Impact of Providing Fee Data on Laboratory Test Ordering A Controlled Clinical Trial
Impact of Providing Fee Data on Laboratory Test Ordering A Controlled Clinical Trial
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DOI：
10.1001/jamainternmed.2013.232
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发表时间：
2013-05-27
影响因子：
39
通讯作者：
Brotman, Daniel J.
中科院分区：
文献类型：
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作者：
Feldman, Leonard S.;Shihab, Hasan M.;Brotman, Daniel J.
重要性：住院护理提供者经常订购实验室检查，而不了解检查的费用。目的：确定我们是否可以通过在三级护理医院订单输入时向提供者提供检查费用来减少订购的实验室检查数量，而不增加订购过程的额外步骤。设计：对照临床试验。设置：三级护理医院。参与者：所有的供应商，包括医生和非医生，谁通过计算机化的供应商订单输入系统在约翰霍普金斯Hospital.Intervention订购实验室检查：我们随机分配61诊断实验室检查的“积极”的手臂（费用显示）或控制臂（费用不显示）。在6个月的基准期内（2008年11月10日至2009年5月9日），我们没有显示任何费用数据。在1年后的6个月干预期间（2009年11月10日至2010年5月9日），我们显示了基于Medicare允许费用的费用，仅用于主动检测。主要结果指标：我们检查了订单总数的变化，有序测试的频率（每个患者-天），以及根据时间段与订单相关的总费用（基线vs干预期）和按研究组（活性测试与对照）。对于主动臂测试，测试排序率从基线期的3.72次/患者-天降低到干预期的3.40次/患者-天（降低8.59%; 95% CI，-8.99%至-8.19%）。对于对照组测试，从基线期到干预期，排序从1.15增加到1.22测试/患者-天（增加5.64%; 95% CI，4.90%至6.39%）（活性测试和对照测试之间随时间的差异P < .001）。结论和相关性：在订单输入时向供应商提供费用数据导致测试订单略有减少。采用这种干预措施可能会减少不适当的诊断测试的数量。
Importance: Inpatient care providers often order laboratory tests without any appreciation for the costs of the tests.Objective: To determine whether we could decrease the number of laboratory tests ordered by presenting providers with test fees at the time of order entry in a tertiary care hospital, without adding extra steps to the ordering process.Design: Controlled clinical trial.Setting: Tertiary care hospital.Participants: All providers, including physicians and nonphysicians, who ordered laboratory tests through the computerized provider order entry system at The Johns Hopkins Hospital.Intervention: We randomly assigned 61 diagnostic laboratory tests to an "active" arm (fee displayed) or to a control arm (fee not displayed). During a 6-month baseline period (November 10, 2008, through May 9, 2009), we did not display any fee data. During a 6-month intervention period 1 year later (November 10, 2009, through May 9, 2010), we displayed fees, based on the Medicare allowable fee, for active tests only.Main Outcome Measures: We examined changes in the total number of orders placed, the frequency of ordered tests (per patient-day), and total charges associated with the orders according to the time period (baseline vs intervention period) and by study group (active test vs control).Results: For the active arm tests, rates of test ordering were reduced from 3.72 tests per patient-day in the baseline period to 3.40 tests per patient-day in the intervention period (8.59% decrease; 95% CI, -8.99% to -8.19%). For control arm tests, ordering increased from 1.15 to 1.22 tests per patient-day from the baseline period to the intervention period (5.64% increase; 95% CI, 4.90% to 6.39%) (P < .001 for difference over time between active and control tests).Conclusions and Relevance: Presenting fee data to providers at the time of order entry resulted in a modest decrease in test ordering. Adoption of this intervention may reduce the number of inappropriately ordered diagnostic tests.