title: Family physicians' perceptions on how they deliver cost-effective care: a qualitative study from the Residency Research Network of Texas (RRNeT).
abstract: OBJECTIVE
  The aim of our study was to deepen our understanding of the factors that may explain the observational literature that more primary care physicians in an area contribute to better population health outcomes and lower health care costs.
  
  
  METHODS
  This study used in-depth, qualitative interviewing of family physicians in both urban and rural, academic, and private practices. Interviews were initiated with a series of grand tour questions asking subjects to give examples and personal narratives demonstrating cost-effectiveness and cost inefficiencies in their own practices. An iterative open-coding approach was used to analyze transcripts to search for unifying themes and sub-themes until consensus among investigators was achieved.
  
  
  RESULTS
  Thirty-eight respondents gave examples of how their decision-making approaches resulted in improved patient outcomes and lower costs. Family physicians' cost-effective care was founded on two themes-characteristic attitudes and skills of the physicians themselves and a thorough knowledge of the whole patient. Family physicians also felt their approaches to gathering information and then making diagnostic and treatment decisions resulted in fewer tests and fewer treatments ordered overall. Family physicians also delivered care in less expensive facilities and generated lower overall charges for physician fees.
  
  
  CONCLUSIONS
  Family physicians perceived that their approaches to patient care result in medical decision making priorities and care delivery processes that contribute to more cost-effective health care. These outcomes were achieved less by providing preventive services and strictly adhering to guidelines but rather by how they individualized the management of new symptoms and chronic conditions.
authors.affiliation: John Peter Smith Family Medicine Residency Program, Fort Worth, TX 76104, USA. ryoung01@ jpshealth.org
authors.forename: Richard A
authors.initials: RA
authors.lastname: Young
authors.forename: Bryan
authors.initials: B
authors.lastname: Bayles
authors.forename: Terrell B
authors.initials: TB
authors.lastname: Benold
authors.forename: Jason H
authors.initials: JH
authors.lastname: Hill
authors.forename: Kaparabonya A
authors.initials: KA
authors.lastname: Kumar
authors.forename: Sandra
authors.initials: S
authors.lastname: Burge
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000191:economics*; D003362:Cost-Benefit Analysis; D003657:Decision Making; D006801:Humans; D010353:Patient Education as Topic; D010465:Perception; D010817:Physician-Patient Relations; D010821:Physicians, Family / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D036301:Qualitative Research; D012648:Self Care / Q000191:economics; D013781:Texas; D035502:Trust