Disentangling the relationship between physician and organizational performance: a signal detection approach
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Published version
Author(s)
Kostopoulou, Olga
Nurek, Martine
Delaney, Brendan
Type
Journal Article
Abstract
Background. In previous research, we employed a signal detection approach to measure the performance of general practitioners (GPs) when deciding about urgent referral for suspected lung cancer. We also explored associations between provider and organizational performance. We found that GPs from practices with higher referral positive predictive value (PPV; chance of referrals identifying cancer) were more reluctant to refer than those from practices with lower PPV. Here, we test the generalizability of our findings to a different cancer. Methods. A total of 252 GPs responded to 48 vignettes describing patients with possible colorectal cancer. For each vignette, respondents decided whether urgent referral to a specialist was needed. They then completed the 8-item Stress from Uncertainty scale. We measured GPs’ discrimination (d′) and response bias (criterion; c) and their associations with organizational performance and GP demographics. We also measured correlations of d′ and c between the 2 studies for the 165 GPs who participated in both. Results. As in the lung study, organizational PPV was associated with response bias: in practices with higher PPV, GPs had higher criterion (b = 0.05 [0.03 to 0.07]; P < 0.001), that is, they were less inclined to refer. As in the lung study, female GPs were more inclined to refer than males (b = −0.17 [−0.30 to −0.105]; P = 0.005). In a mediation model, stress from uncertainty did not explain the gender difference. Only response bias correlated between the 2 studies (r = 0.39, P < 0.001). Conclusions. This study confirms our previous findings regarding the relationship between provider and organizational performance and strengthens the finding of gender differences in referral decision making. It also provides evidence that response bias is a relatively stable feature of GP referral decision making.
Date Issued
2020-08-01
Date Acceptance
2020-05-14
Citation
Medical Decision Making, 2020, 40 (6), pp.746-755
ISSN
0272-989X
Publisher
SAGE Publications
Start Page
746
End Page
755
Journal / Book Title
Medical Decision Making
Volume
40
Issue
6
Copyright Statement
© The Author(s) 2020. This article is distributed under the terms of the Creative Commons Attribution 4.0 License (https://creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).
License URL
Sponsor
Cancer Research UK
Identifier
https://journals.sagepub.com/doi/full/10.1177/0272989X20936212
Grant Number
17871
Subjects
Science & Technology
Life Sciences & Biomedicine
Health Care Sciences & Services
Health Policy & Services
Medical Informatics
colorectal cancer
conversion rate
detection rate
gender differences
primary care
QCancer
response bias
stress from uncertainty
SUSPECTED CANCER
ASSOCIATION
UNCERTAINTY
RISK
QCancer
colorectal cancer
conversion rate
detection rate
gender differences
primary care
response bias
stress from uncertainty
Health Policy & Services
1117 Public Health and Health Services
1402 Applied Economics
Publication Status
Published
Date Publish Online
2020-07-01