1. Clinical Autonomy and the Rationalization of Clinical Practice.
- Author
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Jin, Lei
- Subjects
MEDICAL care ,HEALTH care reform ,DECISION making ,MEDICINE ,POLITICAL autonomy ,HEALTH policy - Abstract
Background: During the recent healthcare reform, clinical practice has been increasingly been rationalized. Measures have been implemented to standardize the context and process of clinical decision-making, and physician performance were quantified and evaluated with the intention of influencing the decision-making process. Clinical practice has traditionally been the exclusive domain of the medical profession. This paper therefore examines the relationship between rationalization of clinical practice and physician perception of clinical autonomy and how this relationship vary by physician cohorts and physicians? elite status, and the organizational context in which they work. Data: Two rounds of the Community Tracking Study Physician Survey, which is a nationally representative and longitudinal study of physicians, are used. The dependent variable is physicians? assessment of their clinical autonomy at round two of the survey; the independent variables are changes in the impact of four rationalizing measures on physicians? practice of medicine between two rounds. Method: We use multivariable logistic regression models for binary responses that comprise a first-order Markov chain. Interaction terms are used to assess how the relationship between rationalization of clinical practice and physician perception of clinical autonomy vary by physician and organization characteristics. Results: Our study shows that rationalizing measures that directly guide clinical decision-making are perceived as more restrictive on clinical autonomy than those measures that monitor and evaluate physician behavior. The knowledge elite, defined as medical school faculty, physicians whose practice is heavily influenced by electronic data entry, and those working in large practice are more likely to have a favorable view of the effect of guidelines on clinical autonomy. Discussion: Not all rationalizing measures negatively influence physician assessment of their clinical autonomy. Improving the use of clinical information technology and implementing guidelines by physicians? immediate organizations may facilitate the introduction of guidelines. Efforts are needed to minimize the gap between knowledge elites and rank-and-file physicians in their understanding of the implication of rationalization of clinical practice on clinical autonomy. [ABSTRACT FROM AUTHOR]
- Published
- 2004
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