House Officer–Driven Reduction in Laboratory Utilization. Issue 1 (January 2016)

• Record Type: Journal Article
• Authors: Tawfik, Bernard; Collins, J.B.; Fino, Nora F.; Miller, David P.
• Is Part Of: Southern medical journal. Volume 109:Issue 1(2016)
• Publication Date: 2016-01
• Subjects: cost analysis -- decision making -- healthcare costs -- physician decision support -- laboratory utilization; Medicine -- Periodicals; 610.5
• DOI: 10.14423/SMJ.0000000000000390
• Languages: English
• ISSNs: 0038-4348

Abstract

Abstract : Objectives: To determine whether sharing laboratory charge and personal utilization information with physicians can reduce laboratory test orders and expenditures, thereby decreasing the overutilization of laboratory testing. Methods: This was a prospective study. By querying our electronic medical records, we calculated the median laboratory charges per patient/per day (PP/PD) and median laboratory tests ordered PP/PD for the resident general internal medicine and hospitalist services. For 10 weeks, we shared this team-based information with physicians with weekly updates. We calculated total laboratory charges for the 10 most common discharge diagnoses to capture laboratory charges for entire episodes of care. Results: During the intervention, the mean number of laboratory tests ordered PP/PD by resident service decreased from 5.56 to 5.17 (−0.389, P <0.001); the mean charge PP/PD decreased from $488 to $461 (−$27, P < 0.001). The hospitalist service decreased the number of laboratory tests ordered PP/PD from 3.54 to 3.36 (−0.18, P = 0.77) and the mean charge PP/PD decreased from $331 to $301 (−$30, P = 0.96). The statistically significant decline in laboratory charges persisted after controlling for the 10 most common discharge diagnoses. Compared with the 3-month period before the study began, physicians in the 10-week intervention period ordered 1464 fewer laboratory tests, resulting in a $188, 000 reduction in charges and a 3% to 4% reduction in utilization. Conclusions: Informing physicians of the charges for laboratory tests and their personal utilization patterns can reduce the number of laboratory tests ordered and laboratory expenditures, especially for physicians in training. Abstract : Medical costs are increasing rapidly to the point of unsustainability, and overutilization is one of the leading reasons for which physicians are primarily responsible. This study is a prospective cohort study, testing the ability of a cost-information–sharing intervention to reduce laboratory testing utilization and expenses that resulted in physicians ordering 1460 fewer laboratory tests and saving charges totaling $188, 000.