University of California, San Diego, Department of Emergency Medicine and Department of Anesthesiology, Division of Critical Care, San Diego, California.
The University of Oklahoma, Tulsa, Department of Emergency Medicine, Tulsa, Oklahoma.
West J Emerg Med. 2017 Jan;18(1):159-162. doi: 10.5811/westjem.2016.10.31234. Epub 2016 Nov 15.
Diagnostic testing represents a significant portion of healthcare spending, and cost should be considered when ordering such tests. Needless and excessive spending may occur without an appreciation of the impact on the larger healthcare system. Knowledge regarding the cost of diagnostic testing among emergency medicine (EM) residents has not previously been studied.
A survey was administered to 20 EM residents from a single ACGME-accredited three-year EM residency program, asking for an estimation of patient charges for 20 commonly ordered laboratory tests and seven radiological exams. We compared responses between residency classes to evaluate whether there was a difference based on level of training.
The survey completion rate was 100% (20/20 residents). We noted significant discrepancies between the median resident estimates and actual charge to patient for both laboratory and radiological exams. Nearly all responses were an underestimate of the actual cost. The group median underestimation for laboratory testing was $114, for radiographs $57, and for computed tomography exams was $1,058. There was improvement in accuracy with increasing level of training.
This pilot study demonstrates that EM residents have a poor understanding of the charges burdening patients and health insurance providers. In order to make balanced decisions with regard to diagnostic testing, providers must appreciate these factors. Education regarding the cost of providing emergency care is a potential area for improvement of EM residency curricula, and warrants further attention and investigation.
诊断测试在医疗保健支出中占很大比例，在订购此类测试时应考虑成本。如果不了解其对更大的医疗保健系统的影响，可能会出现不必要和过度的支出。之前尚未研究过急诊医学（EM）住院医师对诊断测试成本的了解。
我们向来自一个经过 ACGME 认证的为期三年的急诊住院医师培训计划的 20 名急诊住院医师进行了一项调查，要求他们估算 20 种常见的实验室检查和 7 种影像学检查的患者费用。我们比较了不同住院医师培训阶段的答复，以评估培训水平是否存在差异。
调查的完成率为 100%（20/20 名住院医师）。我们注意到实验室和影像学检查的住院医师中位数估计值与患者实际收费之间存在显著差异。几乎所有的回答都低估了实际成本。实验室检查的小组中位数低估值为 114 美元，射线照相术为 57 美元，计算机断层扫描检查为 1058 美元。随着培训水平的提高，准确性有所提高。
这项试点研究表明，急诊住院医师对患者和医疗保险提供者的费用负担了解甚少。为了在诊断测试方面做出平衡的决策，提供者必须了解这些因素。关于提供紧急护理费用的教育是急诊住院医师培训课程改进的潜在领域，值得进一步关注和研究。
