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Effect of Cost Education, Cost Audits, and Faculty Chart Review on the Use of Laboratory Services

Effect of Cost Education, Cost Audits, and Faculty Chart Review on the Use of Laboratory Services Abstract • A randomized controlled trial of several strategies designed to reduce the use of laboratory tests by house staff was performed in two parts. Part 1 compared cost education, cost audits, and both methods combined, all after a baseline observation period. Significant reductions were achieved only in the combination group for the categories of total tests (9.4%) and Sequential Multiple Analysis (SMA)-12 (10.8%), but not for charges, SMA-6, or complete blood cell counts (CBCs). Part 2 compared a group subjected to faculty chart review with a control group. Significant reductions in total charges (9.8%), total tests (15.1%), SMA-12s (20.6%), SMA-6s (12.5%), and CBCs (18.5%) were observed in the intervention group, as compared with the control group. Among the methods examined, faculty chart review seems to be the most effective method of reducing the amount of laboratory testing performed by house staff. (Arch Intern Med 1983;143:942-944) References 1. Conn RB: Clinical laboratories: Profit center, production industry or patient-care resource. N Engl J Med 1978;298:422-427.Crossref 2. Fineberg HV: Clinical Chemistries: The High Cost of Low-Cost Diagnostic Tests . US Dept of Health, Education, and Welfare publication 79-3216. 1979, pp 144-165. 3. Phillip PJ, Hai A: Growth in laboratory tests indicative of increase in service intensity. Hospitals 1979;53:46-47. 4. Grams RR, Lezotte D: Unlimited volumes of laboratory data. J Med Syst 1978;2:343-353.Crossref 5. Griner PF, Liptzin B: Use of the laboratory in a teaching hospital: Implications for patient care, education, and hospital costs. Ann Intern Med 1971;75:157-163.Crossref 6. Dixon RH, Laszlo J: Utilization of clinical chemistry services by medical housestaff. Arch Intern Med 1974;13:1064-1067.Crossref 7. Garg ML, Gliebe WA, Elkhatib MB: Diagnostic testing as a cost factor in teaching hospitals. Hospitals 1978;52:97-100. 8. Freeborn DK, Baer D, Greenlick MR, et al: Determinants of medical care utilization: Physicians' use of laboratory services. Am J Public Health 1972;62:846-853.Crossref 9. Chiids AW, Hunter ED: Non-medical factors influencing use of diagnostic x-rays by physicians. Med Care 1972;5:323-335.Crossref 10. Pineault R: The effect of medical training factors on physician utilization behavior. Med Care 1977;15:51-67.Crossref 11. Schroeder SA, Renders K, Cooper JK, et al: Use of laboratory tests and pharmaceuticals: Variation among physicians and effect of cost audit on subsequent use. JAMA 1973;225:969-973.Crossref 12. Hardwick FJ, Vertinsky P, Barth RT, et al: Clinical styles and motivation: Study of laboratory test use. Med Care 1979;13:397-408.Crossref 13. Daniels M, Schroeder SA: Variation among physicians' use of laboratory tests: II. Relation to clinical productivity and outcomes of care. Med Care 1977;15:428-487.Crossref 14. Schroeder SA, Schliftman BA, Piemme TE: Variation among physicians in use of laboratory tests: Relation to quality-of-care. Med Care 1974;12:709-713.Crossref 15. Eisenberg JM, Williams SV, Garner L, et al: Computer-based audit to detect and correct overutilization of laboratory tests. Med Care 1977;15: 915-921.Crossref 16. Griner PF: Use of laboratory tests in a teaching hospital: Long-term trends: Reduction in use and relative cost. Ann Intern Med 1979;90:243-248.Crossref 17. Cohen DI, Jones P, Littenberg B, et al: Does cost information availability reduce physician test usage? A randomized clinical trial with unexpected findings. Med Care 1982;20:286-293.Crossref 18. Cummings KM, Frisof KB, Long MJ, et al: The effects of price information on physicians' test-ordering behavior: Ordering of diagnostic tests. Med Care 1982;20:293-301.Crossref 19. Hoey J, Eisenberg JM, Spitzer WO, et al: Physician sensitivity to the price of diagnostic tests: A US-Canadian analysis. Med Care 1982;20: 302-307.Crossref 20. Martin AR, Wolf MA, Thibodeau LA, et al: A trial of two strategies to modify the test-ordering behavior of medical residents. N Engl J Med 1980;303:1330-1336.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Effect of Cost Education, Cost Audits, and Faculty Chart Review on the Use of Laboratory Services

