Time-of-day changes in physician clinical decision making: A retrospective study.

<h4>Background</h4>Time of day has been associated with variations in certain clinical practices such as cancer screening rates. In this study, we assessed how more general process measures of physician activity, particularly rates of diagnostic test ordering and diagnostic assessments,...

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Autores principales:	Peter Trinh, Donald R Hoover, Frank A Sonnenberg
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/fd5e3318a4c142a0a7ac88fc7d94691e
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spelling	oai:doaj.org-article:fd5e3318a4c142a0a7ac88fc7d94691e2021-12-02T20:14:32ZTime-of-day changes in physician clinical decision making: A retrospective study.1932-620310.1371/journal.pone.0257500https://doaj.org/article/fd5e3318a4c142a0a7ac88fc7d94691e2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0257500https://doaj.org/toc/1932-6203<h4>Background</h4>Time of day has been associated with variations in certain clinical practices such as cancer screening rates. In this study, we assessed how more general process measures of physician activity, particularly rates of diagnostic test ordering and diagnostic assessments, might be affected by time of day.<h4>Methods</h4>We conducted a retrospective chart review of 3,342 appointments by 20 attending physicians at five outpatient clinics, matching appointments by physician and comparing the average diagnostic tests ordered and average diagnoses assessed per appointment in the first hour of the day versus the last hour of the day. Statistical analyses used sign tests, two-sample t-tests, Wilcoxon tests, Kruskal Wallis tests, and multivariate linear regression.<h4>Results</h4>Examining physicians individually, four and six physicians, respectively, had statistically significant first- versus last-hour differences in the number of diagnostic tests ordered and number of diagnoses assessed per patient visit (p ≤ 0.04). As a group, 16 of 20 physicians ordered more tests on average in the first versus last hour (p = 0.012 for equal chance to order more in each time period). Substantial intra-clinic heterogeneity was found in both outcomes for four of five clinics (p < 0.01).<h4>Conclusions</h4>There is some statistical evidence on an individual and group level to support the presence of time-of-day effects on the number of diagnostic tests ordered per patient visit. These findings suggest that time of day may be a factor influencing fundamental physician behavior and processes. Notably, many physicians exhibited significant variation in the primary outcomes compared to same-specialty peers. Additional work is necessary to clarify temporal and inter-physician variation in the outcomes of interest.Peter TrinhDonald R HooverFrank A SonnenbergPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0257500 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Peter Trinh Donald R Hoover Frank A Sonnenberg Time-of-day changes in physician clinical decision making: A retrospective study.
description	<h4>Background</h4>Time of day has been associated with variations in certain clinical practices such as cancer screening rates. In this study, we assessed how more general process measures of physician activity, particularly rates of diagnostic test ordering and diagnostic assessments, might be affected by time of day.<h4>Methods</h4>We conducted a retrospective chart review of 3,342 appointments by 20 attending physicians at five outpatient clinics, matching appointments by physician and comparing the average diagnostic tests ordered and average diagnoses assessed per appointment in the first hour of the day versus the last hour of the day. Statistical analyses used sign tests, two-sample t-tests, Wilcoxon tests, Kruskal Wallis tests, and multivariate linear regression.<h4>Results</h4>Examining physicians individually, four and six physicians, respectively, had statistically significant first- versus last-hour differences in the number of diagnostic tests ordered and number of diagnoses assessed per patient visit (p ≤ 0.04). As a group, 16 of 20 physicians ordered more tests on average in the first versus last hour (p = 0.012 for equal chance to order more in each time period). Substantial intra-clinic heterogeneity was found in both outcomes for four of five clinics (p < 0.01).<h4>Conclusions</h4>There is some statistical evidence on an individual and group level to support the presence of time-of-day effects on the number of diagnostic tests ordered per patient visit. These findings suggest that time of day may be a factor influencing fundamental physician behavior and processes. Notably, many physicians exhibited significant variation in the primary outcomes compared to same-specialty peers. Additional work is necessary to clarify temporal and inter-physician variation in the outcomes of interest.
format	article
author	Peter Trinh Donald R Hoover Frank A Sonnenberg
author_facet	Peter Trinh Donald R Hoover Frank A Sonnenberg
author_sort	Peter Trinh
title	Time-of-day changes in physician clinical decision making: A retrospective study.
title_short	Time-of-day changes in physician clinical decision making: A retrospective study.
title_full	Time-of-day changes in physician clinical decision making: A retrospective study.
title_fullStr	Time-of-day changes in physician clinical decision making: A retrospective study.
title_full_unstemmed	Time-of-day changes in physician clinical decision making: A retrospective study.
title_sort	time-of-day changes in physician clinical decision making: a retrospective study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/fd5e3318a4c142a0a7ac88fc7d94691e
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Time-of-day changes in physician clinical decision making: A retrospective study.

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