Ryskina Kira L, Halpern Scott D, Minyanou Nancy S, Goold Susan D, Tilburt Jon C
Division of General Internal Medicine, University of Pennsylvania, Philadelphia.
Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Biostatistics and Epidemiology, and Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia.
Mayo Clin Proc. 2015 Mar;90(3):313-20. doi: 10.1016/j.mayocp.2014.12.005. Epub 2015 Jan 26.
To examine a potential relationship between training environment and physician views about cost consciousness.
This was a cross-sectional study of US physicians who responded to the Physicians, Health Care Costs, and Society survey conducted between May 30, 2012, and September 30, 2012, for whom information was available about the care intensity environment of their residency training hospital. The exposure of interest was a measure of the health care utilization environment during residency from the Dartmouth Atlas of Health Care Hospital Care Intensity (HCI) index of primary training hospitals. The main outcome measure was agreement with an 11-point cost-consciousness scale. The generalized estimating equations method was used to measure the association between exposure and outcome.
Of the 2556 physicians who responded to the survey, 2424 had a valid HCI index (95%), representing 649 residency programs. The mean ± SD cost-consciousness score among physicians trained at hospitals in the lowest quartile of care intensity (31.8±5.0) was higher than that for physicians trained at hospitals in the top quartile of care intensity (30.7±5.1; P<.001). Adjusting for other physician and practice characteristics, a population of physicians trained in hospitals with a 1.0-point higher HCI index would score approximately 0.83 points lower on the cost-consciousness scale (beta coefficient = -0.83; 95% CI, -1.60 to -0.05; P=.04).
The intensity of the health care utilization environment during training may play a role in shaping physician cost consciousness later in their careers.
探讨培训环境与医生对成本意识的看法之间的潜在关系。
这是一项针对美国医生的横断面研究，这些医生回应了2012年5月30日至2012年9月30日期间进行的“医生、医疗成本与社会”调查，且可获取其住院医师培训医院护理强度环境的相关信息。感兴趣的暴露因素是根据达特茅斯医疗地图集医院护理强度（HCI）指数衡量的住院医师培训期间的医疗保健利用环境。主要结局指标是对一个11分成本意识量表的认同度。采用广义估计方程法来衡量暴露因素与结局之间的关联。
在回应调查的2556名医生中，2424名有有效的HCI指数（95%），代表649个住院医师培训项目。在护理强度处于最低四分位数的医院接受培训的医生的平均成本意识得分±标准差为（31.8±5.0），高于在护理强度处于最高四分位数的医院接受培训的医生（30.7±5.1；P<.001）。在对其他医生和执业特征进行调整后，在HCI指数高1.0分的医院接受培训的医生群体在成本意识量表上的得分会低约0.83分（β系数 = -0.83；95%CI，-1.60至-0.05；P = .04）。
培训期间的医疗保健利用环境强度可能在塑造医生职业生涯后期的成本意识方面发挥作用。
