Doktorların teşhis amaçlı test kullanımının iş yükü etkisi altında ampirik olarak araştırılması

ABSTRACTAn Empirical Analysis for Test Ordering Behavior of Physicians atOutpatient Units under the Influence of WorkloadBüşra Ergün-ŞahinDoctor of Philosophy in Business AdministrationAugust 5, 2019In recent years, there has been concerns about the increasing and potentially un-necessary use of diagnostic tests, which not only increases healthcare expenditures,but may also be harmful for the patients. There are numerous factors affecting thephysicians' use of diagnostic test orders. In this thesis, we empirically investigate theinfluence of workload and physician characteristics such as gender and experience onthe diagnostic test ordering behavior of physicians. Data from a public hospital isused in this thesis. In the first study, we define workload in two forms: the unfinishedworkload, that is, the number of patients waiting to be examined, and the finishedworkload, that is, the number of patients examined.We hypothesize that physiciansorder more diagnostic tests at higher unfinished workload since physicians use di-agnostic tests as a substitute for time with the patient, and physicians order fewerdiagnostic tests at higher finished workload due to fatigue and mental depletion. Inorder to tests these hypotheses, we employed zero inflated negative binomial regres-sion models and we find evidence supporting our hypotheses. In the second study,we analyze how physicians' characteristics affect test ordering behavior of physiciansand distribution of daily load, since previous literature suggests that test orderingbehavior is adjusted more by physicians' habits and characteristics than by objectiveevidence and clinical need (Vinker et al. 2007). Employing negative binomial re-gression model with random effects, we find that experienced physicians and femalephysicians order more, and distribute their daily load more evenly. Our findingscontribute to the body of knowledge in both healthcare operations management andmedical literature by showing state dependency of work content and showing thatcharacteristic of workers are also covariates of work conten