The DOI matches its Crossref record; 34 of the 34 references it cites were found in a registry or an index.
Discretionary Decision Making By Primary Care Physicians And The Cost Of U.S. Health Care
Open accessAbstract
Efforts to improve the quality and costs of U.S. health care have focused largely on fostering physician adherence to evidence-based guidelines, ignoring the role of clinical judgment in more discretionary settings. We surveyed primary care physicians to assess variability in discretionary decision making and evaluate its relationship to the cost of health care. Physicians in high-spending regions see patients back more frequently and are more likely to recommend screening tests of unproven benefit and discretionary interventions compared with physicians in low-spending regions; however, both appear equally likely to recommend guideline-supported interventions. Greater attention should be paid to the local factors that influence physicians' clinical judgment in discretionary settings.
Overview
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“because physician behavior has been shown to be a factor in variations in regional healthcare spending.”
From Social Media and Clinical Care: Ethical, Professional, and Social Implications (2013) · cites this paper as [76]
In the citing paper
“Regional variations in medical treatment have been demonstrated, 75,76 with both patients and physicians not always aware of the current best practices.”
From Social Media and Clinical Care: Ethical, Professional, and Social Implications (2013) · cites this paper as [76]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Citations
Cites
The quality of health care delivered to adults in the United States
McGlynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E. A. (2003) · New England Journal of Medicine · doi:10.1056/nejmsa022615 · Cited by 5,079
Gibbons, R. J., Abrams, J., Chatterjee, K., Daley, J., DEEDWANIA, P. C., Douglas, J. S., Ferguson, T. B., Fihn, S. D., Fraker, T. D., Gardin, J. M., et al. (2002) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(02)02848-6 · Cited by 1,685
Fisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, É. L. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-4-200302180-00006 · Cited by 1,537
Self-citationFisher, E. S., Wennberg, D. E., Stukel, T. A., Gottlieb, D. J., Lucas, F. L., & Pinder, É. L. (2003) · Annals of Internal Medicine · doi:10.7326/0003-4819-138-4-200302180-00007 · Cited by 1,341
Self-citationPeabody, J. W., Luck, J., Glassman, P., Dresselhaus, T., & Lee, M. (2000) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.283.13.1715 · Cited by 1,311
Disease and disadvantage in the United States and in England
Banks, J., Marmot, M., Oldfield, Z., & Smith, J. P. (2006) · JAMA · doi:10.1001/jama.295.17.2037 · Cited by 807
Peabody, J., Luck, J., Glassman, P., Jain, S., Hansen, J., Spell, M., & Lee, M. L. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-141-10-200411160-00008 · Cited by 773
American Cancer Society Guidelines for the Early Detection of Cancer, 2006
Smith, R. A., Cokkinides, V. E., & Eyre, H. J. (2006) · CA A Cancer Journal for Clinicians · doi:10.3322/canjclin.56.1.11 · Cited by 637
Geography And The Debate Over Medicare Reform
Wennberg, J. E., Fisher, E. S., & Skinner, J. (2002) · Health Affairs · doi:10.1377/hlthaff.w2.96 · Cited by 593
Self-citationInfluence of Patient Preferences and Local Health System Characteristics on the Place of Death
Pritchard, R. S., Fisher, E. S., Teno, J. M., Sharp, S. M., Reding, D. J., Knaus, W. A., Wennberg, J. E., Lynn, J., & SUPPORT Investigators (1998) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1998.tb04540.x · Cited by 396
Self-citation
Flagged first, then by citations
Research works printed but not linked: 17
- 10.1542/peds.2005-2587 · DOI
- 10.1542/peds.2005-2587 · DOI
- 10.1377/hlthaff.var.19 · DOI
- 10.1377/hlthaff.var.19 · DOI
- 10.1377/hlthaff.var.19 · DOI
- 10.1377/hlthaff.21.w96 · DOI
- 10.1007/s11606-004-0003-2 · DOI
- 10.1007/s11606-004-0003-2 · DOI
- 10.1007/s11606-004-0003-2 · DOI
- 10.1007/s11606-004-0003-2 · DOI
- 10.1097/00005650-200103000-00004 · DOI
- 10.1097/00005650-200103000-00004 · DOI
- 10.1001/archpedi.157.3.279 · DOI
- 10.1136/bmj.297.6648.599 · DOI
- 10.3322/canjclin.56.1.11 · DOI
- 10.1148/radiol.2361040512 · DOI
- 10.1001/jama.1994.03510360040033 · DOI · Paper page
Cited by
Sorted by citations
Items 201–254 of 254
Bhatia, R. S., Chu, C., Kaoutskaia, A., Ko, D. T., Shojania, K. G., Dorian, P., Yu, B., Shurrab, M., Fang, J., Ross, H. J., et al. (2021) · Journal of the American Heart Association · doi:10.1161/jaha.120.020708 · Cited by 2
Audits of Antimicrobial Usage in a Tertiary Care Center in Hyderabad
Jyothi, L., Kaliappan, A., Saranya, S., Dara, C., Sakthivadivel, V., Sandepogu, T. S., & Archana Gaur, T. (2022) · Cureus · doi:10.7759/cureus.21125 · Cited by 2
Surgical assessment: measuring unobserved health
Crump, T., Wing, K., Bansback, N. J., & Sutherland, J. M. (2015) · BMC Surgery · doi:10.1186/1471-2482-15-4 · Cited by 2
It Is a Good Time to Expand Your Circle!
