Association of Clinical Characteristics With Variation in Emergency Physician Preferences for Patients.
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ABSTRACT:
SUBMITTER: Chang CY
PROVIDER: S-EPMC6991274 | biostudies-literature | 2020 Jan
REPOSITORIES: biostudies-literature
Publications
Association of Clinical Characteristics With Variation in Emergency Physician Preferences for Patients.
Chang Cindy Y CY Obermeyer Ziad Z
JAMA network open 20200103 1
<h4>Importance</h4>Much of the wide variation in health care has been associated with practice variation among physicians. Physicians choosing to see patients with more (or fewer) care needs could also produce variations in care observed across physicians.<h4>Objective</h4>To quantify emergency physician preferences by measuring nonrandom variations in patients they choose to see.<h4>Design, setting, and participants</h4>This cross-sectional study used a large, detailed clinical data set from an ...[more]
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Project description:ImportanceThe rapid transition to virtual health care has depended on physician and patient abilities to adopt new technology and workflows. Physicians transitioning more slowly or not at all could result in access challenges for their patients.ObjectiveTo identify physician characteristics associated with the transition to virtual health care in a large regional health care system.Design, setting, and participantsThis retrospective cross-sectional study uses administrative health system databases to analyze data from all 3473 physicians providing ambulatory care through a large New England health care system, which includes 12 hospitals and their ambulatory practices, from October 1, 2019, through December 31, 2020.ExposuresPhysicians characterized based on gender, popularized generational demographic cohort (Silent Generation, born 1928-1945; Baby Boomers, born 1946-1964; Generation X, born 1965-1980; and Millennials, born 1981-1996), specialty (behavioral health, primary care, medical, and surgical), and hospital affiliation as well as selected patient characteristics (number of visits and proportion of patients with self-pay or Medicaid insurance, aged 65 years or older, preference for speaking a language other than English, from a racial or ethnic minority group, and with an active patient portal).Main outcomes and measuresEarly adoption of virtual health care. Bivariate comparisons were made, and regression modeling was used to examine characteristics associated with the likelihood of early adoption of virtual health care.ResultsOf 3473 physicians conducting ambulatory visits during the study period, 1624 (46.8%) were women, 83 (2.4%) were in the Silent Generation, 994 (28.6%) were Baby Boomers, 1637 (47.1%) were in Generation X, and 759 (21.9%) were Millennials. There were 1649 physicians (47.5%) in medical specialties, 749 physicians (21.6%) in surgical specialties, and 248 physicians (7.1%) in behavioral health. After accounting for other characteristics, female (odds ratio [OR], 1.23; 95% CI, 1.06-1.44), behavioral health (OR, 2.92; 95% CI, 2.11-4.04), and primary care (OR, 1.69; 95% CI, 1.36-2.09) physicians had greater odds of being early adopters, and physicians in the Silent Generation (OR, 0.39, 95% CI, 0.24-0.65) and in surgical specialties (OR, 0.46; 95% CI, 0.38-0.57) were less likely to be early adopters. Patient characteristics were less strongly associated with physician adoption.Conclusions and relevanceIn this cross-sectional study, there was physician-level variation in the adoption of virtual health care, with female, primary care, and behavioral health physicians in this system most likely to lead the transformation to virtual health care.
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