The hypothesis that a diagnostic evaluation performed by a generalist is less expensive than that performed by a specialist is untested.
We retrospectively evaluated the indications and financial ramifications of radionuclide exercise stress testing by cardiologists and non-cardiologists in 1,902 consecutive adults with normal resting electrocardiograms.
Subjects completed radionuclide exercise tests for the diagnosis or management of coronary artery disease during a 14-month period.
Tests were considered « indicated » or « not indicated » based on criteria determined from published reports and established practice guidelines.
Savings in costs and charges were determined for a strategy of referral to a cardiologist before ordering tests.
Non-cardiologists ordered more tests that were not indicated than cardiologists (69.6% vs 36.2%, chi-square=209.07, p<0.00001).
Non-cardiologists also ordered tests that were not indicated in patients with (chi-square=110.02, p<0.00001) and without (chi-square=45.44, p<0.00001) chest pain.
Tests that were not indicated resulted in excess costs of $591,384 and excess charges of $1,082,400.
Referral to a cardiologist before ordering tests could have saved $63,257 in costs and $169,800 in charges.
Both cardiologists and non-cardiologists overutilized radionuclide exercise stress tests ; however, non-cardiologists were more likely to order tests that were not indicated.
A strategy of referral to a cardiologist before ordering test...
Mots-clés Pascal : Scintigraphie, Myocarde, Spécialité médicale, Médecin, Coût, Economie santé, Epreuve effort, Indication, Exploration, Homme, Exploration radioisotopique
Mots-clés Pascal anglais : Scintigraphy, Myocardium, Medical specialty, Physician, Costs, Health economy, Exercise tolerance test, Indication, Exploration, Human, Radionuclide study
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0094828
Code Inist : 002B24B04. Création : 199608.