Thilen, S. R., & Sweitzer, B. J. (2011) · Anesthesia & Analgesia · doi:10.1213/ane.0b013e31822d39e6 · Cited by 2
Incentives for Clinical Decisions Where Evidence Is Lacking∗
Heidenreich, P. A. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.01.015 · Cited by 2
The Ethics of Universal Health Insurance
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.001.0001 · Cited by 1
Inpatient total thyroidectomy costs and outcomes vary regionally: A nationwide study
Choudhry, H. S., Patel, A. M., Lemdani, M. S., Choudhry, H. S., Revercomb, L., Patel, R., Park, R. C. W., & Fang, C. H. (2025) · Laryngoscope Investigative Otolaryngology · doi:10.1002/lio2.70072 · Cited by 1
Tsujimoto, Y., Shiraishi, M., Yamanaka, H., Lee, H., Okazaki, M., & Morimoto, N. (2026) · European Journal of Surgical Oncology · doi:10.1016/j.ejso.2026.111391 · Cited by 1
Ostrovsky, D. A., Haran, U., & Novack, V. (2026) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2026.107032 · Cited by 1
A preliminary predictive model for wheelchair use 4 months after receipt
Hoenig, H., Landerman, L. R., Shipp, K. M., Richardson, M., Pieper, C. F., & Winkler, S. H. (2012) · Technology and Disability · doi:10.3233/tad-2012-0335 · Cited by 1
Variations in prescription opioids and related harms: a key to understanding and effective policy
Samet, J. H., & Tsui, J. I. (2014) · Addiction · doi:10.1111/add.12308 · Cited by 1
High Reliability and Informatics Tools: PKC Software in Primary Care
Weaver, R. R. (2014) · Cited by 1
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.003.0004 · Cited by 1
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.003.0008 · Cited by 1
Trends in Volume and Charges of Retinal Tear Patients in the Emergency Department
Taneja, K., Diaz, M. J., Taneja, T., Patel, K., Batchu, S., Oak, S., Zhang, A., Joshi, A., & Patel, U. K. (2023) · Ophthalmic Epidemiology · doi:10.1080/09286586.2023.2203227 · Cited by 1
Essays in the Economics of Health Care and the Regulation of Medical Technology
Stern, A. D. (2014) · Digital Access to Scholarship at Harvard (DASH) (Harvard University) · Cited by 1
Less is not always more: embracing (appropriate) medical intensity
Burke, L. G., & Jha, A. K. (2014) · BMJ Quality & Safety · doi:10.1136/bmjqs-2014-003586 · Cited by 1
Licurse, A. M. (2010) · Cited by 1
4 The Economic and Regulatory Impact of Evidence-Based Medicine on Radiology
Larson, D. B. (2011) · Springer eBooks · doi:10.1007/978-1-4419-7777-9_4
Smoldt, R. K. (2009) · Information Knowledge Systems Management · doi:10.3233/iks-2009-0141
Essays on Inequality and Market Failure
Hilger, N. (2013) · Digital Access to Scholarship at Harvard (DASH) (Harvard University)
Evidence-Based Medicine on Radiology: Economic and Regulatory Impact
Larson, D. B., & Hollingworth, W. (2013) · Springer eBooks · doi:10.1007/978-1-4614-3320-0_8
Houdbare zorg: niet zonder ons!
