Results Summary

PCORI funded the Pilot Projects to explore how to conduct and use patient-centered outcomes research in ways that can better serve patients and the healthcare community. Learn more.

Background

Sometimes patients ask for—and doctors order—medical tests that do not give useful information. Researchers call these “low-value tests.” More than 70 doctor organizations say that reducing the number of unneeded tests could improve health care in the United States.

Project Purpose

This study evaluated a program to train doctors on how to respond when a patient requests a low-value test.

Methods

The researchers randomly assigned 61 primary care doctors to one of two groups. All of the doctors practiced internal medicine or family medicine at a medical school in northern California.

Medical coaches acted the part of patients in visits with doctors in both groups. In the appointment, they asked for a specific kind of test that would be low-value for that patient.

After the appointment was over, the medical coaches gave the doctors in the first group feedback about how well they did in responding to patient concerns without ordering a low-value test. They discussed six methods for responding.

In the other group, the doctors didn’t receive any feedback. Instead, they got an email with guidelines on when the test requested would be considered low value and when it would be needed.

The coaches made three more visits to each doctor during a nine-month period. They asked for low-value tests each time. The medical coaches made a total of 155 visits.

Researchers wanted to see if the medical coaches’ feedback made a difference in the way doctors responded to patient requests for low-value tests. To do this, the researchers compared the number of times doctors in each group ordered a low-value test for the medical coaches. 

The researchers listened to recordings of the visits to hear if the doctor used one or more of the six ways to handle requests for low-value tests. Researchers asked the medical coaches to rate how satisfied they would be as a patient on a scale of 1 to 10. The researchers also looked at electronic medical records to see how many low-value tests the doctors ordered for their real patients.

Findings

Doctors ordered low-value tests in one of every four visits with the medical coaches. That was fewer low-value tests than the researchers had expected.

Doctors who got feedback from coaches were just as likely to order low-value tests as those who did not. This was true for all three visits. The doctors’ rate of ordering low-value tests for real patients did not change over the study time in either group.

The medical coaches who shared feedback with the doctors were more satisfied with their visits than the medical coaches who did not share feedback with their doctors.

Limitations

Doctors might have figured out which of their patients were actually medical coaches. Doctors might have changed their behavior if they thought they were being tested.

All the doctors worked at one of two clinics. Those who got coaching might have shared what they learned with those who did not get coaching, so that everyone’s behavior might have changed.

The clinics had supervisor doctors on staff. They may have talked to the doctors about what tests they ordered in addition to the feedback the doctors got from the medical coaches.

There were fewer medical coach visits than the researchers had planned. The doctors also ordered fewer low-value tests than the researchers thought they would. Thus, the researchers might not have been able to detect differences between the groups.

Researchers conducted the study with only one type of doctor in only two clinics. The results may not be the same with other kinds of doctors at more clinics.

Conclusions

The feedback did not appear to have an effect on the way that doctors ordered tests. Thus, the researchers cannot recommend that doctors get this type of short-term coaching to reduce the number of low-value tests ordered.

Sharing the Results

The researchers presented the results at a meeting and in journal articles (see below).

Project Information

Joshua J. Fenton, MD, MPH
University of California, Davis
$687,732
Promoting Patient-Centered Counseling to Reduce Inappropriate Diagnostic Tests

Key Dates

June 2012
December 2014
2012
2014

Study Registration Information

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Last updated: March 4, 2022