The role of training environment care intensity in US physician cost consciousness

Kira L. Ryskina, Scott D. Halpern, Nancy S. Minyanou, Susan D. Goold, Jon C Tilburt

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

OBJECTIVE: To examine a potential relationship between training environment and physician views about cost consciousness.

PARTICIPANTS AND METHODS: This was a cross-sectional study of US physicians who responded to the Physicians, Health Care Costs, and Society survey conducted between May 30, 2012, and September 30, 2012, for whom information was available about the care intensity environment of their residency training hospital. The exposure of interest was a measure of the health care utilization environment during residency from the Dartmouth Atlas of Health Care Hospital Care Intensity (HCI) index of primary training hospitals. The main outcome measure was agreement with an 11-point cost-consciousness scale. The generalized estimating equations method was used to measure the association between exposure and outcome.

RESULTS: Of the 2556 physicians who responded to the survey, 2424 had a valid HCI index (95%), representing 649 residency programs. The mean ± SD cost-consciousness score among physicians trained at hospitals in the lowest quartile of care intensity (31.8±5.0) was higher than that for physicians trained at hospitals in the top quartile of care intensity (30.7±5.1; P<.001). Adjusting for other physician and practice characteristics, a population of physicians trained in hospitals with a 1.0-point higher HCI index would score approximately 0.83 points lower on the cost-consciousness scale (beta coefficient = -0.83; 95% CI, -1.60 to -0.05; P=.04).

CONCLUSION: The intensity of the health care utilization environment during training may play a role in shaping physician cost consciousness later in their careers.

Original languageEnglish (US)
Pages (from-to)313-320
Number of pages8
JournalMayo Clinic Proceedings
Volume90
Issue number3
DOIs
StatePublished - Mar 1 2015

Fingerprint

Consciousness
Physicians
Costs and Cost Analysis
Internship and Residency
Patient Acceptance of Health Care
Atlases
Population Characteristics
Health Care Costs
Cross-Sectional Studies
Outcome Assessment (Health Care)
Delivery of Health Care

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The role of training environment care intensity in US physician cost consciousness. / Ryskina, Kira L.; Halpern, Scott D.; Minyanou, Nancy S.; Goold, Susan D.; Tilburt, Jon C.

In: Mayo Clinic Proceedings, Vol. 90, No. 3, 01.03.2015, p. 313-320.

Research output: Contribution to journalArticle

Ryskina, Kira L. ; Halpern, Scott D. ; Minyanou, Nancy S. ; Goold, Susan D. ; Tilburt, Jon C. / The role of training environment care intensity in US physician cost consciousness. In: Mayo Clinic Proceedings. 2015 ; Vol. 90, No. 3. pp. 313-320.
@article{25fcbf1c83d74a84bd46be619bf42393,
title = "The role of training environment care intensity in US physician cost consciousness",
abstract = "OBJECTIVE: To examine a potential relationship between training environment and physician views about cost consciousness.PARTICIPANTS AND METHODS: This was a cross-sectional study of US physicians who responded to the Physicians, Health Care Costs, and Society survey conducted between May 30, 2012, and September 30, 2012, for whom information was available about the care intensity environment of their residency training hospital. The exposure of interest was a measure of the health care utilization environment during residency from the Dartmouth Atlas of Health Care Hospital Care Intensity (HCI) index of primary training hospitals. The main outcome measure was agreement with an 11-point cost-consciousness scale. The generalized estimating equations method was used to measure the association between exposure and outcome.RESULTS: Of the 2556 physicians who responded to the survey, 2424 had a valid HCI index (95{\%}), representing 649 residency programs. The mean ± SD cost-consciousness score among physicians trained at hospitals in the lowest quartile of care intensity (31.8±5.0) was higher than that for physicians trained at hospitals in the top quartile of care intensity (30.7±5.1; P<.001). Adjusting for other physician and practice characteristics, a population of physicians trained in hospitals with a 1.0-point higher HCI index would score approximately 0.83 points lower on the cost-consciousness scale (beta coefficient = -0.83; 95{\%} CI, -1.60 to -0.05; P=.04).CONCLUSION: The intensity of the health care utilization environment during training may play a role in shaping physician cost consciousness later in their careers.",
author = "Ryskina, {Kira L.} and Halpern, {Scott D.} and Minyanou, {Nancy S.} and Goold, {Susan D.} and Tilburt, {Jon C}",
year = "2015",
month = "3",
day = "1",
doi = "10.1016/j.mayocp.2014.12.005",
language = "English (US)",
volume = "90",
pages = "313--320",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "3",

