 1983;143:1886–9.
Feinglass J, Martin GJ, Sen A. The financial effect of physician practice style on hospital resource use. Health Serv Res. 1991;26:183–205.
Bernard AM, Shapiro LR, McMahon LF Jr. The influence of attending physician subspecialization on hospital length of stay. Med Care. 1990;28:170–4.
Eisenberg JM, Nicklin D. Use of diagnostic services by physicians in community practice. Med Care. 1981;19:297–309.
Eisenberg JM. Physician utilization: the state of research about physicians’ practice patterns. Med Care. 1985;23:461–83.
Donabedian A. Aspects of Medical Care Administration: Specifying Requirements for Health Care. Cambridge, MA: Harvard University Press, 1973.
Eisenberg JM. Doctors’ Decisions and the Cost of Medical Care. Ann Arbor, MI: Health Administration Press, 1986.
Gerrity MS, DeVellis RF, Earp JA. Physicians’ reactions to uncertainty in patient care. A new measure and new insights. Med Care. 1990;28:724–36.
Breslin FA, Taylor KR, Brodsky SL. Development of a litigaphobia scale: measurement of excessive fear of litigation. Psychol Rep. 1986;58:547–50.
Shapiro RS, Simpson DE, Lawrence SL, Talsky AM, Sobocinski KA, Schiedermayer DL. A survey of sued and nonsued physicians and suing patients. Arch Intern Med. 1989;149:2190–6.
Kim J. Factor Analysis: Statistical Methods and Practical Issues. Beverly Hills, CA: Sage Publications, 1978.
Holzinger KJ, Harman HH. Factor Analysis: A Synthesis of Factorial Methods. Chicago, IL: University of Chicago Press, 1941.
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Supported in part by the Lyle C. Roll Memorial Fund.
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Goold, S.D., Hofer, T., Zimmerman, M. et al. Measuring physician attitudes toward cost, uncertainty, malpractice, and utilization review. J Gen Intern Med 9, 544–549 (1994). https://doi.org/10.1007/BF02599278
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DOI: https://doi.org/10.1007/BF02599278