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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.
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“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]
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“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]
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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
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