An educational intervention conducted for inpatient services at the University of California, San Francisco (UCSF) Medical Center had a significant impact on both the number of diagnostic imaging tests ordered and the level of staff cost-consciousness, according to a research letter published online Aug. 27 in Archives of Internal Medicine.
Naama Neeman, MSc, and colleagues from UCSF described the two-phase intervention as first focusing on costs, then on radiation exposure, and targeted a total of 48 house staff and 32 attending physicians. The first intervention, which took place from October through November 2011, provided cost and utilization data on commonly ordered radiographic tests, along with national comparisons. After a two-month intervention-free period, which allowed researchers to measure the effect of the first intervention, radiation exposure data was provided from February through March.
Educational materials were sent electronically and posted in common areas, explained the authors. Educational guides also were developed for attending physicians to use during teaching rounds.
Neeman and colleagues reported that the mean number of tests ordered per 100 patient-days was cut by 19.8 percent during the first intervention and 9.5 percent during the second intervention. During the first intervention, chest radiography demonstrated the greatest reduction, while body CT saw the biggest decrease in the second intervention.
The reduced utilization resulted in reduced costs, with estimated annual direct cost savings reported to be $108,285 and $78,155, respectively, during each intervention.
House staff self-reported increased knowledge and said they were likely to change test-ordering behavior, according to the authors. There was a 27.3 percent increase in response to the statement “I know the cost of radiology tests I order” after the first intervention compared with baseline. There was also a 14.9 percent increase in response to the statement “I take the cost of radiology tests into consideration when ordering them.”
“Our findings demonstrate that in our current culture, interventions to improve the utilization of health care resources need not be high-cost themselves,” wrote the authors. “Providing physicians with individualized audit and feedback reports on their resource utilization, clinical decision-support tools, and educational interventions such as ours offer ways to reinforce an important message.”