Diagnostic test use in different practice settings. A controlled comparison

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Abstract
Health maintenance organizations (HMO) have lower than average medical care costs but the reasons remain controversial. Diagnostic practices of cardiologists from a HMO, a university and a community were surveyed. Cardiologists defined indications for coronary bypass surgery and then evaluated randomly selected case summaries of patients with chest pain. After review, the cardiologist rated the need for an exercise Th scintiscan and for a coronary angiogram in each case. Community cardiologists had the broadest indications for bypass surgery. HMO cardiologists chose Th scintigraphy significantly less often than did the other 2 types of cardiologists. HMO and university cardiologists rated the need for coronary angiography significantly lower than did community cardiologists. Physicians in different practice settings recommend costly diagnostic and therapeutic methods differently, even for identical patients.