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October 1983

Diagnostic Test Use in Different Practice Settings: A Controlled Comparison

Author Affiliations

From the Robert Wood Johnson Clinical Scholars Program (Dr Hlatky), the Department of Medicine, Division of Cardiology (Drs Botvinick and Brundage), the Department of Radiology, Division of Nuclear Medicine (Dr Botvinick), and the Cardiovascular Research Institute (Drs Botvinick and Brundage), the University of California, San Francisco; and the Division of Biometry, Department of Community and Family Medicine, Duke University Medical Center, Durham, NC (Dr Lee). Dr Hlatky is now with the Division of Cardiology, Department of Medicine, Duke University Medical Center.

Arch Intern Med. 1983;143(10):1886-1889. doi:10.1001/archinte.1983.00350100048014

• Health maintenance organizations (HMOs) have lower than average medical care costs, but the reasons remain controversial. The diagnostic practices of cardiologists from an HMO, a university, and a community were therefore surveyed. First, cardiologists defined indications for coronary bypass surgery and then evaluated randomly selected case summaries of patients with chest pain. After review, the cardiologist rated the need for an exercise thallium scintiscan and for a coronary angiogram in each case. Community cardiologists had the broadest indications for bypass surgery. The HMO cardiologists chose thallium scintigraphy significantly less often than the other two types of cardiologists did. The HMO and university cardiologists both rated the need for coronary angiography significantly lower than did community cardiologists. Physicians in different practice settings therefore recommend costly diagnostic and therapeutic methods differently, even for identical patients.

(Arch Intern Med 1983;143:1886-1889)

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