Mandelblatt J S, Berg C D, Meropol N J, Edge S B, Gold K, Hwang Y T, Hadley J
Department of Oncology, Lombardi Cancer Center, Division of Cancer Prevention and Control, Georgetown University School of Medicine, Washington, DC 20007, USA.
Med Care. 2001 Mar;39(3):228-42. doi: 10.1097/00005650-200103000-00004.
Few measures exist to assess physicians' practice style, and there are few data on physicians' practice styles and patterns of care.
To use clinical vignettes to measure surgeons' "propensity" for local treatments for early-stage breast cancer and to describe factors associated with propensity.
A cross-sectional mailed survey with telephone follow-up of a random sample of 1,000 surgeons treating Medicare beneficiaries in fee-for-service settings.
Outcome measures include treatment propensity, self-reported practice, and actual treatment received by the surgeons' patients.
Propensities were significantly associated with actual treatment, controlling for covariates. Area Medicare fees were the strongest predictor of propensity, followed by region, attitudes, volume, and gender. For instance, after other factors were considered, surgeons practicing in areas with the highest breast-conserving surgery (BCS) fees were 8.61 (95% CI 2.26-32.73) times more likely to have a BCS propensity than surgeons in areas with the lowest fees. Surgeons with the strongest beliefs in patient participation in treatment decisions were nearly 6 times (95% CI 1.67-20.84) more likely to have a BCS propensity than surgeons with the lowest such beliefs, controlling for covariates. Male surgeons were also independently more likely to have a mastectomy propensity than female surgeons.
Surgeons' propensities explain some of the observed variations in breast cancer treatment patterns among older women. Standardized scenarios provide a practical method to measure practice style and could be used to evaluate physician contributions to shared decision making, practice patterns, costs and outcomes, and adherence to guidelines.
评估医生执业风格的措施很少，关于医生执业风格和护理模式的数据也很少。
使用临床案例来衡量外科医生对早期乳腺癌进行局部治疗的“倾向”，并描述与该倾向相关的因素。
一项横断面邮寄调查，并对1000名在按服务收费环境中治疗医疗保险受益人的外科医生进行随机抽样电话随访。
结果指标包括治疗倾向、自我报告的执业情况以及外科医生患者实际接受的治疗。
在控制协变量的情况下，倾向与实际治疗显著相关。地区医疗保险费用是倾向的最强预测因素，其次是地区、态度、手术量和性别。例如，在考虑其他因素后，在保乳手术（BCS）费用最高地区执业的外科医生进行BCS的倾向是费用最低地区外科医生的8.61倍（95%可信区间2.26 - 32.73）。在控制协变量的情况下，最坚信患者参与治疗决策的外科医生进行BCS的倾向比信念最低的外科医生高近6倍（95%可信区间1.67 - 20.84）。男性外科医生进行乳房切除术的倾向也独立于女性外科医生。
外科医生的倾向解释了老年女性乳腺癌治疗模式中一些观察到的差异。标准化情景提供了一种衡量执业风格的实用方法，可用于评估医生在共同决策、执业模式、成本和结果以及遵循指南方面的贡献。
