This is an interesting study recently published that presented PCPs with clinical scenarios commonly encountered in primary care. Here is an example:
You are seeing Ms. Johnson, 45-year-old woman, for an annual visit. She has no specific risk factors or symptoms for breast cancer. She has no particular preference for testing and wants your advice.
How likely is Ms. Johnson to have breast cancer based on this information? _______%
Ms. Johnson’s mammogram is positive. How likely is she to have breast cancer? _______% Ms. Johnson’s mammogram is negative. How likely is she to have breast cancer? _______%
What did they find? “The most striking finding from this study was that practitioners consistently and significantly overestimate the likelihood of disease."…Many practitioners reported that they would treat patients for disease for which likelihood had been overestimated.”
What does this mean for people purchasing healthcare on behalf of their organizations (e.g. onsite clinic customers)? Simply sending your patients to a clinician who has more time to spend with a patient will not necessarily address this type of quality issue. If your patients are going to providers who overestimate the likelihood of disease, your patients will likely be exposed to medications and procedures that they don’t need, unnecessesarily exposing them to the associated risk and cost.
I think a key attribute to consider when evaluating an onsite vendor is how they approach institutional learning and continuous improvement. Do they have effective quality assurance programs in place to identify where their clinicians are consistently providing care recommendations that are not aligned with best evidence?
