Evidence map›Paper›PMID 30850907›Full record

ArticleThe international journal of cardiovascular imaging2019

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

Patrick M Kozak, Silas P Trumbo, Bradley W Christensen, David L Leverenz, Matthew S Shotwell, Adam J Kingeter

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Article in The international journal of cardiovascular imaging, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Patrick M KozakDepartment of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, D-3100, Nashville, TN, 37232, USA. pkozak@wakehealth.edu.ORCID http://orcid.org/0000-0002-6325-0627
Silas P TrumboDepartment of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, D-3100, Nashville, TN, 37232, USA.
Bradley W ChristensenDepartment of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, D-3100, Nashville, TN, 37232, USA.
David L LeverenzDepartment of Medicine, Vanderbilt University Medical Center, 1161 21st Ave S, D-3100, Nashville, TN, 37232, USA.
Matthew S ShotwellDepartment of Biostatistics, Vanderbilt University Medical Center, 2525 West End Ave. Suite 11000, Nashville, TN, 37203, USA.
Adam J KingeterDivision of Cardiothoracic Anesthesiology, Vanderbilt University Medical Center, 1211 21st. Ave S. MAB 526, Nashville, TN, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

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.

Indexed as

Formative FeedbackInpatientsAttitude of Health PersonnelCost-Benefit AnalysisCost SavingsEchocardiographyEducation, Medical, ContinuingFeasibility StudiesHealth Care CostsHealth Knowledge, Attitudes, PracticeHospital CostsHumansInternship and ResidencyPractice Patterns, Physicians'Predictive Value of TestsProspective StudiesCharge-transparencyEchocardiographyGraduate medical educationQuality improvement

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.