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Addition of price transparency to an education and feedback intervention reduces utilization of inpatient echocardiography by resident physicians

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Abstract

Previous studies have demonstrated the impact of appropriate use criteria (AUC) education and feedback interventions in reducing unnecessary ordering of transthoracic echocardiography (TTE) by trainees. To our knowledge, no study has evaluated the impact of the addition of price transparency to this education and feedback model on TTE utilization by resident physicians. We performed an education and feedback quality improvement initiative combining charge transparency data with information on AUC. We hypothesized that the initiative would reduce the number of complete TTE ordered and increase the number of limited TTE ordered, anticipating there would be substitution of limited for complete studies. Residents rotating on inpatient teaching cardiology ward teams received education on AUC for TTE, indications for limited TTE, and hospital charges for TTE. Feedback was provided on the quantity and charges for complete and limited TTE ordered by each team. We analyzed the effects of the intervention using a linear mixed effects regression model to adjust for potential confounders. The post-intervention weeks showed a reduction of 4.6 complete TTE orders per 100 patients from previous weekly baseline of 31.3 complete TTE orders per 100 patients (p value = 0.012). Charges for complete TTE decreased $122 from baseline of $980 per patient (p value = 0.040) on a per-week basis. Secondarily, there was no statistically significant change in limited TTE ordering during the intervention period. This initiative shows the feasibility of a house staff-driven charge transparency and education/feedback initiative that decreased medical residents’ ordering of inpatient TTE.

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Authors and Affiliations

  1. Department of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, D-3100, Nashville, TN, 37232, USA

    Patrick M. Kozak, Silas P. Trumbo, Bradley W. Christensen & David L. Leverenz

  2. Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave. Suite 11000, Nashville, TN, 37203, USA

    Matthew S. Shotwell

  3. Division of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, 1211 21st. Ave S. MAB 526, Nashville, TN, USA

    Adam J. Kingeter

  4. Section of Cardiovascular Medicine, Wake Forest Baptist Medical Center, 1 Medical Center Blvd, Winston Salem, NC, 27157, USA

    Patrick M. Kozak

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  1. Patrick M. Kozak
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  2. Silas P. Trumbo
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  4. David L. Leverenz
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Correspondence to Patrick M. Kozak.

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As this was a quality-improvement initiative, our institution granted an IRB-approval exemption.

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Kozak, P.M., Trumbo, S.P., Christensen, B.W. et al. Addition of price transparency to an education and feedback intervention reduces utilization of inpatient echocardiography by resident physicians. Int J Cardiovasc Imaging 35, 1259–1263 (2019). https://doi.org/10.1007/s10554-019-01572-2

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  • DOI: https://doi.org/10.1007/s10554-019-01572-2

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