Bates D W, Kuperman G J, Jha A, Teich J M, Orav E J, Ma'luf N, Onderdonk A, Pugatch R, Wybenga D, Winkelman J, Brennan T A, Komaroff A L, Tanasijevic M J
Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Arch Intern Med. 1997 Nov 24;157(21):2501-8.
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.
To assess whether the computerized display of charges for clinical laboratory or radiological tests affected physician-ordering behavior.
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.
The number of clinical laboratory and radiological tests ordered per admission and the charges for these tests.
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.
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.
门诊辅助检查费用的计算机化显示已被发现会影响医生的医嘱行为，但该问题在住院患者中尚未得到研究。
评估临床实验室检查或放射检查费用的计算机化显示是否会影响医生的医嘱行为。
进行了两项按患者随机分组的前瞻性对照试验。每项试验纳入了1家大型教学医院在4个月和7个月期间的所有内科和外科住院患者：临床实验室检查组中有3536例干预患者和3554例对照患者，放射检查组中有8728例干预患者和8653例对照患者。干预措施包括在开医嘱时计算机化显示检查费用。
每次住院所开临床实验室检查和放射检查的数量以及这些检查的费用。
对于临床实验室检查，在为期4个月的研究期间，干预组患者的检查数量减少了4.5%，这些检查的总费用降低了4.2%，尽管两者差异均无统计学意义。与一年前同一4个月期间的历史对照相比，每次住院的检查费用下降了13.3%，但这种下降与未来检查医嘱的限制在时间上相关，而与费用显示的引入无关。对于放射检查，在7个月期间，干预组的检查数量和这些检查的费用几乎相同。
费用的计算机化显示对所开或所做的临床实验室检查数量或放射检查程序没有统计学上的显著影响，尽管临床实验室检查存在微小趋势。可能需要更深入的干预措施来影响医生对检查的使用。
