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An educational intervention to improve cost-effective care among medicine housestaff: A randomized controlled trial

机译:一种教育干预措施,以提高药物收容所中成本效益的护理:一项随机对照试验

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Purpose: High medical costs create significant burdens. Research indicates that doctors have little awareness of costs. This study tested whether a brief educational intervention could increase residents' awareness of cost-effectiveness and reduce costs without negatively affecting patient outcomes. Method: The authors conducted a clustered randomized controlled trial of 33 teams (96 residents) at an internal medicine residency program (2009-2010). The intervention was a 45-minute teaching session; residents reviewed the hospital bill of a patient for whom they had cared and discussed reducing unnecessary costs. Primary outcomes were laboratory, pharmacy, radiology, and total hospital costs per admission. Secondary measures were length of stay (LOS), intensive care unit (ICU) admission, 30-day readmission, and 30-day mortality. Multivariate adjustment controlled for patient demographics and health. A follow-up survey assessed resident attitudes three months later. Results: Among 1,194 patients, there were no significant cost differences between intervention and control groups. In the intervention group, 30-day readmission was higher (adjusted odds ratio 1.51, P = .010). There was no effect on LOS or the composite outcome of readmission, mortality, and ICU transfer. In a subgroup analysis of 835 patients newly admitted during the study, the intervention group incurred $163 lower adjusted lab costs per admission (P = .046). The follow-up survey indicated persistent differences in residents' exposure to concepts of cost-effectiveness (P = .041). Conclusions: A brief intervention featuring a discussion of hospital bills can fill a gap in resident education and reduce laboratory costs for a subset of patients, but may increase readmission risk.
机译:目的:高昂的医疗费用带来了沉重的负担。研究表明,医生几乎不了解费用。这项研究测试了简短的教育干预措施是否可以提高居民对成本效益的认识并降低成本,而不会对患者的病情产生负面影响。方法:作者在一项内部药物住院医师程序(2009-2010年)中对33个团队(96位居民)进行了一项集群随机对照试验。干预时间为45分钟。居民审查了他们所照顾的患者的医院账单,并讨论了减少不必要的费用。主要结局为实验室,药房,放射学和每次入院的总医院费用。次要指标是住院时间(LOS),重症监护病房(ICU)入院,30天再入院和30天死亡率。多变量调整可控制患者的人口统计和健康状况。三个月后,一项后续调查评估了居民的态度。结果:在1,194例患者中,干预组和对照组之间的费用没有显着差异。在干预组中,30天再入院率更高(调整后的优势比1.51,P = .010)。对LOS或再入院,死亡率和ICU转移的综合结果没有影响。在对研究期间新入院的835名患者进行的亚组分析中,干预组的每次入院调整后实验室费用降低了163美元(P = .046)。后续调查表明,居民在接触成本效益概念方面存在持续差异(P = .041)。结论:以讨论医院账单为特色的简短干预措施可以填补住院医师教育的空白,并降低部分患者的实验室成本,但可能会增加再次住院的风险。

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