An Educational Intervention to Improve Cost-Effective Care Among Medicine Housestaff

Sommers, Benjamin D.; Desai, Nihar R.; Fiskio, Julie M.; Licurse, Adam; Thorndike, Mary; Katz, Joel T.; Bates, David W.

doi:10.1097/acm.0b013e31825373b3

Cited by 36 publications

(31 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This has led to the development of multiple educational curricula 10 25 26. Several prior studies have demonstrated the immediate impact of didactic or audit-and-feedback interventions on physicians’ cost knowledge or ordering behaviour.…”

Section: Discussionmentioning

confidence: 99%

Impact of laboratory cost display on resident attitudes and knowledge about costs

Long

Bongiovanni

Dashevsky

et al. 2016

Postgraduate Medical Journal

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of laboratory cost display on resident attitudes and knowledge about costs

Long

Bongiovanni

Dashevsky

et al. 2016

Postgraduate Medical Journal

View full text Add to dashboard Cite

show abstract

“…Retrospective review of cost information, however, may not be effective at achieving real cost savings. 19 In addition, that methodology does not guide residents toward the practice of evidence-based medicine.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Process Change and Educational Intervention to Reduce the Use of Unnecessary Preoperative Tests

Richards¹,

Shiffermiller²,

Wells³

et al. 2014

Journal of Graduate Medical Education

View full text Add to dashboard Cite

Background Internal medicine residents receive limited training on how to be good stewards of health care dollars while preserving high-quality care. Intervention We implemented a clinical process change and an educational intervention focused on the appropriate use of preoperative diagnostic testing by residents at a Veterans Administration (VA) medical center. Methods The clinical process change consisted of reducing routine ordering of preoperative tests in the absence of specific indications. Residents received a short didactic session, which included algorithms for determining the appropriate use of perioperative diagnostic testing. One outcome was the average cost savings on preoperative testing for a continuous cohort of patients referred for elective knee or hip surgery. Resident knowledge and confidence prior to and after the intervention was measured by pre- and posttest. Results The mean cost of preoperative testing decreased from $74 to $28 per patient after the dual intervention (P < .001). The bulk of cost savings came from elimination of unnecessary blood and urine tests, as well as reduced numbers of electrocardiograms and chest radiographs. Among residents who completed the pretest and posttest, the mean score on the pretest was 54%, compared with 80% on the posttest (P = .027). Following the educational intervention, 70% of residents stated they felt “very comfortable” ordering appropriate preoperative testing (P = .006). Conclusions This initiative required few resources, and it simultaneously improved the educational experience for residents and reduced costs. Other institutions may be able to adopt or adapt this intervention to reduce unnecessary diagnostic expenditures.

show abstract

“…Despite the fact that this was a small, single-institution sample of medical students near the beginning of their clinical training, students were able to identify many common practices, echoed by residents [ 2 ] and attendings [ 3 ], that were not consistent with the practice of high-value care. However, the possibility for availability bias is pronounced, as the themes outlined by students closely mirrored those taught in the required online module.…”

mentioning

confidence: 94%

Capsule Commentary on Tartaglia et al., Medical Student Perceptions of Cost-Conscious Care in an Internal Medicine Clerkship: A Thematic Analysis

Sateia¹

2015

J GEN INTERN MED

View full text Add to dashboard Cite

T his analysis by Tartaglia et al.[ 1 ] qualitatively examined medical student reflections on cost-conscious care as part of an integrated high-value care curriculum during the thirdyear internal medicine clerkship at the Ohio State University College of Medicine. The curriculum consisted of an online high-value care educational module and a reflective exercise in which students were asked to describe a case from their clerkship that lacked Battention to high-value care,^identify a solution, and discuss potential barriers to the success of the solution. Following student completion of the exercise at a 72 % participation rate, responses were coded and analyzed for themes. The most commonly identified contributors to low-value care included unnecessary or duplicative tests and treatments. Proposed solutions focused on processes such as discussion with the team and on interventions such as more appropriate lab testing. Barriers included time/effort, ingrained practices, and defensive medicine. The majority of respondents reported that an attending physician addressed cost versus benefit with the team.Despite the fact that this was a small, single-institution sample of medical students near the beginning of their clinical training, students were able to identify many common practices, echoed by residents [ 2 ] and attendings [ 3 ], that were not consistent with the practice of high-value care. However, the possibility for availability bias is pronounced, as the themes outlined by students closely mirrored those taught in the required online module. What is most notable is that this is the first assessment of medical student perceptions of costconscious care in the literature. At the very least, this study lends support to the inclusion of medical students in the growing effort to educate learners at all levels on the importance of high-value care. Studies that examine retention or degradation of the knowledge, as well as whether high-value care curricula for medical students can influence behavior of both the students and the teams with which they rotate, would advance this field of inquiry.

show abstract

An Educational Intervention to Improve Cost-Effective Care Among Medicine Housestaff

Abstract: A brief intervention featuring a discussion of hospital bills can fill a gap in resident education and reduce laboratory costs for a subset of patients, but may increase readmission risk.

Cited by 36 publications

References 18 publications

Impact of laboratory cost display on resident attitudes and knowledge about costs

Impact of laboratory cost display on resident attitudes and knowledge about costs

A Clinical Process Change and Educational Intervention to Reduce the Use of Unnecessary Preoperative Tests

Capsule Commentary on Tartaglia et al., Medical Student Perceptions of Cost-Conscious Care in an Internal Medicine Clerkship: A Thematic Analysis

Contact Info

Product

Resources

About