title: Rhemulatologists' performance in dailiy practice.
abstract: OBJECTIVE
  To assess rheumatologists' performance for 8 rheumatologic conditions and to explore possible explanatory factors.
  
  
  METHODS
  After written informed consent was obtained, 27 rheumatologists (21% of all Dutch rheumatologists) practicing in 16 outpatient departments were each visited by 8 incognito "standardized patients" (SPs). The diagnoses of these 8 cases account for about 23% of all new referred patients in the Netherlands. Results for ordered lab tests as well as real radiographs with corresponding results from a radiologist were simulated. Information from the visits was obtained from the SPs, who completed predefined case-specific checklists, and by collecting data on resource utilization. Feedback was provided.
  
  
  RESULTS
  Altogether 254 encounters took place, of which 201 were first visits and 53 were followup visits. SPs were unmasked twice during a visit. There was considerable variation in resource utilization (lab tests and imaging) between cases and between rheumatologists. Mean costs per rheumatologist ranged from US $ 4.67 to $ 65.36 per visit for lab tests and from US $ 33.15 to $ 226.84 per visit for imaging tests. No significant correlations were seen between resource utilization costs and number of years of clinical experience or performance on checklist scores. Rheumatologists with longer experience had lower total item checklist scores (r = -0.47; P < 0.05).
  
  
  CONCLUSIONS
  A considerable variation in resource utilization was found among 27 Dutch rheumatologists. The information obtained is an excellent source for discussion on the appropriateness of care.
authors: Division of Rheumatology, University Hospital Maastricht, The Netherlands.
authors: S
authors: S
authors: Gorter
authors: S
authors: S
authors: van der Linden
authors: J
authors: J
authors: Brauer
authors: D
authors: D
authors: van der Heijde
authors: H
authors: H
authors: Houben
authors: J J
authors: JJ
authors: Rethans
authors: A
authors: A
authors: Scherpbier
authors: C
authors: C
authors: van der Vleuten
authors: A
authors: A
authors: Boonen
authors: H
authors: H
authors: Dinant
authors: H G
authors: HG
authors: Thè
authors: E
authors: E
authors: Griep
authors: I
authors: I
authors: van der Horst-Bruinsma
authors: A
authors: A
authors: Linssen
authors: M
authors: M
authors: van Santen-Hoeufft
authors: H
authors: H
authors: van der Tempel
authors: T
authors: T
authors: Westgeest
mesh_terms: D000328:Adult; D002136:Calcium, Dietary / Q000008:administration & dosage; D002983:Clinical Competence; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology; D012219:Rheumatology / Q000193:education; D012307:Risk Factors
chemical_list: D002136:Calcium, Dietary