Horn Daniel M, Koplan Kate E, Senese Margaret D, Orav E John, Sequist Thomas D
Division of General Medicine, Massachusetts General Hospital, Boston, MA, USA.
J Gen Intern Med. 2014 May;29(5):708-14. doi: 10.1007/s11606-013-2672-1. Epub 2013 Nov 21.
Physicians are under increased pressure to help control rising health care costs, though they lack information regarding cost implications of patient care decisions.
To evaluate the impact of real-time display of laboratory costs on primary care physician ordering of common laboratory tests in the outpatient setting.
Interrupted time series analysis with a parallel control group.
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.
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).
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.
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.
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.
尽管医生缺乏有关患者护理决策成本影响的信息，但他们在帮助控制不断上涨的医疗保健成本方面面临着越来越大的压力。
评估实验室成本实时显示对门诊环境中初级保健医生开具常见实验室检查医嘱的影响。
采用平行对照组的中断时间序列分析。
2010年4月至2011年11月期间，215名使用通用电子健康记录的初级保健医生（153名干预组和62名对照组）。研究地点为马萨诸塞州的一个由五个多专科集团诊所组成的联盟。
在开具医嘱时，电子健康记录中显示27项实验室检查的平均医疗保险报销率，其中包括21项低成本检查（<40.00美元）和6项高成本检查（>40.00美元）。
我们比较了干预前12个月和干预后6个月干预组和对照组医生每月实验室检查医嘱开具率的斜率变化。在干预后6个月，我们对所有干预组和对照组医生进行了调查，以评估他们对成本和成本显示的态度。
在27项实验室检查中，干预组医生开具的5项（19%）检查医嘱率与对照组医生相比显著下降。这包括21项（19%）低成本实验室检查中的4项和6项（17%）高成本实验室检查中的1项的医嘱率显著相对下降。大多数（81%）医生报告说，该干预措施提高了他们对实验室检查相对成本的了解。
电子健康记录中成本信息的实时显示可导致实验室检查医嘱开具量适度减少，且受到好评。我们的研究表明，电子健康记录可作为促进成本透明度和减少实验室检查使用的工具。
