Impact of a cybernetic system of feedback to physicians on inappropriate hospital use.

A cybernetic control program aimed at reducing inappropriate days of hospital stay for patients was implemented for all Medicare admissions at hospitals in four counties in Western Maryland. The findings of a study of the program are reported here. The objective of the study was to determine the relationship of the volume of the physician's hospitalized patients on both the existing levels of inappropriate hospital utilization and the physician's response to the cybernetic system. The findings indicated that: (a) existing levels of inappropriate hospital use generally increased with higher patient volume, (b) physicians with a low volume of hospitalized patients were less likely to decrease their inappropriate use of hospitals as a result of feedback than physicians with medium or high volumes of admitted patients, and (c) at all volume levels, the average decrease in inappropriate days was larger than the average increase in inappropriate days.