Understanding physicians' imaging test use in low back pain care: The role of focus groups

International Journal for Quality in Health Care

Volumn 10, Issue 2, 1998, Pages 83-91

  Shye, Diana ^a,c   Freeborn, Donald K ^a   Romeo, Jeffrey ^b   Eraker, Steve ^b  

^a CENTER FOR HEALTH RESEARCH   (United States)

^b Northwest Permanente   (United States)

^c BEN GURION UNIVERSITY OF THE NEGEV   (Israel)

Author keywords

Focus groups; Health maintenance organization; Imaging test orders; Low back pain; Primary care; Role conflict

Indexed keywords

ARTICLE; CLINICAL PRACTICE; CONFLICT; DIAGNOSTIC IMAGING; GENERAL PRACTITIONER; HEALTH MAINTENANCE ORGANIZATION; LOW BACK PAIN; LUMBAR SPINE; MEDICAL DECISION MAKING; MEDICAL SPECIALIST; PATIENT REFERRAL; PHYSICIAN ATTITUDE; PRACTICE GUIDELINE; PRIMARY MEDICAL CARE; PRIORITY JOURNAL;

COST CONTROL; DECISION MAKING; DIAGNOSTIC IMAGING; FAMILY PRACTICE; FOCUS GROUPS; FORECASTING; HEALTH MAINTENANCE ORGANIZATIONS; HUMANS; INTERNAL MEDICINE; LOW BACK PAIN; PHYSICIAN'S PRACTICE PATTERNS; PHYSICIAN-PATIENT RELATIONS; QUALITY ASSURANCE, HEALTH CARE; UNITED STATES;

EID: 0031863383     PISSN: 13534505     EISSN: None     Source Type: Journal    
DOI: 10.1093/intqhc/10.2.83     Document Type: Article

References (47)

