title: Randomized controlled trial of feedback on cost of hospital care among gastroenterology inpatients.
abstract: BACKGROUND
  Spending on hospital inpatients comprises a major proportion of healthcare costs. This study assessed the impact of systematic feedback to gastroenterologists on the cost of care provided to inpatients on a gastrointestinal/hepatology (GIH) hospital service.
  
  
  METHODS
  Patients with a GIH diagnosis were randomly assigned to be cared for by one of two hospital services. Over 3 months, teams were randomized to receive feedback (GIH A) or no feedback (GIH B, control group); feedback consisted of an email sent twice weekly to all physicians on the GIH A service detailing the length of stay (LOS) and real-time cost of care accrued by each inpatient.
  
  
  RESULTS
  Over 3 months, care was provided to 56 (GIH A) and 47 (GIH B) inpatients with a GIH illness. Patient complexity level was similar for both services as demonstrated by mean relative value: 1.11 (GIH A) vs. 1.27 (GIH B), p=0.2. Weighted LOS and weighted cost of care values were calculated to adjust for the respective RV of each patient. Mean weighted LOS (10.8 [GIH A] vs. 13.8 days/pt [GIH B], p=0.02) and mean weighted cost of care (9,904 [GIH A] vs. 12,654 euros/pt [GIH B], p=0.02) were significantly lower in the feedback group. Subsequent hospital readmission rates did not differ among both groups.
  
  
  CONCLUSIONS
  Systematic feedback on cost of care was associated with lower healthcare costs without compromising quality. Incorporating a running total of patient costs into computer software used to order patient tests may represent one approach to controlling healthcare expenses.
authors: Department of Gastroenterology, Beaumont Hospital, Dublin, Ireland, Slattery.eoin@gmail.com.
authors: E
authors: E
authors: Slattery
authors: G C
authors: GC
authors: Harewood
authors: K X
authors: KX
authors: Clancy
authors: F
authors: F
authors: Murray
authors: S
authors: S
authors: Patchett
mesh_terms: D005246:Feedback; D005767:Gastrointestinal Diseases / Q000191:economics / Q000628:therapy; D017048:Health Care Costs; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000191:economics; D016896:Treatment Outcome