After reading the article, participants should be able to discuss the influence of financial incentives, accompanied with information regarding risk and benefit, on patient preferences for diagnostic testing. Activity Disclosures This activity received no commercial support. CME Editor Corey Heitz discloses no relevant financial relationships. This activity underwent peer review in line with standards of editorial integrity and publication ethics. Conflicts of interest have been identified and resolved in accordance with John Wiley and Sons, Inc.'s Policy on Activity Disclosure and Conflict of Interest. Accreditation John Wiley and Sons, Inc. is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. John Wiley and Sons, Inc. designates this journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit TM. Physicians should only claim credit commensurate with the extent of their participation in the activity. For information on applicability and acceptance of continuing medical education credit for this activity, please consult your professional licensing board. This activity is designed to be completed within 1 hour. To successfully earn credit, participants must complete the activity during the valid credit period, which is up to two years from initial publication. Additionally, up to 3 attempts and a score of 70% or better is needed to pass the post test.
BackgroundExcessive diagnostic testing and defensive medicine contribute to billions of dollars in avoidable costs in the US annually. Our objective was to determine the influence of financial incentives, accompanied with information regarding test risk and benefit, on patient preference for diagnostic testing.MethodsWe conducted a cross-sectional survey of patients at the University of Michigan Emergency Department (ED). Each participant was presented with a hypothetical scenario involving an ED visit following minor traumatic brain injury. Participants were given information regarding potential benefit (detecting brain hemorrhage) and risk (developing cancer) of head CT scan, as well as an incentive of 0 or 100 USD to forego testing. We used 0.1% and 1% for test benefit and risk, and values for risk, benefit, and financial incentive varied across participants. Our primary outcome was patient preference to undergo testing. We also collected demographic and numeracy information. Then, we used logistic regression to estimate odds ratios, which were adjusted for multiple potential confounders. Our sample size was designed to find at least 300 events (preference for testing) to allow for inclusion of up to 30 covariates in fully adjusted modules. We had 99% power to detect a 10% absolute difference in testing rate across groups, assuming a 95% significance level.ResultsWe surveyed 913 patients. Increasing test benefit from 0.1% to 1% significantly increased test acceptance (adjusted Odds Ratio [AOR] 1.6; 95% Confidence Interval [CI] 1.2-2.1) and increasing test risk from 0.1% to 1% significantly decreased test acceptance (OR 0.70; 95% CI 0.52-0.93). Finally, a 100 USD incentive to forego low-value testing significantly reduced test acceptance (OR 0.6; 95% CI 0.4-0.8).ConclusionsProviding financial incentives to forego testing significantly decreased patient preference for testing, even when accounting for varying test benefit and risk. This work is preliminary, hypothetical, and requires confirmation in larger patient cohorts facing these actual decisions.
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