Primary care physicians make very different decisions about the evaluation and treatment of patientsdepending on where they practice - decisions that appear to underlie, at least in part, the vast differences inhealth care utilization and spending seen between different areas of the United States. While there isconsiderable variation across patients in the kind of health care they want, there is also evidence thatphysician beliefs are the more important determinant of regional variations in health care. Our work alsoshows that clinicians recognize important non-clinical motivations underlying practice behavior. In thisSurvey Core, we seek to understand 1) what influences physician behavior, whether financial factors,information 'networks,' or other factors and 2) How well informed are patients when they make importantdecisions about the type of care they receive.
The specific aims are:To develop and field a national physician mail survey of primary care physicians that focuses on twoareas: physician practice behavior, and motivations and influences on behavior. Practice behaviorencompasses resource use, including special attention to prescribing behavior and referral patterns; andquality, including the ability to adopt new and efficient technologies: both are necessary in order tounderstand efficiency. The current survey will allow us to explore the roles of a number of potentialinfluences, including: physicians' connectedness, both social and professional; financial incentives thatencourage or discourage intervention; malpractice concerns; training and education; patient pressures;and industry pressures (specifically related to prescribing behavior).To develop and field a national mail survey of elderly patients that will focus on major decisions they haveparticipated in - decisions about treatment for major conditions including heart disease, prostate cancer,and breast cancer. We will aim to learn what patients knew about their treatment options, their knowledgeabout the risks and benefits for each option, and their perceptions of the process by which the treatmentdecisions were made. The overall goal will be to shed light on how important medical decisions are madeand to learn in what ways, if any, decision quality is related to the intensity of medical intervention.A better understanding of how physicians make decisions about referrals, treatment, and the adoption ofnew technologies, and how patients acquire information necessary to make important decisions about theircare, is central to improving both productive efficiency - that physicians follow best practice - and allocativeefficiency - that patients get the kind of treatment they want
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