JGIM Twitter Journal Club
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May 27, 2014
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Instructions for JGIM Twitter Journal Club
We are starting a journal club on Twitter based a recent article published in the Journal of General Internal Medicine. We will use the medical education hashtag (#meded) for this event. Please follow these 4 easy steps to join in.
- Make sure you have a Twitter account and know how to log in. If you don't have one you can sign up for one at http://www.twitter.com.
- On Thursday, June 5, 2014 at 9.00 PM EST, go to http://www.tweetchat.com
- Sign in to your Twitter account.
- When you click “Authorize App”, you will return to the tweetchat page.
- Enter meded in the hashtag box at the top and click “Go”.
Now you will be able to view all posts with the #meded hashtag as they appear in real-time. All of your posts during the chat will also be tagged with #meded so that you can contribute to the discussion.
For our first journal club, we will gather on June 5 at 9:00 PM (Eastern Standard Time) to discuss:
The impact of cost displays on primary care physician laboratory test ordering. Horn DM, Koplan KE, Senese MD, Orav EJ, Sequist TD. J Gen Intern Med. 2014 May;29(5):708-14.
BACKGROUND:
Physicians are under increased pressure to help control rising health care costs, though they lack information regarding cost implications of patient care decisions.
OBJECTIVE:
To evaluate the impact of real-time display of laboratory costs on primary care physician ordering of common laboratory tests in the outpatient setting.
DESIGN:
Interrupted time series analysis with a parallel control group.
PARTICIPANTS:
Two hundred and fifteen primary care physicians (153 intervention and 62 control) using a common electronic health record between April 2010 and November 2011. The setting was an alliance of five multispecialty group practices in Massachusetts.
INTERVENTION:
The average Medicare reimbursement rate for 27 laboratory tests was displayed within an electronic health record at the time of ordering, including 21 lower cost tests (< $40.00) and six higher cost tests (> $40.00).
MAIN MEASURES:
We compared the change-in-slope of the monthly laboratory ordering rate between intervention and control physicians for 12 months pre-intervention and 6 months post-intervention. We surveyed all intervention and control physicians at 6 months post-intervention to assess attitudes regarding costs and cost displays.
KEY RESULTS:
Among 27 laboratory tests, intervention physicians demonstrated a significant decrease in ordering rates compared to control physicians for five (19 %) tests. This included a significant relative decrease in ordering rates for four of 21 (19 %) lower cost laboratory tests and one of six (17 %) higher cost laboratory tests. A majority (81 %) of physicians reported that the intervention improved their knowledge of the relative costs of laboratory tests.
CONCLUSIONS:
Real-time display of cost information in an electronic health record can lead to a modest reduction in ordering of laboratory tests, and is well received. Our study demonstrates that electronic health records can serve as a tool to promote cost transparency and reduce laboratory test use.
We will address the following questions during the Journal Club:
1: What potential role might cost displays within electronic medical records have on reducing healthcare costs?
2: How should clinicians integrate cost information into decision-making?
3: How can we best teach trainees about cost and prepare them to deliver high-value care?
4: What would be possible unintended consequences of showing the cost of tests to house staff?
Please join the authors, the JGIM editorial staff, and your colleagues around the world for a lively chat about this study and its implications for clinical practice and medical education. Click the icon below to add a reminder to your calendar.
Tabor Flickinger and Neil Mehta