Use of standardized patients to assess between-physician variations in resource utilization.
BACKGROUND
As medical costs are increasingly being scrutinized, there is heightened interest in defining variations in physician behavior in clinical settings.


OBJECTIVE
To evaluate if standardized patient (SP) technology is a reliable and feasible method of studying interphysician variations in test ordering, referral requests, prescribing behavior, and visit costs.


METHODS
The study was conducted with blinded SP visits to family medicine and internal medicine residents, university-affiliated family physicians, and community-based family physicians. Resource utilization and visit costs were assessed using test requisitions, consult requests, and prescriptions that were collected by the SPs.


METHODS
Physicians' offices in ambulatory care, hospital-based clinics and in the community.


METHODS
Four persons (aged 57-77 years) trained to simulate having osteoarthritis of the hip. In one simulation, the patient had gastropathy due to nonsteroidal anti-inflammatory drug use, and in the other, the patient sought therapy for hip discomfort.


METHODS
Reliability of cost estimates of physician services, tests, consultations, prescriptions, and total visits and test-ordering behavior for nonsteroidal anti-inflammatory gastropathy.


RESULTS
Overall, 112 (63%) of the physicians who were sent invitations to the study agreed to participate. Of 312 total SP visits conducted over a 1-year period, unblinding due to SP detection occurred on 36 occasions (11.5%). Reliable cost estimates of physician services, tests, and consultations, and moderately reliable estimates of total visit costs, were obtained with 4 visits per practicing physician and with 2 visits per resident. There were extreme variations in total visit costs generated by the study physicians. A small number of physicians had a major impact on this variability.


CONCLUSIONS
Standardized patient technology provides a reliable, feasible method to assess variations in resource utilization between physicians.
McLeod
P J
PJ
Department of Medicine, McGill University, Montreal, Quebec.
Tamblyn
R M
RM
Gayton
D
D
Grad
R
R
Snell
L
L
Berkson
L
L
Abrahamowicz
M
M
D003953:Diagnosis-Related Groups; D003955:Diagnostic Tests, Routine / Q000191:economics / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005240:Feasibility Studies; D006295:Health Resources / Q000191:economics / Q000706:statistics & numerical data*; D006302:Health Services Research / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D016544:Patient Simulation; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D012017:Referral and Consultation / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D014481:United States