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1983.00350050100019
Publisher site
See Article on Publisher Site

Abstract

Abstract • A randomized controlled trial of several strategies designed to reduce the use of laboratory tests by house staff was performed in two parts. Part 1 compared cost education, cost audits, and both methods combined, all after a baseline observation period. Significant reductions were achieved only in the combination group for the categories of total tests (9.4%) and Sequential Multiple Analysis (SMA)-12 (10.8%), but not for charges, SMA-6, or complete blood cell counts (CBCs). Part 2 compared a group subjected to faculty chart review with a control group. Significant reductions in total charges (9.8%), total tests (15.1%), SMA-12s (20.6%), SMA-6s (12.5%), and CBCs (18.5%) were observed in the intervention group, as compared with the control group. Among the methods examined, faculty chart review seems to be the most effective method of reducing the amount of laboratory testing performed by house staff. (Arch Intern Med 1983;143:942-944) References 1. Conn RB: Clinical laboratories: Profit center, production industry or patient-care resource. N Engl J Med 1978;298:422-427.Crossref 2. Fineberg HV: Clinical Chemistries: The High Cost of Low-Cost Diagnostic Tests . US Dept of Health, Education, and Welfare publication 79-3216. 1979, pp 144-165. 3. Phillip PJ, Hai A: Growth in laboratory tests indicative of increase in service intensity. Hospitals 1979;53:46-47. 4. Grams RR, Lezotte D: Unlimited volumes of laboratory data. J Med Syst 1978;2:343-353.Crossref 5. Griner PF, Liptzin B: Use of the laboratory in a teaching hospital: Implications for patient care, education, and hospital costs. Ann Intern Med 1971;75:157-163.Crossref 6. Dixon RH, Laszlo J: Utilization of clinical chemistry services by medical housestaff. Arch Intern Med 1974;13:1064-1067.Crossref 7. Garg ML, Gliebe WA, Elkhatib MB: Diagnostic testing as a cost factor in teaching hospitals. Hospitals 1978;52:97-100. 8. Freeborn DK, Baer D, Greenlick MR, et al: Determinants of medical care utilization: Physicians' use of laboratory services. Am J Public Health 1972;62:846-853.Crossref 9. Chiids AW, Hunter ED: Non-medical factors influencing use of diagnostic x-rays by physicians. Med Care 1972;5:323-335.Crossref 10. Pineault R: The effect of medical training factors on physician utilization behavior. Med Care 1977;15:51-67.Crossref 11. Schroeder SA, Renders K, Cooper JK, et al: Use of laboratory tests and pharmaceuticals: Variation among physicians and effect of cost audit on subsequent use. JAMA 1973;225:969-973.Crossref 12. Hardwick FJ, Vertinsky P, Barth RT, et al: Clinical styles and motivation: Study of laboratory test use. Med Care 1979;13:397-408.Crossref 13. Daniels M, Schroeder SA: Variation among physicians' use of laboratory tests: II. Relation to clinical productivity and outcomes of care. Med Care 1977;15:428-487.Crossref 14. Schroeder SA, Schliftman BA, Piemme TE: Variation among physicians in use of laboratory tests: Relation to quality-of-care. Med Care 1974;12:709-713.Crossref 15. Eisenberg JM, Williams SV, Garner L, et al: Computer-based audit to detect and correct overutilization of laboratory tests. Med Care 1977;15: 915-921.Crossref 16. Griner PF: Use of laboratory tests in a teaching hospital: Long-term trends: Reduction in use and relative cost. Ann Intern Med 1979;90:243-248.Crossref 17. Cohen DI, Jones P, Littenberg B, et al: Does cost information availability reduce physician test usage? A randomized clinical trial with unexpected findings. Med Care 1982;20:286-293.Crossref 18. Cummings KM, Frisof KB, Long MJ, et al: The effects of price information on physicians' test-ordering behavior: Ordering of diagnostic tests. Med Care 1982;20:293-301.Crossref 19. Hoey J, Eisenberg JM, Spitzer WO, et al: Physician sensitivity to the price of diagnostic tests: A US-Canadian analysis. Med Care 1982;20: 302-307.Crossref 20. Martin AR, Wolf MA, Thibodeau LA, et al: A trial of two strategies to modify the test-ordering behavior of medical residents. N Engl J Med 1980;303:1330-1336.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 1, 1983

References