1. Wennberg JE, Blowers L, Parker R, Gittlesohn AM. Changes in tonsillectomy rates associated with feedback and review. Pediatrics 1977; 59: 821-826.
2. Wennberg J, Freeman JL, Clup SJ. Are hospital services rationed in New Haven or over-utilized in Boston? Lancet 1987; 1: 1185-1189.
3. Wennberg J, Freeman JL, Shelton RM, Bubolz TA. Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. N Engl J Med 1989; 321: 1168-1173.
4. Wennberg J, Gittelsohn A. Small area variations in health care delivery. Science 1973; 182: 1102-1108.
5. Eisenberg JM. Doctors Decisions and the Cost of Medical Care. Ann Arbor: Health Administration Press, 1986.
6. Schwartz RK, Soumerai SB, Avorn J. Physician motivations for nonscientific drug prescribing. Soc Sci Med 1989; 28: 577-582.
7. Axt-Adam P, van der Wouden JC, van der Does E. Influencing behavior of physicians ordering laboratory tests: a literature study. Med Care 1993; 31: 784-794.
8. Epstein AM. Changing physician behavior. Increasing challenges for the 1990s. Arch Intern Med 1991; 151: 2147-2149.
9. Mittman B, Siu A. Changing provider behavior: applying research on outcomes and effectiveness in health care. In: Shortell S, Reinhardt U (eds). Improving Health Policy and Management. Ann Arbor: Health Administration Press, 1992, pp. 195-226.
10. Mittman BS, Tonesk X, Jacobson PD. Implementing clinical practice guidelines: social influence strategies and practitioner behavior change. Qual Rev Bull 1992; 18: 412-422.
11. Soumerai SB, Avorn J. Principles of educational outreach ('academic detailing') to improve clinical decision making. J Am Med Assoc 1990; 263: 549-556.
12. Berwick D, Coltin KL. Feedback reduces test use in a health maintenance organization. J Am Med Assoc 1986; 255: 1450-1454.
13. Berwick DM. Continuous improvement as an ideal in health care. New Engl J Med 1989; 320: 53-56.
14. Kritchevsky SB, Simmons BP. Continuous quality improvement. J Am Med Assoc 1991; 266: 1817-1823.
15. Laffel G, Blumenthal D. The case for using industrial quality management science in health care organizations. J Am Med Assoc 1989; 262: 2869-2873.
16. Cypress BK. Characteristics of physician visits for back symptoms: a national perspective. Am J Publ Health 1983; 3: 389-395.
17. Frymoyer JW, Cats-Baril WL. An overview of the incidences and costs of low back pain. Orthop Clin North Am 1991; 22: 263-271.
18. Deyo RA. Newer thinking on diagnosis and therapy. Consultant 1993; 33: 88-100.
19. AHCPR Low Back Pain Guideline Panel. Acute Low Back Pain Problems in Adults, Clinical Practice Guideline No. 14 (Publication No. 95-0644). Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research, Washington, DC, 1995.
20. Deyo RA. Acute low back pain: a new paradigm for management (editorial). Br Med J 1996; 313: 1343-1344.
21. Waddell G, Feder G, McIntosh A et al. Low Back Pain Evidence Review. London: Royal College of General Practitioners, 1996.
22. Gherkin DC, Deyo RA, Loeser JD et al. An international comparison of back surgery rates. Spine 1994; 19: 1201-1206.
23. Gherkin DC, Deyo RA, Wheeler K, Ciol MA. Physician variation in diagnostic testing for low back pain. Who you see is what you get. Arthritis Rheumatism 1994; 37: 15-22.
24. Gherkin DC, Deyo RA, Wheeler K, Ciol MA. Physician views about treating low back pain. The results of a national survey. Spine 1995; 20: 1-9.
25. Deyo RA, Gherkin DC, Conrad D, Volinn E. Cost, controversy, crisis: low back pain in the health of the public. Ann Rev Publ Health 1991; 12: 141-156.
26. Elam KG, Gherkin DC, Deyo RA. How emergency physicians approach low back pain: choosing costly options. J Emerg Med 1995; 13: 143-150.
27. Hart LG, Deyo RA, Gherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a U.S. national survey. Spine 1995; 20: 11-19.
28. Taylor VM, Deyo RA, Gherkin DC, Kreuter W. Low back pain hospitalization: recent United States trends and regional variations. Spine 1994; 19: 1207-1213.
29. Volinn E, Mayer J, Diehr P et al. Small area analysis of surgery for low-back pain. Spine 1992; 17: 575-580.
30. Volinn E, Turczyn KM, Loeser JD. Patterns in low back pain hospitalizations: implications for the treatment of low back pain in an era of health care reform, Clin J Pain 1995; 10: 643-670.
31. Walsh K, Cruddas M, Coggon D. Low back pain in eight areas of Britain. J Epidemiol Comm Health 1992; 46: 227-230.
32. White AA III, Gordon SL. Synopsis: workshop on idiopathic low-back pain. Spine 1982; 7: 141-149.
33. Schroth WS, Schectman JM, Elinsky EG, Panagides JC. Utilization of medical services for the treatment of acute low back pain: conformance with clinical guidelines. J Gen Intern Med 1992; 7: 486-491.
34. Deyo RA. Magnetic resonance imaging of the lumbar spine. Terrific test or tar baby? N Engl J Med 1994; 331: 115-116.
35. Carey TS, Garrett J. The North Carolina Back Pain Project. Patterns of ordering diagnostic tests for patients with acute low back pain. Ann Intern Med 1996; 125: 807-814.
36. Boden SD, Davis DO, Dina TS et al. Abnormal magnetic resonance scans of the lumbar spine in asymptomatic subjects. J Bone Joint Surg 1990; 72A: 403-408.
37. Verilli D, Welch HG. The impact of diagnostic testing on therapeutic interventions. J Am Med Assoc 1996; 255: 1189-1191.
38. Wiesel SW, Tsourmas N, Feffer HL et al. A study of computer-assisted tomography. I. The incidence of positive CAT scans in an asymptomatic group of patients. Spine 1984; 9: 549-551.
39. Freeborn DK, Shye D, Mullooly J et al. Primary care physicians use of lumbar spine imaging tests: effects of guidelines and practice pattern feedback. J Gen Intern Med 1997; 12: 619-625.
40. Kitzinger J. Introducing focus groups. Br Med J 1995; 311: 299-302.
41. Morgan DL. Focus groups. Annual Review of Sociology. Palo Alto CA: Annual Reviews, Inc., 1996.
42. Mechanic D, Schlesinger M. The impact of managed care on patients' trust in medical care and their physician. J Am Med Assoc 1996; 275: 1693-1697.
43. Mechanic D. Changing medical organization and the erosion of trust. Milbank Quart 1996; 74: 171-189.
44. Budrys G. Coping with change: physicians in prepaid practice. Social Health Illness 1993; 15: 353-374.
45. Gherkin D, Deyo RA, Berg AO, Lishner DM. Evaluation of a physician education intervention to improve primary care for low back pain. I. Impact on physicians. Spine 1991; 16: 1168-1172.
46. Deyo RA, Diehl AK, Rosenthal M. Reducing roentgenography use. Can patient expectations be altered? Arch Int Med 1987; 147: 141-145.
47. Freeborn DK, Pope CR. Promise and Performance in Managed Care. The Prepaid Group Practice Mode. Baltimore: The Johns Hopkins University Press, 1994.