Stephen D. Flach, MD, PhD Robert S. Wigton, MD Craig J. Longenecker, MD, MPH Connie Parenti, MD Teresa J. Bryan, MD Thomas G. Tape, MD Omaha, Nebraska; Philadelphia, Pennsylvania; Minneapolis, Minnesota; and Birmingham, Alabama Submitted, revised, April 22, 2001. From the Section of General Internal Medicine, Department of Internal Medicine University of Nebraska Medical Center College of Medicine, Omaha (S.D.F., R.S.W., T.G.T.); the Department of Medicine, Abington Memorial Hospital, Philadelphia (J.C.L.); the Department of Medicine, University of Minnesota, Minneapolis (C.P.); and the Division of General Medicine, Department of Medicine, University of Alabama at Birmingham (T.J.B.). Dr. Longenecker is now at the Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland. This research was presented at the 1998 Annual Meeting of the Society for Medical Decision Making. (Flach SD, Wigton RS, Tape TG, Longenecker C, Parenti C, Bryan T. How doctors diagnose urinary tract infection: the potential influence of laboratory regulations on test prevalence and use. Med Decis Making 1998; 18:4. Abstract.) Reprint requests should be addressed to Stephen D. Flach, MD, PhD, 983331 Nebraska Medical Center, Omaha, NE 68198 3331. E-mail: sdflach@unmc.edu.
References
Finally, since the analysis is based on cross-sectional data, the results do not give any indication of how rapidly in-office testing declines after the implementation of quality regulations. However, as mentioned before, statistics indicate that the mix of tests in physicians’ offices has continued to move towards simpler tests since CLIA-88 was implemented. Our study provides a snapshot of the circumstances as CLIA-88 was first implemented; it would be worthwhile to assess changes in test prevalence and use in our survey population over the last several years. It may be the case that other changes underway in health care delivery (eg, improving technology, vertical and horizontal integration of physician groups, and growth of managed care) may hasten or reverse the changes in office laboratory availability implied in this study.
Conclusions
The availability of common office tests used in the diagnosis of UTI appears to be related to many factors, including the presence of office laboratory regulations. Lower availability of tests, in turn, was associated with the diagnostic approach when treating patients with a possible UTI. The net effects on patient welfare are difficult to predict, but our findings raise a serious concern about the possibility of a detrimental overall effect on patient welfare. Determining the full effect of quality regulations will require careful study to measure the changes in treatment patterns, treatment quality, and patient outcomes subsequent to the implementation of increased levels of regulation.
Acknowledgments
This research was funded by the Department of Internal Medicine at the University of Nebraska Medical Center, Omaha, and by the Department of Internal Medicine at Abington Memorial Hospital, Philadelphia, Pennsylvania.
