Evaluating Patient and Physician Cost Knowledge in the Emergency Department

Do Providers and Consumers Know the Cost of Common Tests and Procedures Delivered in the Emergency Department?

The purpose of this study is to identify existing cost knowledge of Emergency Medicine (EM) physicians and patients and investigates its reported impacts on medical compliance. A cross-sectional survey will be administered electronically to Emergency Medicine physicians at the University of Utah Hospital and the Emergency Physician Integrated Care, LLC (EPIC) who staff ten-community hospital Emergency Departments (ED) in order to investigate physician knowledge and attitudes regarding cost and perceived patient compliance. In addition, a cross-sectional survey will be administered to a convenience sample of patients presenting to the University of Utah Emergency Department to obtain information about their cost knowledge and reported compliance. All ED patients will complete a follow-up phone survey to measure compliance with recommendations made during the ED visits. Following administration of the baseline survey physicians will be provided the prices of the test and procedures and will be re-surveyed 30-days later as a post intervention test to measure changes in knowledge and attitudes.

Study Overview

• Status: Completed
• Conditions: Economic Problems

• Study Type: Observational
• Enrollment (Actual): 512

Contacts and Locations

Study Locations

• United States
  • Utah
    • Salt Lake City, Utah, United States, 84132
      • University of Utah

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

There will be two distinct study populations in this study. The first population will consist of physicians from Emergency Medicine. There are 51 Emergency Medicine physicians at the University of Utah (27 attending, 24 residents); there are 138 board-certified Emergency Medicine physicians in the EPIC group therefore a projected provider cohort of n=90 (about 50% of 189) is anticipated. The only exclusion criterion for physicians is they do not practice in one of the above-mentioned provider groups.

The second population will consist of patients presenting to the University Utah Emergency Department who are determined by the attending physicians to be mentally and physically competent to complete the questionnaire (n=450). Included in this cohort are all English speaking patients who are eighteen years of age and older, who are deemed psychologically and medically stable by the ED care provider, are not prisoners, and were not brought in by EMS.

Description

Inclusion Criteria Patient Population:

• 18 years old or older
• Deemed psychologically and medically stable by the ED care provide
• Speak English

Exclusion Criteria Patient Population:

• Prisoner
• Brought to Emergency Department by Emergency Medical Service

Inclusion Criteria Physician Population:

• Employed in target medical practices

Exclusion Criteria Physician Population:

• none

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Emergency Department Patients
Emergency Medicine Physicians

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of emergency medicine physician with accurate (+/- 25% of actual cost) cost knowledge of common medical services; influence on testing and prescribing patterns.	Measure the extent of formal education regarding cost of medical services that physicians in the survey population have received and how that impacts knowledge and accuracy; perceived impact on medical compliance among patients.	1 year

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Proportion of emergency department patients with accurate (+/- 25% actual costs) knowledge of medical service cost; correlation between health literacy and cost knowledge accuracy in patients.	Measure patient health literacy using the REALM-SF (AHRQ) and determine any correlation with cost estimation accuracy and reported impact on medical compliance among patients.	1 year

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Efficacy of intervention to improving accuracy in cost estimation in emergency physicians.	Changes in self-reported cost knowledge competency and cost estimation accuracy using the intervention comparing the baseline report at time of enrollment to 30 days post intervention.	1 year

Collaborators and Investigators

• Sponsor: University of Utah

Publications and helpful links

General Publications

• Broadwater-Hollifield C, Gren LH, Porucznik CA, Youngquist ST, Sundwall DN, Madsen TE. Emergency physician knowledge of reimbursement rates associated with emergency medical care. Am J Emerg Med. 2014 Jun;32(6):498-506. doi: 10.1016/j.ajem.2014.01.044. Epub 2014 Feb 3.

Study record dates

Study Major Dates

• Study Start: August 1, 2012
• Primary Completion (Actual): August 1, 2013
• Study Completion (Actual): August 1, 2013

Study Registration Dates

• First Submitted: June 10, 2013
• First Submitted That Met QC Criteria: June 18, 2013
• First Posted (Estimate): June 21, 2013

Study Record Updates

• Last Update Posted (Estimate): December 26, 2016
• Last Update Submitted That Met QC Criteria: December 22, 2016
• Last Verified: December 1, 2016

More Information

Terms related to this study

• Keywords: Questionnaires; Health literacy; Cost analysis; Policy; Attitudes of health personnel; Attitudes of patients; Medical compliance; Cost awareness; Patient knowledge; Physician knowledge; Medical economics
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 00057136