Risk, Benefit, and Cost Thresholds for Emergency Department Testing: A Cross‐sectional, Scenario‐based Study

Abstract

The desire for testing was strongly sensitive to the benefits, risks, and costs. Many participants wanted a test when there was no added cost, regardless of benefit or risk levels, but far fewer elected to receive the test as cost increased incrementally. This suggests that out-of-pocket costs may deter patients from undergoing diagnostic testing with low potential benefit.

Patient Preferences for Diagnostic Testing in the Emergency Department: A Cross‐sectional Study

“…These values were chosen to maximize the sensitivity of the study to detect differences in patient preferences based on a preliminary study performed by the authors, where we believed the most interesting zone of variation in patients’ desire for diagnostic testing was for risk and benefit levels of 0.1% and 1% and cost levels of $0 and $100. 4 Additionally, risk values of 0.1% and 1% were felt to represent a realistic chance of developing cancer from diagnostic testing with radiation. 5 In order to improve participants’ incorporation of numerical values into their decision-making, patients were presented with both textual and graphical representations where risk and benefit values were presented as a ratio and percentage, as well as with a pictograph representing values of 1 in 100 and 1 in 1000.…”

“…Prior to launch, we used this survey in a prior, online only study. 4 In addition, we pilot tested the questions amongst adults associated with the study team. The survey was read aloud to all patients to reduce any misunderstandings caused by difficulties with reading or seeing.…”

Physician-identified barriers to and facilitators of shared decision-making in the Emergency Department: an exploratory analysis

“…It has been previously noted that for patients to participate in SDM, they need to ‘appreciate that there is uncertainty in medicine.’23 Our results suggest that EPs would agree with this and may withhold SDM for patients they believe will have difficulty with uncertainty. What is unknown is how much uncertainty or risk ED patients are willing to accept, although it is likely this varies considerably by patient and by clinical scenario 24. Although research exists to bolster accurate risk communication, it is unclear whether we can affect our ‘ambiguity aversion’ as a culture 25.…”

Point‐of‐Care Ultrasonography (POCUS) in a Community Emergency Department: An Analysis of Decision Making and Cost Savings Associated With POCUS

“…Providers’ use of and competency with ultrasonography can yield benefits not only for patient care but also for direct and indirect cost savings at the institutional and national levels . Many of these studies rely on Medicare claims data, insurance claims data, or general surveys asking providers about their habits of ultrasonography use . This strategy, while yielding useful insights, does not necessarily provide information about providers’ decisions regarding POCUS use at the moment of clinical contact.…”

“…18 Many of these studies rely on Medicare claims data, insurance claims data, or general surveys asking providers about their habits of ultrasonography use. [19][20][21][22] This strategy, while yielding useful insights, does not necessarily provide information about providers' decisions regarding POCUS use at the moment of clinical contact. In light of the established evidence about the clinical importance of ultrasonography use and its potential for cost saving, we sought to investigate emergency department physicians' perceptions regarding the role of ultrasonography as a branch point in clinical decision making.…”