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Physician management in primary care.

B S Hulka, L L Kupper and J C Cassel

Minimal explicit consensus criteria in the management of patients with four indicator conditions were established by an ad hoc committee of primary care physicians practicing in different locations. These criteria were then applied to the practices of primary care physicians located in a single community by abstracting medical records and obtaining questionnaire data about patients with the indicator conditions. A standardized management score for each physician was used as the dependent variable in stepwise regression analysis with physician/practice and patient/disease characteristics as the candidate independent variables. For all physicians combined, the mean management scores were high, ranging from .78 to .93 for the four conditions. For two of the conditions, care of the normal infant and pregnant woman, the management scores were better for pediatricians and obstetricians respectively than for family physicians. For the other two conditions, adult onset diabetes and congestive heart failure, there were no differences between the management scores of family physicians and internists. Patient/disease characteristics did not contribute significantly to explaining the variation in the standardized management scores.

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