Physician Variation in Test Ordering in the Management of Gastroenteritis in Children


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Abstract

ObjectivesTo 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.DesignProspective, nonmasked, observational study and controlled trial of price information.SettingUrban, university-affiliated pediatric emergency department.ParticipantsPediatric emergency medicine faculty (n = 10) and fellows (n = 5).MethodsTest-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.ResultsWe 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).ConclusionsPhysicians 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.

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