Provider “Hotspotters:” Individual Residents Demonstrate Different Patterns of Test Utilization across 3 Standardized Cases

We sought to quantify ordering behaviors in primary care practice across three unannounced standardized cases by comparing patterns of preventive vs diagnostic test/lab ordering and looking at specific test ordering correlates. USPs portrayed three clinical scenarios a “Well” visit, a chief complaint of “Fatigue,” and “Asthma.” USPs were scheduled to visit residents in an urban, safety-net hospital. Electronic orders were extracted via chart review and compared to scenario-specific practice guidelines. We found variation in appropriate preventative and diagnostic ordering; and frequent high utilization. Excessive ordering was positively correlated with indicated and discretionary ordering, and negatively with omitting indicated tests.