The Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering
The Impact of Cost Displays on Primary Care Physician Laboratory Test Ordering
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DOI：
10.1007/s11606-013-2672-1
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发表时间：
2014-05-01
影响因子：
5.7
通讯作者：
Sequist, Thomas D.
中科院分区：
文献类型：
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作者：
Horn, Daniel M.;Koplan, Kate E.;Sequist, Thomas D.
背景技术背景：医生们正面临着越来越大的压力，以帮助控制不断上升的医疗保健成本，但他们缺乏有关成本的影响，病人的护理decision.Objective：要评估的影响，实时显示的实验室费用对初级保健医生订购的常见实验室检查在门诊setting.Design：中断时间序列分析与平行对照组。2010年4月至2011年11月期间，215名初级保健医生（153名干预医生和62名对照医生）使用共同的电子健康记录。背景是马萨诸塞州的五个多专业小组实践的联盟。干预：在订购时，27项实验室检查的平均医疗保险报销率显示在电子健康记录中，包括21项低成本检查（<40. 00美元）和6项高成本检查（> 40. 00美元）。主要措施：我们比较了干预前12个月和干预后6个月干预和对照医生之间每月实验室订购率的斜率变化。我们调查了所有的干预和控制医生在6个月后干预，以评估对成本和成本showers.KEY结果的态度：在27个实验室测试，干预医生表现出显着下降，订购率相比，控制医生的五个（19%）测试。这包括21项较低成本实验室检测中的4项（19%）和6项较高成本实验室检测中的1项（17%）的订购率相对显著下降。大多数（81%）的医生报告说，干预措施提高了他们的知识的相对成本的实验室tests.CONCLUSIONS：实时显示的成本信息在电子健康记录可以导致适度减少订购的实验室检查，并受到好评。我们的研究表明，电子健康记录可以作为一种工具，以促进成本透明度和减少实验室测试的使用。
BACKGROUND: Physicians are under increased pressure to help control rising health care costs, though they lack information regarding cost implications of patient care decisions.OBJECTIVE: To evaluate the impact of real-time display of laboratory costs on primary care physician ordering of common laboratory tests in the outpatient setting.DESIGN: Interrupted time series analysis with a parallel control group.PARTICIPANTS: Two hundred and fifteen primary care physicians (153 intervention and 62 control) using a common electronic health record between April 2010 and November 2011. The setting was an alliance of five multispecialty group practices in Massachusetts.INTERVENTION: The average Medicare reimbursement rate for 27 laboratory tests was displayed within an electronic health record at the time of ordering, including 21 lower cost tests (< $40.00) and six higher cost tests (> $40.00). MAIN MEASURES: We compared the change-in-slope of the monthly laboratory ordering rate between intervention and control physicians for 12 months pre-intervention and 6 months post-intervention. We surveyed all intervention and control physicians at 6 months post-intervention to assess attitudes regarding costs and cost displays.KEY RESULTS: Among 27 laboratory tests, intervention physicians demonstrated a significant decrease in ordering rates compared to control physicians for five (19 %) tests. This included a significant relative decrease in ordering rates for four of 21 (19 %) lower cost laboratory tests and one of six (17 %) higher cost laboratory tests. A majority (81 %) of physicians reported that the intervention improved their knowledge of the relative costs of laboratory tests.CONCLUSIONS: Real-time display of cost information in an electronic health record can lead to a modest reduction in ordering of laboratory tests, and is well received. Our study demonstrates that electronic health records can serve as a tool to promote cost transparency and reduce laboratory test use.