Cost-aware care: critical core competency.
OBJECTIVE
Resident core competence can be improved by learning to accurately estimate the costs of postoperative complications.


METHODS
Prospective, institutional review board-approved study. In step 1, residents were provided 3 clinical vignettes detailing specific treatment measures for postsurgical complications and asked to assign total cost estimates for the treatment for each vignette; in step 2 they were given a pocket-sized cost card listing hospital costs, and in step 3, after 2 weeks, they were retested using the same clinical vignettes as in step 1.


METHODS
University of Connecticut, Farmington, and the Yale University School of Medicine, New Haven.


METHODS
Fifty-three general surgery residents.


METHODS
Cost estimates for steps 1 and 3 were compared using the paired t test and analysis of variance to examine whether there is a difference between the baseline cost estimates and the actual cost; whether introduction of the cost card improves performance; and whether responses correlate to postgraduate year level or to the clinical vignette.


RESULTS
There was a statistically significant difference between the baseline cost estimates (before introduction of the cost card) and the actual cost of the treatment (P = .03). Introduction of the cost card resulted in a statistically significant improvement between the cost estimates before and after the intervention (P = .002), with a drop in average percentage error by 35% (range, 32%-38%). Level of postgraduate training or type of test vignette (at analysis of variance) did not seem to be a significant factor.


CONCLUSIONS
There is a lack of awareness among surgical residents of the cost of treatment of postoperative complications. Introduction of a simple educational tool such as a cost card measurably improves their overall understanding of the cost of care and can be easily incorporated into the residency curriculum.
Chandawarkar
Rajiv Y
RY
Division of Plastic Surgery and Departments of Medicine and Surgery, University of Connecticut School of Medicine, Farmington, CT 06030-1601, USA. Chandawarkar@uchc.edu
Taylor
Shiv
S
Abrams
Peter
P
Duffy
Andrew
A
Voytovich
Anthony
A
Longo
Walter E
WE
Kozol
Robert A
RA
D000368:Aged; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects*; D003082:Colectomy / Q000009:adverse effects*; D003365:Costs and Cost Analysis; D005260:Female; D005500:Follow-Up Studies; D013502:General Surgery / Q000193:education*; D017048:Health Care Costs; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D011446:Prospective Studies