A pilot study assessing the influences of charge data and group process ondiagnostic test ordering by residents

Purpose. Providing charge data to resident physicians has been shown to red uce the amounts spent on diagnostic testing. This pilot study sought to det ermine the influences of charge data and group decision making on diagnosti c test ordering by internal medicine residents. Method. In an interactive workshop, 23 internal medicine residents received a hypothetical case. They completed an 18-item questionnaire estimating ch arges for diagnostic tests and then "ordered" tests. The residents were the n randomly divided into groups that either received charge data, received c harge data after ordering tests, or received no charge data. The groups ord ered tests by consensus. Tests were weighted for appropriateness (+1 to +6) and inappropriateness;(-1 to -6). Analyses compared individual and group d ecisions and effect of availability of charge data. Results. Residents with access to charge data spent less on tests, but also had lower appropriateness scores. The appropriateness of the diagnostic wo rkup was better by groups than by individuals, but cost more. Conclusion. Cost-containment interventions targeted towards doctors in trai ning need to address the effect on quality of care and the influence of the group process in clinical decision making. Group diagnostic decisions may be more costly, but more appropriate.