We studied the effect of informing physicians of the charges for outpatient diagnostic tests on their ordering of such tests in an academic primary care medical practice. All tests were ordered at microcomputer workstations by 121 physicians. For half (the intervention group), the charge for the test being ordered and the total charge for tests for that patient on that day were displayed on the computer screen. The remaining physicians (control group) also used the computers but received no message about charges. The primary outcomes measured were the number of tests ordered and the charges for tests per patient visit. In the 14 weeks before the study, the number of tests ordered and the average charge for tests per patient visit were similar for the intervention and control groups. During the 26-week intervention period, the physicians in the intervention group ordered 14 percent fewer tests per patient visit than did those in the control group (P less than 0.005), and the charges for tests were 13 percent ($6.68 per visit) lower (P less than 0.05). The differences were greater for scheduled visits (17 percent fewer tests and 15 percent lower charges for the intervention group; P less than 0.01) than for unscheduled (urgent) visits (11 percent fewer tests and 10 percent lower charges; P greater than 0.3). During the 19 weeks after the intervention ended, the number of tests ordered by the physicians in the intervention group was only 7.7 percent lower than the number ordered by the physicians in the control group, and the charges for tests were only 3.5 percent lower (P greater than 0.3). Three measures of possible adverse outcomes--number of hospitalizations, emergency room visits, and outpatient visits during the study period and the following six months--were similar for the patients seen by the physicians in both groups. We conclude that displaying the charges for diagnostic tests significantly reduced the number and cost of tests ordered, especially for patients with scheduled visits. The effects of this intervention did not persist after it was discontinued.
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Department of Medicine, Indiana University School of Medicine, Indianapolis.
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[Abstract][Full Text]
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(1997). Recommendations for Responsible Monitoring and Regulation of Clinical Software Systems. J Am Med Inform Assoc
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[Abstract][Full Text]
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[Abstract][Full Text]
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[Abstract][Full Text]
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[Abstract][Full Text]
Elson, R. B., Faughnan, J. G., Connelly, D. P.
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[Abstract][Full Text]
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[Abstract][Full Text]
Auleley, G.-R., Ravaud, P., Giraudeau, B., Kerboull, L., Nizard, R., Massin, P., de Loubresse, C. G., Vallee, C., Durieux, P.
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277: 1935-1939
[Abstract]
Balas, E. A., Austin, S. M., Mitchell, J. A., Ewigman, B. G., Bopp, K. D., Brown, G. D.
(1996). The Clinical Value of Computerized Information Services: A Review of 98 Randomized Clinical Trials. Arch Fam Med
5: 271-278
[Abstract]
Jones, D. L., Kroenke, K., Landry, F. J., Tomich, D. J., Ferrel, R. J.
(1996). Cost Savings Using a Stepped-Care Prescribing Protocol for Nonsteroidal Anti-inflammatory Drugs. JAMA
275: 926-930
[Abstract]
Winkens, R. A G, Pop, P., Grol, R. P T M, Bugter-Maessen, A. M A, Kester, A. D M, Beusmans, G. H M I, Knottnerus, J A.
(1996). Effects of routine individual feedback over nine years on general practitioners' requests for tests. BMJ
312: 490-490
[Full Text]
Davis, D. A., Thomson, M. A., Oxman, A. D., Haynes, R. B.
(1995). Changing Physician Performance: A Systematic Review of the Effect of Continuing Medical Education Strategies. JAMA
274: 700-705
[Abstract]
Elson, R. B., Connelly, D. P.
(1995). Computerized Patient Records in Primary Care: Their Role in Mediating Guideline-Driven Physician Behavior Change. Arch Fam Med
4: 698-705
[Abstract]
Yano, E. M., Fink, A., Hirsch, S. H., Robbins, A. S., Rubenstein, L. V.
(1995). Helping Practices Reach Primary Care Goals: Lessons From the Literature. Arch Intern Med
155: 1146-1156
[Abstract]
Chilingerian, J. A., Glavin, M. P. V.
(1994). Temporary Firms in Community Hospitals: Elements of a Managerial Theory of Clinical Efficiency. Med Care Res Rev
51: 289-335
Davis, D. A., Thomson, M. A., Oxman, A. D., Haynes, R. B.
(1992). Evidence for the Effectiveness of CME: A Review of 50 Randomized Controlled Trials. JAMA
268: 1111-1117
[Abstract]
Plasencia, C. M., Alderman, B. W., Baron, A. E., Rolfs, R. T., Boyko, E. J.
(1992). A Method to Describe Physician Decision Thresholds and Its Application in Examining the Diagnosis of Coronary Artery Disease Based on Exercise Treadmill Testing. Med Decis Making
12: 204-212
[Abstract]
Schectman, J. M., Elinsky, E. G., Pawlson, L. G.
(1991). Effect of Education and Feedback on Thyroid Function Testing Strategies of Primary Care Clinicians. Arch Intern Med
151: 2163-2166
[Abstract]
Rosenstein, A. H.
(1991). Utilization Review: Health Economics and Cost-Effective Resource Management. American Journal of Medical Quality
6: 85-90
[Abstract]
Woodside, J. R., Bodne, R., Tonnesen, A. S., Frazier, J.
(1991). Intensive, Focused Utilization Management in a Teaching Hospital An Exploratory Study. American Journal of Medical Quality
6: 47-50
[Abstract]
Osheroff, J. A., Forsythe, D. E., Buchanan, B. G., Bankowitz, R. A., Blumenfeld, B. H., Miller, R. A.
(1991). Physicians' Information Needs: Analysis of Questions Posed during Clinical Teaching. ANN INTERN MED
114: 576-581
[Abstract]
WOOLF, S. H., KAMEROW, D. B.
(1990). Testing for Uncommon Conditions: The Heroic Search for Positive Test Results. Arch Intern Med
150: 2451-2458
[Abstract]
(1990). HOUSE OFFICERS ORDER FEWER TESTS WHEN REMINDED ABOUT COSTS. JWatch General
1990: 5-5
[Full Text]
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