Alyna T Chien1,2, Smitha Ganeshan3, Mark A Schuster3,2, Lisa Soleymani Lehmann3,4,5,6, Laura A Hatfield7, Kate E Koplan8, Carter R Petty9, Anna D Sinaiko4, Thomas D Sequist5,7,10, Meredith B Rosenthal4. 1. Harvard Medical School, Boston, Massachusetts; alyna.chien@childrens.harvard.edu. 2. Division of General Pediatrics, Department of Medicine, and. 3. Harvard Medical School, Boston, Massachusetts. 4. Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts. 5. Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts. 6. National Center for Ethics in Health Care, Veterans Health Administration, Washington, District of Columbia. 7. Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts. 8. Kaiser Permanente of Georgia, Atlanta, Georgia; and. 9. Clinical Research Center, Boston Children's Hospital, Boston, Massachusetts. 10. Partners Healthcare System, Boston, Massachusetts.
Abstract
BACKGROUND AND OBJECTIVES: Ordering rates for imaging studies and procedures may change if clinicians are shown the prices of those tests while they are ordering. We studied the effect of 2 forms of paid price information, single median price and paired internal/external median prices, on how often pediatric-focused and adult-oriented clinicians (most frequently general pediatricians and adult specialists caring for pediatric-aged patients, respectively) order imaging studies and procedures for 0- to 21-year-olds. METHODS:In January 2014, we randomized 227 pediatric-focused and 279 adult-oriented clinicians to 1 of 3 study arms: Control (no price display), Single Median Price, or Paired Internal/External Median Prices (both with price display in the ordering screen of electronic health record). We used 1-way analysis of variance and paired t tests to examine how frequently clinicians (1) placed orders and (2) designated tests to be completed internally within an accountable care organization. RESULTS: For pediatric-focused clinicians, there was no significant difference in the rates at which orders were placed or designated to be completed internally across the study arms. For adult-oriented clinicians caring for children and adolescents, however, those in the Single Price and Paired Price arms placed orders at significantly higher rates than those in the Control group (Control 3.2 [SD 4.8], Single Price 6.2 [SD 6.8], P < .001 and Paired Prices 5.2 [SD 7.9], P = .04). The rate at which adult-oriented clinicians designated tests to be completed internally was not significantly different across arms. CONCLUSIONS: The effect of price information on ordering rates appears to depend on whether the clinician is pediatric-focused or adult-oriented.
RCT Entities:
BACKGROUND AND OBJECTIVES: Ordering rates for imaging studies and procedures may change if clinicians are shown the prices of those tests while they are ordering. We studied the effect of 2 forms of paid price information, single median price and paired internal/external median prices, on how often pediatric-focused and adult-oriented clinicians (most frequently general pediatricians and adult specialists caring for pediatric-aged patients, respectively) order imaging studies and procedures for 0- to 21-year-olds. METHODS: In January 2014, we randomized 227 pediatric-focused and 279 adult-oriented clinicians to 1 of 3 study arms: Control (no price display), Single Median Price, or Paired Internal/External Median Prices (both with price display in the ordering screen of electronic health record). We used 1-way analysis of variance and paired t tests to examine how frequently clinicians (1) placed orders and (2) designated tests to be completed internally within an accountable care organization. RESULTS: For pediatric-focused clinicians, there was no significant difference in the rates at which orders were placed or designated to be completed internally across the study arms. For adult-oriented clinicians caring for children and adolescents, however, those in the Single Price and Paired Price arms placed orders at significantly higher rates than those in the Control group (Control 3.2 [SD 4.8], Single Price 6.2 [SD 6.8], P < .001 and Paired Prices 5.2 [SD 7.9], P = .04). The rate at which adult-oriented clinicians designated tests to be completed internally was not significantly different across arms. CONCLUSIONS: The effect of price information on ordering rates appears to depend on whether the clinician is pediatric-focused or adult-oriented.
Authors: Craig B Monsen; Joshua M Liao; Barak Gaster; Kevin J Flynn; Thomas H Payne Journal: J Am Med Inform Assoc Date: 2019-10-01 Impact factor: 4.497