Docs with their eyes on the clock? The effect of time pressures on primary care productivity

Seth Freedman, Ezra Golberstein, Tsan-Yao Huang, David J. Satin, Laura Barrie Smith

Research output: Contribution to journalArticlepeer-review

Abstract

This paper examines how time pressure, an important constraint faced by medical care providers, affects productivity in primary care. We generate empirical predictions by incorporating time pressure into a model of physician behavior by Tai-Seale and McGuire (2012). We use data from the electronic health records of a large integrated delivery system and leverage unexpected schedule changes as variation in time pressure. We find that greater time pressure reduces the number of diagnoses recorded during a visit and increases both scheduled and unscheduled follow-up care. We also find some evidence of increased low-value care, decreased preventive care, and decreased opioid prescribing.

Original languageEnglish (US)
Article number102442
JournalJournal of Health Economics
Volume77
DOIs
StatePublished - May 1 2021

Bibliographical note

Funding Information:
We would like to thank Hannah Neprash, Dan Sacks, Jonathan Skinner, Aaron Sojourner, participants at the 2017 APPAM Fall Research Conference, 2017 IU/UofL/VU Health Economics and Policy Conference, 2018 ASHEcon Conference, 2018 American-European Health Economics Study Group, and seminar participants at the Emory University School of Public Health, IUPUI Department of Economics, IUPUI Department of Health Management and Policy for helpful comments and suggestions. We are grateful to staff of Fairview Health Services for answering many questions about institutional details, and we are grateful to Gretchen Sieger for assistance in obtaining data. Our paper uses proprietary data from an integrated delivery system through its data sharing agreement with the University of Minnesota. Others may apply for access to the data with the sponsorship of a University of Minnesota affiliated researcher. We can provide information about how other researches can apply for the data and we can share all of the STATA code that generates the reported results. This research was supported by the National Institutes of Health's National Center for Advancing Translational Sciences, grant UL1TR002494. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health's National Center for Advancing Translational Sciences. This research was also supported by a University of Minnesota Academic Health Center Seed Grant (#16.22). Dr. Smith was supported by an AHRQ institutional pre-doctoral training, grant T32HS000036. All errors are our own. No conflicts of interest are reported for any author.

Funding Information:
We would like to thank Hannah Neprash, Dan Sacks, Jonathan Skinner, Aaron Sojourner, participants at the 2017 APPAM Fall Research Conference, 2017 IU/UofL/VU Health Economics and Policy Conference, 2018 ASHEcon Conference, 2018 American-European Health Economics Study Group, and seminar participants at the Emory University School of Public Health, IUPUI Department of Economics, IUPUI Department of Health Management and Policy for helpful comments and suggestions. We are grateful to staff of Fairview Health Services for answering many questions about institutional details, and we are grateful to Gretchen Sieger for assistance in obtaining data. Our paper uses proprietary data from an integrated delivery system through its data sharing agreement with the University of Minnesota. Others may apply for access to the data with the sponsorship of a University of Minnesota affiliated researcher. We can provide information about how other researches can apply for the data and we can share all of the STATA code that generates the reported results. This research was supported by the National Institutes of Health’s National Center for Advancing Translational Sciences , grant UL1TR002494 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health’s National Center for Advancing Translational Sciences. This research was also supported by a University of Minnesota Academic Health Center Seed Grant ( #16.22 ). Dr. Smith was supported by an AHRQ institutional pre-doctoral training , grant T32HS000036 . All errors are our own. No conflicts of interest are reported for any author.

Publisher Copyright:
© 2021 Elsevier B.V.

Keywords

  • Health care productivity
  • Primary care
  • Provider decision making

PubMed: MeSH publication types

  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

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