This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

David W. Bates, MD, MSc; Gilad J. Kuperman, MD, PhD; Ashish Jha, MD; Jonathan M. Teich, MD, PhD; E. John Orav, PhD; Nell Ma'luf; Andrew Onderdonk, PhD; Robert Pugatch, MD; Donald Wybenga, MD; James Winkelman, MD; Troyen A. Brennan, MD; Anthony L. Komaroff, MD; Milenko J. Tanasijevic, MD

Arch Intern Med. 1997;157(21):2501-2508.

Abstract
Background
The computerized display of charges for ancillary tests in outpatients has been found to affect physician-ordering behavior, but this issue has not been studied in inpatients.

Objective
To assess whether the computerized display of charges for clinical laboratory or radiological tests affected physician-ordering behavior.

Patients and Methods
Two prospective controlled trials, randomized by patient, were performed. Each trial included all medical and surgical inpatients at 1 large teaching hospital during 4 and 7 months: 3536 intervention and 3554 control inpatients in the group with clinical laboratory tests, and 8728 intervention and 8653 control inpatients in the group with radiological tests. The intervention consisted of the computerized display of charges for tests at the time of ordering.

Main Outcome Measures
The number of clinical laboratory and radiological tests ordered per admission and the charges for these tests.

Results
For the clinical laboratory tests, during a 4-month study period, patients in the intervention group had 4.5% fewer tests ordered, and the total charges for these tests were 4.2% lower, although neither difference was statistically significant. Compared with historical controls from the same 4-month period a year before, the charges for the tests per admission had decreased 13.3%, but the decrease was temporally correlated with a restriction of future ordering of tests, and not with the introduction of the display of charges. For the radiological tests, during a 7-month period, the intervention group had almost identical numbers of tests ordered and charges for these tests.

Conclusions
The computerized display of charges had no statistically significant effect on the number of clinical laboratory tests or radiological procedures ordered or performed, although small trends were present for clinical laboratory tests. More intensive interventions may be needed to affect physician test utilization.

Arch Intern Med. 1997;157:2501-2508

Author Affiliations
From the Center for Applied Medical Information Systems Research (Drs Bates, Kuperman, Teich, and Komaroff), the Division of General Medicine, Department of Medicine (Drs Bates, Brennan, Komaroff, and Jha and Ms Ma'luf), the Division of Clinical Epidemiology (Dr Orav), the Department of Radiology (Dr Pugatch), and the Clinical Laboratories (Drs Onderdonk, Wybenga, Winkelman, and Tanasijevic), Brigham and Women's Hospital, Boston, Mass.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Factors contributing to inappropriate ordering of tests in an academic medical department and the effect of an educational feedback strategy
Miyakis et al.
Postgrad. Med. J. 2006;82:823-829.
ABSTRACT | FULL TEXT  

Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care
Chaudhry et al.
ANN INTERN MED 2006;144:742-752.
ABSTRACT | FULL TEXT  

Return on Investment for a Computerized Physician Order Entry System
Kaushal et al.
J. Am. Med. Inform. Assoc. 2006;13:261-266.
ABSTRACT | FULL TEXT  

Test-Ordering Strategy in the Intensive Care Unit
Krinsley
J Intensive Care Med 2003;18:330-339.
ABSTRACT  

Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality
Bates et al.
J Am Med Inform Assoc 2003;10:523-530.
ABSTRACT | FULL TEXT  

Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality
Bates et al.
J. Am. Med. Inform. Assoc. 2003;10:523-530.
ABSTRACT | FULL TEXT  

Computer Physician Order Entry: Benefits, Costs, and Issues
Kuperman and Gibson
ANN INTERN MED 2003;139:31-39.
ABSTRACT | FULL TEXT  

Improving Response to Critical Laboratory Results with Automation: Results of a Randomized Controlled Trial
Kuperman et al.
J. Am. Med. Inform. Assoc. 1999;6:512-522.
ABSTRACT | FULL TEXT  

Contrasting Views of Physicians and Nurses about an Inpatient Computer-based Provider Order-entry System
Weiner et al.
J. Am. Med. Inform. Assoc. 1999;6:234-244.
ABSTRACT | FULL TEXT  

The Effect of Price Information on Test-ordering Behavior and Patient Outcomes in a Pediatric Emergency Department
Hampers et al.
Pediatrics 1999;103:877-882.
ABSTRACT | FULL TEXT  

Techniques to Improve Physicians' Use of Diagnostic Tests: A New Conceptual Framework
Solomon et al.
JAMA 1998;280:2020-2027.
ABSTRACT | FULL TEXT