USE OF STANDARDIZED PATIENTS TO ASSESS BETWEEN-PHYSICIAN VARIATIONS IN RESOURCE UTILIZATION

Context.-As medical costs are increasingly being scrutinized, there is heightened interest in defining variations in physician behavior in c linical settings. Objective.-To evaluate if standardized patient (SP) technology is a reliable and feasible method of studying interphysicia n variations in test ordering, referral requests, prescribing behavior , and visit costs, Design.-The study was conducted with blinded SP vis its to family medicine and internal medicine residents, university-aff iliated family physicians, and community-based family physicians, Reso urce utilization and visit costs were assessed using test requisitions , consult requests, and prescriptions that were collected by the SPs. Setting.-Physicians' offices in ambulatory care, hospital-based clinic s and in the community, Participants.-Four persons (aged 57-77 years) trained to simulate having osteoarthritis of the hip. In one simulatio n, the patient had gastropathy due to nonsteroidal anti-inflammatory d rug use, and in the other, the patient sought therapy for hip discomfo rt, Main Outcome Measures.-Reliability of cost estimates of physician services, tests, consultations, prescriptions, and total visits and te st-ordering behavior for nonsteroidal anti-inflammatory gastropathy, R esults.-Overall, 112 (63%) of the physicians who were sent invitations to the study agreed to participate, Of 312 total SP visits conducted over a I-year period, unblinding due to SP detection occurred on 36 oc casions (11.5%), Reliable cost estimates of physician services, tests, and consultations, and moderately reliable estimates of total visit c osts, were obtained with 4 visits per practicing physician and with 2 visits per resident. There were extreme variations in total visit cost s generated by the study physicians. A small number of physicians had a major impact on this variability. Conclusion.-Standardized patient t echnology provides a reliable, feasible method to assess variations in resource utilization between physicians.