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Do malpractice concerns, payment mechanisms, and attitudes influence test-ordering decisions?

From the Departments of Neurology and Epidemiology (Dr. Birbeck), Michigan State University, East Lansing; Department of Medicine (Dr. Gifford), Brown University, Providence, RI; and Departments of Biostatistics (Drs. Song and Belin), Psychiatry and Biobehavioral Sciences (Dr. Belin), and Neurology (Dr. Vickrey) and Alzheimer’s Disease Research Center (Dr. Vickrey), University of California at Los Angeles, VA Greater Los Angeles Healthcare System PADRECC (Drs. Mittman and Vickrey), and RAND (Dr. Mittman).

Address correspondence and reprint requests to Dr. G.L. Birbeck, 138 Service Rd., A-217, East Lansing, MI 48824-1313; e-mail: Gretchen.Birbeck{at}ht.msu.edu

Greater understanding is needed of nonclinical factors that determine neurologists’ decisions to order tests. The authors surveyed 595 US neurologists and utilized demographic information, attitude scales, and clinical scenarios to evaluate the influence of nonclinical factors on test-ordering decisions. Greater test reliance, higher malpractice concerns, and receiving reimbursement for testing were all associated with a higher likelihood of test ordering. These findings have implications for training needs and suggest malpractice worries may inflate health care costs.

Received May 20, 2003. Accepted in final form September 11, 2003.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the January 13 issue to find the title link for this article.

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