The effect of price information on test-ordering behavior and patient outcomes in a pediatric emergency department

Objective, We sought to determine whether information on hospital charges ( prices) would affect test-ordering and quality of patient care in a pediatr ic emergency department (ED). Design. Prospective, nonblind, controlled trial of price information. Setting. Urban, university-affiliate pediatric ED. Methods. We prospectively assessed patients 2 months to 10 years of age wit h a presenting temperature greater than or equal to 38.5 degrees C or compl aint of vomiting, diarrhea, or decreased oral intake. The assessments were done during three periods: September 1997 through December 1997 (control), January 1998 through March 1998 (intervention), and April 1998 (washout), I n the control and washout periods, physicians noted tests ordered on a list attached to each chart. In the intervention period, physicians noted tests ordered on a similar list that included standard hospital charges for each test. Records of each visit were reviewed to determine clinical and demogr aphic information as well as patient disposition. In the control and interv ention periods, families of nonadmitted patients were interviewed by teleph one 7 days after the visit. Results. When controlled for triage level, vital signs, and admission rates , in a multivariate model, charges for tests in the intervention period wer e 27% less than charges in the control period, The greatest decrease was se en among low-acuity, nonadmitted patients (43%). In telephone follow-up, pa tients in the intervention period were slightly more likely to have made an unscheduled follow-up visit to a health care provider (24.4% vs 17.8%), bu t did not differ on improved condition (86.7% vs 83.4%) or family satisfact ion (93.8% vs 93.0%). Adjusted charges in the washout period were 15% lower than in the control period and 15% higher than in the intervention period. Conclusion. Providing price information was associated with a significant r eduction in charges for tests ordered on pediatric ED patients with acute i llness not requiring admission. This decrease was associated with a slightl y higher rate of unscheduled follow-up, but no difference in subjective out comes or family satisfaction.