Does the Computerized Display of Charges Affect Inpatient Ancillary Test Utilization?

Abstract

The computerized display of charges had no statistically significant effect on the number of clinical laboratory tests or radiological procedures ordered or performed, although small trends were present for clinical laboratory tests. More intensive interventions may be needed to affect physician test utilization.

The Effect of Charge Display on Cost of Care and Physician Practice Behaviors: A Systematic Review

“…[23][24][25][26][27] Of the seventeen studies, seven were randomized controlled trials, 11,12,14,19,23,24,26 eight were pre-intervention vs. postintervention studies, 15,16,18,[20][21][22]25,27 and two had a concurrent control and intervention groups, but were not randomized. 13,17 Eleven studies examined physician ordering of laboratory or radiology testing, [11][12][13][14][15][16][17][18][19]23,24 while six looked at medication choice. [20][21][22][25][26][27] The details of the study design, study size, bias considerations, and follow-up period for the included studies are summarized in Table 2.…”

“…There were a total of nine papers in this category: four randomized controlled trials, 11,12,14,19 two non-randomized controlled trial, 13,17 and three pre-intervention vs. post-intervention studies 15,16,18 that looked at test ordering. Four interventions were conducted in inpatient wards [11][12][13][14] two were conducted in emergency department, 15,17 two were in intensive care units, 16,18 and one was in an internal medicine outpatient clinic. 19 Six were conducted in the United States 11,12,[14][15][16]19 ; studies were also conducted in South Africa, 13 Sweden, 17 and France.…”

“…Four interventions were conducted in inpatient wards [11][12][13][14] two were conducted in emergency department, 15,17 two were in intensive care units, 16,18 and one was in an internal medicine outpatient clinic. 19 Six were conducted in the United States 11,12,[14][15][16]19 ; studies were also conducted in South Africa, 13 Sweden, 17 and France. 18 Two studies came from the pediatric literature.…”

“…18 Two studies came from the pediatric literature. 15,16 The clinical interventions themselves included four electronic medical record (EMR) 11,12,14,19 and five paper-based interventions. 13,[15][16][17][18] The EMR interventions very similar: the window for a patient's orders included the charge amounts.…”

“…12,14,19 Bates et al had a Bcash register^component that totaled the charges. 11 Among the paper-based methods, Hampers et al and Seguin et al placed charges next to the items ordered on paper order forms in a pediatric ED 15 and in a French intensive care unit, 18 respectively. Sachedeva et al placed itemized charges from the prior day's test charges every morning where orders were subsequently placed.…”