Daniel Durand MD, Presenter: Nothing to Disclose

Leonard Feldman MD, Abstract Co-Author: Nothing to Disclose

Jonathan S. Lewin MD, Abstract Co-Author: Stockholder, Interventional Imaging, Inc Founder, Interventional Imaging, Inc

Gloria Vila, Abstract Co-Author: Nothing to Disclose

Daniel J Brotman MD, Abstract Co-Author: Nothing to Disclose

Displaying the cost of imaging tests within the order entry system alone does not have a significant effect on utilization. This result can be viewed as justification of more complex methods of impacting physician behavior at the provider order entry level published elsewhere.

Imaging is a major driver of growing health care costs. Multiple strategies to eliminate unnecessary imaging requests at the provider order level have been devised, many involving complex algorithms with numerous input fields. In contrast, we focused on a simple intervention to increase cost transparency. We hypothesized that displaying cost information at the order entry level would impact the aggregate ordering behavior of physicians by reducing imaging utilization. Similar methods applied to routine laboratory tests at our institution yielded encouraging initial results.

Using data from fiscal year 2007, we compiled a list of the 15 most frequently ordered imaging tests and randomly assigned 5 of them to the study group (AP chest x-ray, AP abdominal x-ray, non-contrast head CT, renal ultrasound and abdominal vascular ultrasound) and 5 to the control group (PA and lateral chest x-ray, CT chest with contrast, CT abdomen with contrast, extremity vascular ultrasound and abdominal ultrasound). Following a 6-month baseline period, 11/10/08-5/9/09, we displayed cost data in the electronic ordering interface (see Figure) for only the intervention tests during a 6-month intervention period, 11/10/09-5/9/10. Our main outcome measure was the percentage change in utilization for tests in the control group versus the percentage change in utilization in the intervention group. Student’s t-test was used to assess statistical significance.

Net utilization decreased 0.03% for the intervention tests and 1.4% for the control tests. The mean change in utilization for the 5 tests with costs displayed was 2.8% (SD 4.4%) while the mean change in utilization of the 5 control tests was -3.0% (SD 5.5%), with no significant difference between the two. Based on these data, our study had a 90% power to detect a 11.8 % difference in percentage change in utilization between groups.

Durand, D, Feldman, L, Lewin, J, Vila, G, Brotman, D, Presenting the Cost of Radiology Tests via a Provider Order Entry System and Measuring Its Effect on Imaging Utilization: A Controlled Clinical Trial.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11001057.html