De. Wennberg et al., DO PHYSICIANS DO WHAT THEY SAY - THE INCLINATION TO TEST AND ITS ASSOCIATION WITH CORONARY ANGIOGRAPHY RATES, Journal of general internal medicine, 12(3), 1997, pp. 172-176
OBJECTIVE: Efforts to evaluate variations in cardiac procedures have f
ocused on patient factors and differences in health care delivery syst
ems. We wanted to assess how physicians' inclination to test patients
with coronary artery disease influences utilization patterns. SETTING
AND SUBJECTS: Physicians and the populations of Maine, New Hampshire,
and Vermont. DESIGN: We conducted a survey of 263 family practitioners
, internists, and cardiologists residing in 57 hospital service areas
in Maine, New Hampshire, and Vermont. Using patient scenarios, we asse
ssed the clinicians' inclinations to test during the evaluation of pat
ients with coronary artery disease. Self-reported testing intensities
were used to create three indices: a Catheterization Index, an Imaging
Exercise Tolerance Test (ETT) Index, and a Nonimaging ETT Index. Usin
g administrative data, age- and gender-adjusted population-based coron
ary angiography rates were calculated. Physicians were assigned to low
(2.9/1,000), average (4.2/1,000), and high (5.8/1,000) coronary angio
graphy rate areas, based on where they practice. Analysis of variance
techniques were used to assess the relation of the index scores to the
population-based coronary angiography rates and to physician specialt
ies. RESULTS: There was a positive relationship between the population
-based coronary angiography rates and the self-reported scores of the
Catheterization Index (p < .005) and the Imaging ETT Index (p = .01),
but none was found for the Nonimaging ETT Index (p = .10). These relat
ionships were evident in subanalyses of cardiologists and internists,
but not of family practitioners. CONCLUSIONS: Self-reported testing in
tensity by physicians is related to the population-based rates of coro
nary angiography. This relationship cuts across specialties, suggestin
g that there is a ''medical signature'' for the evaluation of patients
with coronary artery disease.