}

TY - JOUR

T1 - The role of training environment care intensity in US physician cost consciousness

AU - Ryskina, Kira L.

AU - Halpern, Scott D.

AU - Minyanou, Nancy S.

AU - Goold, Susan D.

AU - Tilburt, Jon C

PY - 2015/3/1

Y1 - 2015/3/1

N2 - OBJECTIVE: To examine a potential relationship between training environment and physician views about cost consciousness.PARTICIPANTS AND METHODS: This was a cross-sectional study of US physicians who responded to the Physicians, Health Care Costs, and Society survey conducted between May 30, 2012, and September 30, 2012, for whom information was available about the care intensity environment of their residency training hospital. The exposure of interest was a measure of the health care utilization environment during residency from the Dartmouth Atlas of Health Care Hospital Care Intensity (HCI) index of primary training hospitals. The main outcome measure was agreement with an 11-point cost-consciousness scale. The generalized estimating equations method was used to measure the association between exposure and outcome.RESULTS: Of the 2556 physicians who responded to the survey, 2424 had a valid HCI index (95%), representing 649 residency programs. The mean ± SD cost-consciousness score among physicians trained at hospitals in the lowest quartile of care intensity (31.8±5.0) was higher than that for physicians trained at hospitals in the top quartile of care intensity (30.7±5.1; P<.001). Adjusting for other physician and practice characteristics, a population of physicians trained in hospitals with a 1.0-point higher HCI index would score approximately 0.83 points lower on the cost-consciousness scale (beta coefficient = -0.83; 95% CI, -1.60 to -0.05; P=.04).CONCLUSION: The intensity of the health care utilization environment during training may play a role in shaping physician cost consciousness later in their careers.

AB - OBJECTIVE: To examine a potential relationship between training environment and physician views about cost consciousness.PARTICIPANTS AND METHODS: This was a cross-sectional study of US physicians who responded to the Physicians, Health Care Costs, and Society survey conducted between May 30, 2012, and September 30, 2012, for whom information was available about the care intensity environment of their residency training hospital. The exposure of interest was a measure of the health care utilization environment during residency from the Dartmouth Atlas of Health Care Hospital Care Intensity (HCI) index of primary training hospitals. The main outcome measure was agreement with an 11-point cost-consciousness scale. The generalized estimating equations method was used to measure the association between exposure and outcome.RESULTS: Of the 2556 physicians who responded to the survey, 2424 had a valid HCI index (95%), representing 649 residency programs. The mean ± SD cost-consciousness score among physicians trained at hospitals in the lowest quartile of care intensity (31.8±5.0) was higher than that for physicians trained at hospitals in the top quartile of care intensity (30.7±5.1; P<.001). Adjusting for other physician and practice characteristics, a population of physicians trained in hospitals with a 1.0-point higher HCI index would score approximately 0.83 points lower on the cost-consciousness scale (beta coefficient = -0.83; 95% CI, -1.60 to -0.05; P=.04).CONCLUSION: The intensity of the health care utilization environment during training may play a role in shaping physician cost consciousness later in their careers.

UR - http://www.scopus.com/inward/record.url?scp=85027953244&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85027953244&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2014.12.005

DO - 10.1016/j.mayocp.2014.12.005

M3 - Article

C2 - 25633153

AN - SCOPUS:85027953244

VL - 90

SP - 313

EP - 320

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 3

ER -