Effect of incentives on the use of indicated services in managed care

In managed care, financial incentives and utilization review create conflicts of interest for physicians. We sought to determine whether these incentives would lead physicians to deny indicated services. We surveyed internists practicing in areas with at least 30% penetration of managed care. Our questionnaire included four scenarios in which a test or referral is indicated according to clearly established practice guidelines. We randomly assigned physicians to receive one of five versions of the questionnaire, which differed only in the type of reimbursement incentive and utilization review that applied to the scenarios. We received responses from 710 (70%) of 1,009 internists. Although physicians underutilized services regardless of incentives in all scenarios, physicians whose questionnaires depicted full capitation said that they would order fewer services than physicians whose questionnaires depicted fee-for-service. In the scenario in which an x-ray of the lumbosacral spine is indicated for a patient with low back pain, 86% of physicians randomized to the full capitation version said that they would order the test compared to 94% in the fee-for-service version. Similarly, physicians randomized to scenarios requiring utilization review said that they would order fewer services than those randomized to scenarios requiring completion of an insurance form. Scenarios depicting managed care incentives caused consistent, modest underutilization compared to fee-for-service scenarioes, although physicians underutilized services under all financial incentives and utilization review. In response, physicians must develop better methods for detecting underutilization and devise programs to increase the provision of indicated services.     

向本刊2021年度审稿专家致谢

2021年度,共有416位专家为《中国生物化学与分子生物学报》审稿,他们的辛勤劳动保证了学报的学术质量,他们提出的中肯意见帮助作者提高了科研水平和论文写作质量。在此,编辑部谨向所有的审稿专家致以最诚挚的感谢！审稿专家名单请见PDF文件,其中审稿认真、审稿3篇以上的专家被评为优秀审稿专家。在新春佳节到来之际,祝各位专家新春快乐！万事如意！ 《中国生物化学与分子生物学报》编辑部 2022年1月     

Context-Aware Reviewer Assignment for Trust Enhanced Peer Review

Reviewer assignment is critical to peer review systems, such as peer-reviewed research conferences or peer-reviewed funding applications, and its effectiveness is a deep concern of all academics. However, there are some problems in existing peer review systems during reviewer assignment. For example, some of the reviewers are much more stringent than others, leading to an unfair final decision, i.e., some submissions (i.e., papers or applications) with better quality are rejected. In this paper, we propose a context-aware reviewer assignment for trust enhanced peer review. More specifically, in our approach, we first consider the research area specific expertise of reviewers, and the institution relevance and co-authorship between reviewers and authors, so that reviewers with the right expertise are assigned to the corresponding submissions without potential conflict of interest. In addition, we propose a novel cross-assignment paradigm, and reviewers are cross-assigned in order to avoid assigning a group of stringent reviewers or a group of lenient reviewers to the same submission. More importantly, on top of them, we propose an academic CONtext-aware expertise relevanCe oriEnted Reviewer cross-assignmenT approach (CONCERT), which aims to effectively estimate the “true” ratings of submissions based on the ratings from all reviewers, even though no prior knowledge exists about the distribution of stringent reviewers and lenient reviewers. The experiments illustrate that compared with existing approaches, our proposed CONCERT approach can less likely assign more than one stringent reviewers or lenient reviewers to a submission simultaneously and significantly reduce the influence of ratings from stringent reviewers and lenient reviewers, leading to trust enhanced peer review and selection, no matter what kind of distributions of stringent reviewers and lenient reviewers are.     

Quantitative assessment of the quality of medical care provided in five family practices before and after attachment of a family practice nurse.

The standards of patient care were maintained in five urban medical practices after the introduction of family practice nurses. Evaluations were achieved before and after their appointment by the indicator condition method. Minimal explicit criteria for the management of patients with 12 indicator conditions and by the use of 14 drugs were approved by an ad hoc peer group of community physicians. These cirteria were applied to the five practices by the use of a single-blind design and the abstraction of unaltered medical records. A standardized score for each practic e permitted comparison of scores for the management of indicator conditions and for the clinical use of drugs before and after attachment of the family practice nurses. For each of the indicator conditions and the drugs assessed in the five practices similar levels of adequacy were observed in the two study periods. These explicit (objective) audit resutls agreed with the implicit (subjective) assessments of the family practice nurses by their physician colleagues.     

A report from Japan: choices of Japanese patients in the face of disagreement

Background: Patients in different countries have different attitudes toward self-determination and medical information. Little is known how much respect Japanese patients feel should be given for their wishes about medical care and for medical information, and what choices they would make in the face of disagreement.
Methods: Ambulatory patients in six clinics of internal medicine at a university hospital were surveyed using a self-administered questionnaire.
Results: A total of 307 patients participated in our survey. Of the respondents, 47% would accept recommendations made by physicians, even if such recommendations were against their wishes; 25% would try to persuade their physician to change their recommendations; and 14% would leave their physician to find a new one.
Seventy-six percent of the respondents thought that physicians should routinely ask patients if they would want to know about a diagnosis of cancer, while 5% disagreed; 59% responded that physicians should inform them of the actual diagnosis, even against the request of their family not to do so, while 24% would want their physician to abide by their family's request and 14% could not decide. One-third of the respondents who initially said they would want to know the truth would yield to the desires of the family in a case of disagreement.
Interpretations: In the face of disagreement regarding medical care and disclosure, Japanese patients tend to respond in a diverse and unpredictable manner. Medical professionals should thus be prudent and ask their patients explicitly what they want regarding medical care and information.     

