PEDIATRICS Vol. 103 No. 4 April 1999, pp. 877-882
The Effect of Price Information on Test-ordering Behavior and Patient Outcomes in a Pediatric Emergency Department
Received Dec 31, 1998; accepted Jan 5, 1999.
From the Children's Memorial Hospital, Chicago, Illinois.
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).
Design. Prospective, nonblind, controlled trial of price information.
Setting. Urban, university-affiliated pediatric ED.
Methods. We prospectively assessed patients 2 months to 10 years of age with a presenting temperature 
38.5°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.
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.
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. Key words: price information, charges, test-ordering, outcomes.
This article has been cited by other articles:
 |
|
 |
|
  F. J. Dallo, S. C. Weller, and A. R. Cass Variations in Glucose Test Ordering Practices by Diabetes Risk Factors J Am Board Fam Med, May 1, 2008; 21(3): 249 - 250. [Full Text] [PDF]
|
|
|
|
 |
|
 S. Beholz and W. Konertz Improvement in cost-effectiveness and customer satisfaction by a quality management system according to EN ISO 9001:2000 Interactive CardioVascular and Thoracic Surgery, December 1, 2005; 4(6): 569 - 573. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. T. Rosenbloom, A. J. Geissbuhler, W. D. Dupont, D. A. Giuse, D. A. Talbert, W. M. Tierney, W. D. Plummer, W. W. Stead, and R. A. Miller Effect of CPOE User Interface Design on User-Initiated Access to Educational and Patient Information during Clinical Care J. Am. Med. Inform. Assoc., July 1, 2005; 12(4): 458 - 473. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. C. Powell and L. C. Hampers Physician Variation in Test Ordering in the Management of Gastroenteritis in Children Arch Pediatr Adolesc Med, October 1, 2003; 157(10): 978 - 983. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. E. McNulty, L. C. Hampers, and S. E. Krug Primary Care and Emergency Department Decision Making Arch Pediatr Adolesc Med, November 1, 2001; 155(11): 1266 - 1270. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Knowing Costs, Doctors Order Fewer Tests Journal Watch (General), April 30, 1999; 1999(430): 5 - 5. [Full Text]
|
|
