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Modifying Physician Behavior to Improve Cost-Efficiency in Safety-Net Ambulatory Settings

Borkowski, Nancy DBA, CPA, FACHE, FHFMA; Gumus, Gulcin PhD; Deckard, Gloria J. PhD

The Journal of Ambulatory Care Management: April/June 2013 - Volume 36 - Issue 2 - p 129–139
doi: 10.1097/JAC.0b013e318242fe67
Original Articles

Change interventions in one form or another are viewed as important tools to reduce variation in medical services, reduce costs, and improve quality of care. With the current focus on efficient resource use, the successful design and implementation of change strategies are of utmost importance for health care managers. We present a case study in which macro and micro level change strategies were used to modify primary care physicians' practice patterns of prescribing diagnostic services in a safety-net's ambulatory clinics. The findings suggest that health care managers using evidence-based strategies can create a practice environment that reduces barriers and facilitates change.

Health Management Programs (Dr Borkowski) and Department of Decision Science and Information Systems (Dr Deckard), College of Business Administration, Florida International University, Miami; and Department of Management Programs, College of Business, Florida Atlantic University, Boca Raton (Dr Gumus).

Correspondence: Nancy Borkowski, DBA, CPA, FACHE, FHFMA, Health Management Programs, College of Business Administration, Florida International University, 1101 Brickell Ave, S Tower 306, Miami, FL 33131 (

The authors thank the following individuals at the Jackson Health System in Miami-Dade County, Florida, for their contributions: Lenworth L. Anglin, MD, MPH, Medical Director, Ambulatory Managed Care & Quality; Serge A. Boisette, MHSA, Administrator, Ambulatory Managed Care & Quality; and Paul Ling, Senior Systems Analyst, Ambulatory Managed Care & Quality. They also thank the anonymous reviewer for the comments and constructive feedback.

The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article.

© 2013 Lippincott Williams & Wilkins, Inc.