Charge Transparency in Critical Care Practice and Its Effects on Overall Cost of Care (PRICE)

Ordering providers include resident, fellow and attending physicians, as well as mid level providers such as Nurse Practitioners (NP's) and Physician Assistants (PA's). The investigators have developed a dashboard that displays both daily and cumulative charges related to laboratory, pharmacy, radiology, and other services for all patients admitted to Vanderbilt ICU's. Using this dashboard an ICU ordering provider is able to see not only the total daily charges for the previous 24 hours, but also the sum of all charges for that patient's current ICU admission. In addition, a "snapshot" overview tab is available for each patient that displays a day by day trend of the overall charges of the ICU stay for the patient, top 5 most expensive lab/radiology/pharmacy charges, previous 24 hour charges, and the total ICU number of chest x-ray, Complete Blood Count (CBC), Basic Metabolic Panel (BMP), Electrocardiogram (EKG), and Arterial Blood Gas (ABG) charges to the patient. The ordering provider is able to query the database of the dashboard for information regarding individual laboratory and drug charges, as well as view trajectory of total charges for a given patient. This dashboard allows for unprecedented transparency regarding the cost of care for patients in an ICU. Patients are identified in the dashboard by Medical Record Number (MRN), ICU bed, and initials only so as to protect their identity.

AIM 1: To evaluate the effects of introducing charge transparency to ordering providers via a charge dashboard and associated printed synopsis on average charge per patient per day in the Vanderbilt ICUs.

We intend to study the effect of charge transparency to ordering providers on average charge per patient per day by conducting a prospective, self-controlled by unit, multiple cross-over trial. We will divide the study period into four 12-week blocks with two blocks of "charge transparency" and two blocks of "no transparency." Each unit will be assigned to alternating blocks of "transparency" and "no transparency" during the study with each unit on the same schedule so as to prevent cross contamination.

For months during which access is granted, all ordering providers in the study ICU will be granted access to the ICU charge dashboard following a brief orientation. In addition a password protected, unit specific iPad will be provided to each study unit. The iPad will enable point of care access to the patient specific snapshot information, as well as easily incorporate the dashboard information into clinical care.

AIM 2: To evaluate the effects of utilization of a charge dashboard on ordering patterns of providers and cost containment in the Vanderbilt ICUs.

In addition to studying the effect of charge transparency on patient ICU charges, we also intend to study the effect of charge transparency on resource utilization, namely routine laboratory and radiology tests. As surrogate markers for routine laboratory utilization we will measure average number of Comprehensive Blood Count (CBC) and Basic Metabolic Panel (BMP) tests per patient per day, and as surrogate markers for routine radiology utilization we will use average number of chest x-rays per patient per day.