Impact of Cost Display on Ordering Patterns for Hospital Laboratory and Imaging Services
Impact of Cost Display on Ordering Patterns for Hospital Laboratory and Imaging Services
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DOI：
10.1007/s11606-018-4495-6
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发表时间：
2018-08-01
影响因子：
5.7
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
--
作者：
Silvestri, Mark T.;Xu, Xiao;Krumholz, Harlan M.
医生代表病人“购买”许多医疗保健服务，但在很大程度上仍然不知道这些服务的成本。电子健康记录（EHR）成本显示可促进有成本意识的医疗服务订购。确定显示医院实验室和成像订单成本是否与所下订单的数量和成本变化相关。准实验研究。2013年4月至2015年10月期间，多站点医疗系统中所有住院或观察患者。订单成本显示，基于Medicare费用表，实验室和成像订单的结果是（1）订单是否在医院就诊期间下，（2）订单是否在给定的患者日下，（3）每个患者日下的订单数量，以及（4）每个患者日下的订单的成本。在实验室和成像研究期间，有248个，分别为214次和258，267次。成本显示的实施与在遭遇过程中订购任何实验室或成像的几率降低有关（实验室校正比值比[AOR] = 0.97，p = .01;影像学AOR = 0.97，p < .001），在给定患者日订购任何实验室或影像学检查的比值降低（实验室AOR = 0.95，p <0.001;影像学AOR = 0.97，p <0.001），患者日的实验室或影像学医嘱数量减少（实验室调整的计数比率= 0.93，p <0.001;成像调整计数比= 0.98，p < .001），在有订单的患者日，实验室订单成本降低，成像订单成本增加（实验室调整成本比= 0.93，p <0.001;成像调整成本比= 1.02，p = 0.003）。总体而言，干预与每患者日的实验室和成像成本分别降低8.5%和1.7%相关。EHR订购屏幕中的成本与实验室和成像订单数量和成本的降低相关。
Physicians "purchase" many health care services on behalf of patients yet remain largely unaware of the costs of these services. Electronic health record (EHR) cost displays may facilitate cost-conscious ordering of health services.To determine whether displaying hospital lab and imaging order costs is associated with changes in the number and costs of orders placed.Quasi-experimental study.All patients with inpatient or observation encounters across a multi-site health system from April 2013 to October 2015.Display of order costs, based on Medicare fee schedules, in the EHR for 1032 lab tests and 1329 imaging tests.Outcomes for both lab and imaging orders were (1) whether an order was placed during a hospital encounter, (2) whether an order was placed on a given patient-day, (3) number of orders placed per patient-day, and (4) cost of orders placed per patient-day.During the lab and imaging study periods, there were 248,214 and 258,267 encounters, respectively. Cost display implementation was associated with a decreased odds of any lab or imaging being ordered during the encounter (lab adjusted odds ratio [AOR] = 0.97, p = .01; imaging AOR = 0.97, p < .001), a decreased odds of any lab or imaging being ordered on a given patient-day (lab AOR = 0.95, p < .001; imaging AOR = 0.97, p < .001), a decreased number of lab or imaging orders on patient-days with orders (lab adjusted count ratio = 0.93, p < .001; imaging adjusted count ratio = 0.98, p < .001), and a decreased cost of lab orders and increased cost of imaging orders on patient-days with orders (lab adjusted cost ratio = 0.93, p < .001; imaging adjusted cost ratio = 1.02, p = .003). Overall, the intervention was associated with an 8.5 and 1.7% reduction in lab and imaging costs per patient-day, respectively.Displaying costs within EHR ordering screens was associated with decreases in the number and costs of lab and imaging orders.