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Does the Computerized Display of Charges Affect Inpatient Ancillary Test Utilization?
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.
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