Preventive attitudes,beliefs, and practices of physicians in fee-for-service and health maintenance organization settings.

To identify the self-reported differences in preventive practices, attitudes, and beliefs of physicians practicing in fee-for-service (FFS) and health maintenance organization (HMO) settings, we surveyed a 100% sample of primary care physicians practicing in a large, urban, closed-panel HMO and a random sample of physicians, in the same county, who were in an FFS practice. The FFS physicians were more likely to consider behavioral risk factors important than were HMO physicians, and they were more likely to ask their patients about behavioral risk factors. Fee-for-service physicians were more likely than HMO physicians to use continuing medical education courses to upgrade their skills in modifying behavioral risk factors. There was little difference in the self-reported proportion of patients with specific behavioral risks in the FFS and HMO practices. Also, both groups were comparable in their perception of their ability to do behavioral counseling and their perceived success in such counseling. We conclude that FFS physicians are more likely to have positive preventive beliefs, attitudes, and practices than are HMO physicians.     

加拿大医师能力框架对我国制定执业医师能力标准的启示

CanMEDS是加拿大皇家内科和外科医师学会提出的能力框架,指出医师应该扮演7种不同角色,基本满足了医学模式的转变和医疗实践的挑战对医师能力提出的新要求。CanMEDS与英美专业医学管理机构制定的医师能力标准相比更加全面和直观,与我国现有医师能力基本要求相比更加详细而系统。CanMEDS启发我国有关机构提高对执业医师能力标准制定工作的重视,加强调研,使得最终制定的有中国特色的执业医师标准能够更好地指导医学教育、规范医疗实践。     

Factors influencing family physicians to continue providing obstetric care.

To determine the reasons some family physicians continue to practice obstetrics when most of their colleagues do not, we surveyed family physicians in 26 counties of northern California whose practices include obstetrics and those who have recently discontinued it. In all, 70% of family physicians practicing obstetrics cited enjoying it as a reason for continuing this practice. Over a third of family physicians practicing obstetrics thought that obstetric practice was a responsibility to the community. Only 1 in 6 reported obstetrics to be important in terms of financial implications. Despite this, family physicians practicing obstetrics had a mean gross income derived from obstetric practice of $30,000 above the cost of their total malpractice premium. In contrast, a comparison group of family physicians who had recently discontinued obstetrics cited malpractice insurance costs most frequently as the reason for discontinuing it. Nearly 40% of these physicians indicated that they would be willing to return to obstetrics if circumstances were to change substantially. The most frequently cited change necessary for these physicians to return to obstetrics was a reduction in malpractice insurance rates.     

Prion reviewer acknowledgments

Prion is grateful for the ongoing support of its peer reviewers, who ensure that the submissions accepted for publication in Prion continue to be of the highest standard. We very much appreciate their time and the thoughtful reviews they provide. We would like to thank the following peer reviewers for their assistance in 2013:     

向本刊2020年度审稿专家致谢

《中国生物化学与分子生物学报》（以下称《学报》）一直秉承严格的同行评议制度,2020年度共有411位审稿专家为《学报》审稿,他们的辛勤工作保证了本刊的学术质量。有作者向我们反映,每次投稿,都能收到编辑部的建设性意见,使他们的科研工作做得更加完善,提高了文章的学术水平和写作质量,受益匪浅。近几年《学报》的投稿量在持续增加,2020年增加幅度更大,同时也加大了审稿专家的工作量。在此,编辑部谨向所有的审稿专家致以最诚挚的感谢！以下为审稿专家名单,其中审稿3篇以上、审稿认真的专家被评为优秀审稿专家。 《中国生物化学与分子生物学报》编辑部 2021年1月     

Peer Review of Grant Applications: Criteria Used and Qualitative Study of Reviewer Practices

Background

Peer review of grant applications has been criticized as lacking reliability. Studies showing poor agreement among reviewers supported this possibility but usually focused on reviewers’ scores and failed to investigate reasons for disagreement. Here, our goal was to determine how reviewers rate applications, by investigating reviewer practices and grant assessment criteria.

Methods and Findings

We first collected and analyzed a convenience sample of French and international calls for proposals and assessment guidelines, from which we created an overall typology of assessment criteria comprising nine domains relevance to the call for proposals, usefulness, originality, innovativeness, methodology, feasibility, funding, ethical aspects, and writing of the grant application. We then performed a qualitative study of reviewer practices, particularly regarding the use of assessment criteria, among reviewers of the French Academic Hospital Research Grant Agencies (Programmes Hospitaliers de Recherche Clinique, PHRCs). Semi-structured interviews and observation sessions were conducted. Both the time spent assessing each grant application and the assessment methods varied across reviewers. The assessment criteria recommended by the PHRCs were listed by all reviewers as frequently evaluated and useful. However, use of the PHRC criteria was subjective and varied across reviewers. Some reviewers gave the same weight to each assessment criterion, whereas others considered originality to be the most important criterion (12/34), followed by methodology (10/34) and feasibility (4/34). Conceivably, this variability might adversely affect the reliability of the review process, and studies evaluating this hypothesis would be of interest.

Conclusions

Variability across reviewers may result in mistrust among grant applicants about the review process. Consequently, ensuring transparency is of the utmost importance. Consistency in the review process could also be improved by providing common definitions for each assessment criterion and uniform requirements for grant application submissions. Further research is needed to assess the feasibility and acceptability of these measures.