Medical Training And Expensive Care

Moriates, Christopher; Shah, Neel; Arora, Vineet M.

doi:10.1377/hlthaff.2012.1328

Cited by 7 publications

(5 citation statements)

References 1 publication

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“…1 At the University of California, San Francisco (UCSF), Dr Chris Moriates, a leader in valuedriven care, is championing this new movement through an innovative effort that seeks to change culture and the approach to practice. 2 The experience of global health practitioners and those who have worked in resourcelimited settings has a great deal to add to this conversation.…”

Section: Uring Rounds With Liberian Nurses and A Visitingmentioning

confidence: 99%

Global Health Telemedicine Conferences: The System We Save May Be Our Own

Shamasunder¹,

Wu²

2014

Journal of Graduate Medical Education

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Section: Uring Rounds With Liberian Nurses and A Visitingmentioning

confidence: 99%

Global Health Telemedicine Conferences: The System We Save May Be Our Own

Shamasunder¹,

Wu²

2014

Journal of Graduate Medical Education

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“…19,20 Increased laboratory test ordering among resident physicians has been linked to decreased knowledge regarding laboratory test appropriateness, test costs, and other harms of testing. [19][20][21][22] Trainees have also connected the ordering of laboratory tests to their own insecurities and fear of criticism from supervisors for not ordering laboratory tests. 23 A lack of prioritization of teaching on appropriate use of testing and resource stewardship has previously been identified by trainees.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the efforts of Choosing Wisely, in academic hospital medicine there is a culture that values overtesting, with a hidden curriculum that increased ordering of investigations demonstrates medical knowledge and thoroughness 19,20 . Increased laboratory test ordering among resident physicians has been linked to decreased knowledge regarding laboratory test appropriateness, test costs, and other harms of testing 19–22 . Trainees have also connected the ordering of laboratory tests to their own insecurities and fear of criticism from supervisors for not ordering laboratory tests 23 .…”

Section: Introductionmentioning

confidence: 99%

Coagulation test understanding and ordering by medical trainees: Novel teaching approach

Gabarin

Trinkaus

Selby

et al. 2022

Research and Practice in Thrombosis and Haemostasis

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“…It is often assumed that trainees at academic medical centers routinely order more laboratory tests for inpatients compared with more experienced physicians. Resident physicians may order more laboratory testing for many different reasons, including lack of nuanced knowledge about when a laboratory test may or may not be indicated, supervisors who are more likely to criticize missing morning laboratory test results rather than extra tests, and a lack of oversight and cost transparency . A significant proportion of inpatient laboratory tests are unnecessary, potentially harmful, and contribute to rising health care costs across the United States …”

Section: Introductionmentioning

confidence: 99%

“…Resident physicians may order more laboratory testing for many different reasons, including lack of nuanced knowledge about when a laboratory test may or may not be indicated, supervisors who are more likely to criticize missing morning laboratory test results rather than extra tests, and a lack of oversight and cost transparency. [1][2][3][4] A significant proportion of inpatient laboratory tests are unnecessary, 5 potentially harmful, 6 and contribute to rising health care costs across the United States. 7 Prior studies at single academic medical centers have shown that teaching services ordered more laboratory testing 8 and had higher mean laboratory costs 9 compared with nonteaching services.…”

mentioning

confidence: 99%

A Comparison of Laboratory Testing in Teaching vs Nonteaching Hospitals for 2 Common Medical Conditions

et al. 2018

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IMPORTANCE Robust laboratory use data are lacking to support the general assumption that teaching hospitals with trainees routinely order more laboratory tests for inpatients than do nonteaching hospitals.OBJECTIVE To quantify differences in the use of laboratory tests between teaching and nonteaching hospitals. DESIGN, SETTING, AND PARTICIPANTSA cross-sectional study was performed using a statewide database to identify hospitalizations with a primary diagnosis of bacterial pneumonia or cellulitis from January 1, 2014, to June 30, 2015, at teaching and nonteaching hospitals with 100 or more hospitalizations of each condition. Patients included were adult inpatients with a primary diagnosis of bacterial pneumonia (n = 24 118) or cellulitis (n = 19 211); patients excluded were those with an intensive care unit stay, transfer from another hospital, or a length of stay that was 2 SDs or more of the condition's mean length of stay. MAIN OUTCOMES AND MEASURESMean laboratory tests per day stratified by illness severity, as well as factors associated with laboratory use rates.RESULTS A total of 43 329 hospitalized patients (20493 women and 22836 men) had a principal diagnosis of bacterial pneumonia or cellulitis across 11 major teaching hospitals, 12 minor teaching hospitals, and 73 nonteaching hospitals in Texas. Mean number of laboratory tests per day varied significantly by hospital type and was highest for major teaching hospitals for both conditions (bacterial pneumonia: major teaching hospitals, 13.21; 95% CI, 12.91-13.51; nonteaching hospitals, 8.92; 95% CI, 8.84-9.00; P < .001; cellulitis: major teaching hospitals, 10.43; 95% CI, 10.16-10.70; nonteaching hospitals, 7.29; 95% CI, 7.22-7.36; P < .001). This association held for all levels of illness severity for both conditions, except for patients with cellulitis with the highest illness severity level. In generalized mixed linear regression models, controlling for additional patient and encounter covariates, there was a significant difference in the marginal effect of hospital teaching status on mean number of laboratory tests per day between major teaching and nonteaching hospitals (difference in marginal mean laboratory tests per day for bacterial pneumonia, 3.58; 95% CI, 2.61-4.55; P < .001; for cellulitis, 2.61; 95% CI, 1.76-3.47; P < .001). CONCLUSIONS AND RELEVANCECompared with nonteaching hospitals, patients in Texas admitted to major teaching hospitals with bacterial pneumonia or cellulitis received significantly more laboratory tests after controlling for illness severity, length of stay, and patient demographics. These results support the need to examine how the culture of training environments may contribute to increased use of laboratory tests.

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Medical Training And Expensive Care

Cited by 7 publications

References 1 publication

Global Health Telemedicine Conferences: The System We Save May Be Our Own

Global Health Telemedicine Conferences: The System We Save May Be Our Own

Coagulation test understanding and ordering by medical trainees: Novel teaching approach

A Comparison of Laboratory Testing in Teaching vs Nonteaching Hospitals for 2 Common Medical Conditions

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