Association of Liability Concerns with Decisions to Order Echocardiography and Cardiac Stress Tests with Imaging.
J Am Soc Echocardiogr
; 29(12): 1155-1160.e1, 2016 12.
Article
em En
| MEDLINE
| ID: mdl-27639813
ABSTRACT
BACKGROUND:
Professional societies have made efforts to curb overuse of cardiac imaging and decrease practice variation by publishing appropriate use criteria. However, little is known about the impact of physician-level determinants such as liability concerns and risk aversion on decisions to order testing.METHODS:
A web-based survey was administered to cardiologists and general practice physicians affiliated with two academic institutions. The survey consisted of four clinical scenarios in which appropriate use criteria rated echocardiography or stress testing as "may be appropriate." Respondents' degree of liability concerns and risk aversion were measured using validated tools. The primary outcome variable was tendency to order imaging, calculated as the average likelihood to order an imaging test across the clinical scenarios (1 = very unlikely, 6 = very likely). Linear regression models were used to evaluate the association between tendency to order imaging and physician characteristics.RESULTS:
From 420 physicians invited to participate, 108 complete responses were obtained (26% response rate, 54% cardiologists). There was no difference in tendency to order imaging between cardiologists and general practice physicians (3.46 [95% CI, 3.12-3.81] vs 3.15 [95% CI, 2.79-3.51], P = .22). On multivariate analysis, a higher degree of liability concerns was the only significant predictor of decisions to order imaging (mean difference in tendency to order imaging, 0.36; 95% CI, 0.09-0.62; P = .01).CONCLUSION:
In clinical situations in which performance of cardiac imaging is rated as "may be appropriate" by appropriate use criteria, physicians with higher liability concerns ordered significantly more testing than physicians with lower concerns.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Atitude do Pessoal de Saúde
/
Responsabilidade Legal
/
Ecocardiografia sob Estresse
/
Clínicos Gerais
/
Uso Excessivo dos Serviços de Saúde
/
Cardiologistas
Tipo de estudo:
Diagnostic_studies
/
Prognostic_studies
/
Risk_factors_studies
País/Região como assunto:
America do norte
Idioma:
En
Revista:
J Am Soc Echocardiogr
Assunto da revista:
DIAGNOSTICO POR IMAGEM
Ano de publicação:
2016
Tipo de documento:
Article