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Many Physicians View Treatment Guidelines Positively
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ASHINGTON, D.C.—Sometimes dismissed as "cookie-cutter" medicine, treatment guidelines for specific medical conditions influenced more than half of all U.S. physicians in 2001, and nearly two-thirds of affected physicians viewed guidelines positively, according to a national study released today by the HSC.
The study found similar positive results for patient satisfaction surveys and practice profiling, where individual physicians treatment patterns and use of medical resources are compared with other physicians.
In 2001, 62 percent of physicians said patient satisfaction surveys had a moderate, large or very large effect on their practice of medicine, with 77 percent of affected physicians rating the use of patient surveys positively. Practice profiling was less widespread—only 34 percent of physicians reported profiling affected their practice of medicine, and half of those affected reported a positive effect.
"With medicine rapidly changing and increasingly complex, care management tools—such as treatment guidelines—offer the potential to help physicians practice more effectively, so its encouraging that most physicians view these tools positively," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded exclusively by The Robert Wood Johnson Foundation.
The studys findings are detailed in an HSC Issue Brief—Physicians and Care Management: More Acceptance Than You Think—available here. The study is based on results from HSCs Community Tracking Study Physician Survey, a nationally representative survey involving about 12,000 practicing physicians.
The study also found that physicians in practices with more revenue from managed care were somewhat more likely to report that care management tools had affected their practice of medicine, but managed care participation had little effect on whether physicians viewed the tools positively.
Researchers did find that physicians who completed their medical training within the five years prior to the survey were more likely to report that care management tools both influenced their practice and had a positive effect than physicians who completed their training earlier.
"Newer physicians may be more familiar and comfortable with evidence-based medicine and the use of care management tools because they were trained in the era of managed care," said HSC Health Research Analyst Marie Reed, M.H.S, who co-authored the study with HSC Researcher Kelly Devers, Ph.D., and Bruce Landon, M.D., of Harvard Medical School.
The study also examined the use of financial incentives tied to practice profiling and patient satisfaction surveys. Physicians who received financial incentives based on profiling were more than twice as likely to indicate that profiling affected their practice of medicine than physicians without such incentives—62 percent vs. 30 percent.
Similarly, 84 percent of physicians receiving financial incentives tied to patient satisfaction surveys indicated the surveys affected their practice of medicine, compared with 59 percent of physicians without such incentives.
However, physicians positive assessments of care management tools were not strongly linked to the use of financial incentives, suggesting that other factors such as perceived fairness may be more important.
For example, the use of risk adjustment to reflect the greater need for services by patients in poorer health made a large difference in physicians acceptance of practice profiling. Nearly two-thirds (64%) of physicians with financial incentives tied to risk-adjusted profiling reported a positive effect, compared with 46 percent of physicians with a financial incentive whose profiles were not risk adjusted.
"If care management tools are going to improve the quality of care, physicians must perceive them as valid, useful and fair," Reed said.
Stakeholder Comments on the HSC Study
Yank D. Coble Jr., M.D., president, American Medical Association, www.ama-assn.org
Karen Ignagni, president, American Association of Health Plans, www.aahp.org
Helen Darling, president, Washington Business Group on Health, www.wbgh.org
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely insights on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded exclusively by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.