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The effect of price information on test-ordering behavior and patient outcomes in a pediatric emergency department.
- Source :
-
Pediatrics [Pediatrics] 1999 Apr; Vol. 103 (4 Pt 2), pp. 877-82. - Publication Year :
- 1999
-
Abstract
- Objective: We sought to determine whether information on hospital charges (prices) would affect test-ordering and quality of patient care in a pediatric emergency department (ED).<br />Design: Prospective, nonblind, controlled trial of price information.<br />Setting: Urban, university-affiliated pediatric ED.<br />Methods: We prospectively assessed patients 2 months to 10 years of age with a presenting temperature >/=38.5 degrees C or complaint of vomiting, diarrhea, or decreased oral intake. The assessments were done during three periods: September 1997 through December 1997 (control), January 1998 through March 1998 (intervention), and April 1998 (washout). In the control and washout periods, physicians noted tests ordered on a list attached to each chart. In the intervention period, physicians noted tests ordered on a similar list that included standard hospital charges for each test. Records of each visit were reviewed to determine clinical and demographic information as well as patient disposition. In the control and intervention periods, families of nonadmitted patients were interviewed by telephone 7 days after the visit.<br />Results: When controlled for triage level, vital signs, and admission rates, in a multivariate model, charges for tests in the intervention period were 27% less than charges in the control period. The greatest decrease was seen among low-acuity, nonadmitted patients (43%). In telephone follow-up, patients in the intervention period were slightly more likely to have made an unscheduled follow-up visit to a health care provider (24.4% vs 17.8%), but did not differ on improved condition (86.7% vs 83.4%) or family satisfaction (93.8% vs 93.0%). Adjusted charges in the washout period were 15% lower than in the control period and 15% higher than in the intervention period.<br />Conclusion: Providing price information was associated with a significant reduction in charges for tests ordered on pediatric ED patients with acute illness not requiring admission. This decrease was associated with a slightly higher rate of unscheduled follow-up, but no difference in subjective outcomes or family satisfaction.
- Subjects :
- Adolescent
Adult
Analysis of Variance
Chicago
Child
Child, Preschool
Clinical Laboratory Techniques economics
Emergency Service, Hospital standards
Follow-Up Studies
Humans
Illinois
Infant
Multivariate Analysis
Pediatrics economics
Practice Patterns, Physicians' statistics & numerical data
Prospective Studies
Quality of Health Care economics
Triage
Unnecessary Procedures statistics & numerical data
Clinical Laboratory Techniques statistics & numerical data
Emergency Service, Hospital economics
Hospital Charges statistics & numerical data
Information Services supply & distribution
Practice Patterns, Physicians' economics
Treatment Outcome
Subjects
Details
- Language :
- English
- ISSN :
- 0031-4005
- Volume :
- 103
- Issue :
- 4 Pt 2
- Database :
- MEDLINE
- Journal :
- Pediatrics
- Publication Type :
- Academic Journal
- Accession number :
- 10103325