title: An educational intervention to improve cost-effective care among medicine housestaff:  a randomized controlled trial.
abstract: OBJECTIVE
  High medical costs create significant burdens. Research indicates that doctors have little awareness of costs. This study tested whether a brief educational intervention could increase residents' awareness of cost-effectiveness and reduce costs without negatively affecting patient outcomes.
  
  
  METHODS
  The authors conducted a clustered randomized controlled trial of 33 teams (96 residents) at an internal medicine residency program (2009-2010). The intervention was a 45-minute teaching session; residents reviewed the hospital bill of a patient for whom they had cared and discussed reducing unnecessary costs. Primary outcomes were laboratory, pharmacy, radiology, and total hospital costs per admission. Secondary measures were length of stay (LOS), intensive care unit (ICU) admission, 30-day readmission, and 30-day mortality. Multivariate adjustment controlled for patient demographics and health. A follow-up survey assessed resident attitudes three months later.
  
  
  RESULTS
  Among 1,194 patients, there were no significant cost differences between intervention and control groups. In the intervention group, 30-day readmission was higher (adjusted odds ratio 1.51, P = .010). There was no effect on LOS or the composite outcome of readmission, mortality, and ICU transfer. In a subgroup analysis of 835 patients newly admitted during the study, the intervention group incurred $163 lower adjusted lab costs per admission (P = .046). The follow-up survey indicated persistent differences in residents' exposure to concepts of cost-effectiveness (P = .041).
  
  
  CONCLUSIONS
  A brief intervention featuring a discussion of hospital bills can fill a gap in resident education and reduce laboratory costs for a subset of patients, but may increase readmission risk.
authors.affiliation: Department of Health Policy and Management, Harvard School of Public Health, Boston, MA 02115, USA. bsommers@hsph.harvard.edu
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Sommers
authors.forename: Nihar
authors.initials: N
authors.lastname: Desai
authors.forename: Julie
authors.initials: J
authors.lastname: Fiskio
authors.forename: Adam
authors.initials: A
authors.lastname: Licurse
authors.forename: Mary
authors.initials: M
authors.lastname: Thorndike
authors.forename: Joel T
authors.initials: JT
authors.lastname: Katz
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D004521:Educational Measurement; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D016018:Least-Squares Analysis; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D013663:Teaching / Q000379:methods*