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Physician Variation in Test Ordering in the Management of Gastroenteritis in Children
Elizabeth C. Powell, MD, MPH;
Louis C. Hampers, MD, MBA
Arch Pediatr Adolesc Med. 2003;157:978-983.
Objectives To describe the variation among physicians in test ordering when caring for children with gastroenteritis and to explore the effect of hospital charge information on such variation.
Design Prospective, nonmasked, observational study and controlled trial of price information.
Setting Urban, university-affiliated pediatric emergency department.
Participants Pediatric emergency medicine faculty (n = 10) and fellows (n = 5).
Methods Test-ordering practices were reviewed during 3 periods: control, intervention, and washout. During the intervention period, test charge information was placed on patients' emergency department records. Telephone contact with families was initiated 7 days after care.
Results We included 3198 visits. Individual physician mean test charges varied more than 2-fold during the control period (mean, $127; range, $82-$185). Based on their test charges (control period), physicians were assigned to the "high" (n = 8) or "low" (n = 7) test user group. Differences in mean charges in high vs low test users during the control period ($144 vs $112) persisted in the intervention period ($80 vs $52; Mann-Whitney P = .01), as did rates of intravenous fluid use (20% vs 14% in both periods). Among the lowest-acuity patients, low test users exhibited greater price sensitivity (vs high users). Patients treated by low test users did not differ in improved condition (82% vs 86%) or family satisfaction (93% vs 92%); they had more unscheduled follow-up (25% vs 17%; P<.01), but were no more often admitted (5% vs 3%; P = .11).
Conclusions Physicians varied in resource use when treating children with gastroenteritis. High and low test users were sensitive to price information. This intervention did not seem to compromise patient outcome.
From the Division of Pediatric Emergency Medicine, Northwestern University's Feinberg School of Medicine, Chicago, Ill. Dr Hampers is now with the Section of Pediatric Emergency Medicine, Children's Hospital, Denver, Colo.
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