DeSalvo KB, Merrill W; Academy for Health Services Research and Health Policy. Meeting.
Abstr Acad Health Serv Res Health Policy Meet. 2000; 17: UNKNOWN.
Presented by: Karen B. DeSalvo, M.D., M.P.H., Assistant Professor, Department of Medicine, Tulane University School of Medicine. New Orleans, LA 70112. Tel: 504-582-7800; Fax 504-584-1600; email: kdesalv@mailhost.tcs.tulane.edu
Research Objective: Physicians must deal rapidly with significant volumes of data. How physicians use data to care for patients is uncertain.Study Design: We prospectively studied the practice patterns of physicians in two inner city clinics. We studied physician assignment of revisit intervals for their patients with diabetes and hypertension. In all, 222 physician-patient encounters were evaluated. Data gathered included patient level information on markers of disease control (hemoglobin A1C [A1C], systolic [SBP] and diastolic blood pressure [DBP]). We also gathered demographic information on the provider, physician perceptions of the patient's disease stability and compliance with the treatment regiment, and general management plans such as changing therapy for the main diagnosis and ordering diagnostic tests. Physicians assigned an open-ended RVI for each encounter as part of their regular care. Provider specific predictors were sequentially entered into a mathematical model to determine their role in explaining the variance in revisit intervals.Population studied: Internal Medicine residents practicing in a Veteran's Affairs Medical Center and a public hospital continuity clinic system.Principle findings: The RVI correlated with a variety of factors. These included blood pressure (SBP & DBP), the physicians feeling about patient stability and the decision to change therapy for the chronic illness. The physicians feeling about patient stability was the strongest correlate of RVI. Significantly, all of the biomarkers of patient illness (A1C, DBP, SBP) correlated with the physicians perception of patient stability (r=0.457-0.219, p<0.001 for each association). The decision to change therapy also correlated with this perception (r=0.292, p<0.001). In multivariate models, the physicians perception of stability was the only significant factor related to RVI.Conclusions: These data suggest that physicians, confronted with many markers of disease severity, tend to spontaneously aggregate data to form a gestalt. These aggregates correlate with use of clinical resources (clinic appointments) better than individual biologic predictor variables.Implications for Policy, Delivery or Practice: The formation of a clinical gestalt is an important aspect of patient care and understanding how this simple rank is performed will require further study.
Publication Types:
Keywords:
- Appointments and Schedules
- Decision Making
- Humans
- Hypertension
- Patient Compliance
- Perception
- Physicians
- hsrmtgs
Other ID:
UI: 102272633
From Meeting Abstracts