Berden, B. J. J. M. (2012) · Huisarts en Wetenschap · doi:10.1007/s12445-012-0280-7
Chertoff, J. (2015) · Global Advances in Health and Medicine · doi:10.7453/gahmj.2014.077
A Wholesome Adventure with Cystic Fibrosis
Byrnes, I. S. (2015) · Global Advances in Health and Medicine · doi:10.7453/gahmj.2015.108
Ryan, B. (2013) · Trinity College Digital Repository (Trinity College, Hartford CT)
Nyweide, D. J. (n.d.) · ProQuest Demo Repository
Associations between Primary Health Care- and Hospital Utilization among Elderly People in Norway
Deraas, T. (2013) · NORA - Norwegian Open Research Archives
Waddimba, A. C. (2013) · Journal of Spine · doi:10.4172/2165-7939.1000146
The Gap between What is Knowable and What We Do in Clinical Practice
Swennen, M. H. J. (2011) · IGI Global eBooks · doi:10.4018/978-1-60960-561-2.ch705
Healing Practices and Evidence-Based Medicine
James, J. E. (2015) · Elsevier eBooks · doi:10.1016/b978-0-12-802812-4.00010-2
Evidence‐based HMO care for prostate specific antigen testing
Merenstein, D. J., D'Amico, F. J., Vinker, S., Petterson, S. M., & Lahad, A. (2016) · The International Journal of Health Planning and Management · doi:10.1002/hpm.2388
Brown-Philpot, L. (2014) · Digital Commons @ UNT Health Science Center
Franceschini, R., & Frank-Job, B. (2001) · Vox Romanica
Planned Parenthood: Supply Induced Demand for Abortion in the US
Studnicki, J., & Fisher, J. W. (2018) · Open Journal of Preventive Medicine · doi:10.4236/ojpm.2018.84014
Consent for Research Participation in Practice
Califf, R. M. (2019) · The American Journal of Bioethics · doi:10.1080/15265161.2019.1574492
Information about Health Care Systems
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.003.0002
The Case for Universal Health Insurance
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.003.0007
The Gap between What is Knowable and What We Do in Clinical Practice
Swennen, M. H. J. (2011) · IGI Global eBooks · doi:10.4018/978-1-60960-097-6.ch024
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.003.0001
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.003.0006
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.003.0005
Incidence and Economic Burden of Retinal Tears in the United StatesPreprint
Taneja, K., Diaz, M. J., Taneja, T., Patel, K., Batchu, S., Oak, S., Zhang, A., Joshi, A., & Patel, U. K. (2022) · medRxiv · doi:10.1101/2022.10.29.22281697
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.002.0005
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.002.0008
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.002.0003
Rajczi, A. (2019) · doi:10.1093/oso/9780190946838.002.0004
Essays on applications of behavioral decision making in public management and policy
Ghaffarzadegan, N. (2011) · doi:10.54014/7zdg-neq8
Hospital and regional effects on length of stay: a multilevel modeling approach
Shahbazi, M. A., Baheri, A., & Azadeh‐Fard, N. (2026) · IISE Transactions on Healthcare Systems Engineering · doi:10.1080/24725579.2026.2645699
Cho, S., Bai, H., Kim, J. H., Chang, Y., Lee, J. Y., & Lee, J.-S. (2026) · Journal of Korean Medical Science · doi:10.3346/jkms.2027.42.e37
Workshop Discussion Background Paper
Yong, P. L., Saunders, R. S., & Olsen, L. (2010)
Metadata
- Authors
- Sirovich, B., Gallagher, P. M., Wennberg, D. E., & Fisher, E. S.
- Affiliations
- Veterans Health Administration (US)
- White River Junction, Vermont
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2008-05
- Volume
- 27
- Issue
- 3
- Pages
- 813-823
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- PMC
- PMC2438037
- OpenAlex
- W1970716113
- Cited by
- 253
- References
- 34
- Citations by year
- 2026: 4 · 2025: 1 · 2023: 3 · 2022: 6 · 2021: 6 · 2020: 9 · 2019: 20 · 2018: 10 · 2017: 14 · 2016: 16 · 2015: 20 · 2014: 25 · 2013: 21 · 2012: 22
- FWCI
- 48.21
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (P01AG19783, P01AG019783)
- National Heart, Lung, and Blood Institute (R01HL080437)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Keywords
- discretionary decision-making, clinical judgment, primary care physicians, health care costs, guideline adherence, quality of care
- MeSH terms
- Decision Making, Health Services, Humans, Hypertension, Practice Patterns, Physicians', Physicians, Family, Primary Health Care, United States, Health Care Costs, Health Care Surveys
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
