title: Impact of a Cost Visibility Tool in the Electronic Medical Record on Antibiotic Prescribing in an Academic Medical Center.
abstract: BACKGROUND
  Studies evaluating the impact of passive cost visibility tools on antibiotic prescribing are lacking.
  
  
  OBJECTIVE
  The objective of this study was to evaluate whether the implementation of a passive antibiotic cost visibility tool would impact antibiotic prescribing and decrease antibiotic spending.
  
  
  METHODS
  An efficiency and effectiveness initiative (EEI) was implemented in October 2012. To support the EEI, an antibiotic cost visibility tool was created in June 2013 displaying the relative cost of antibiotics. Using an observational study of interrupted time series design, 3 time frames were studied: pre EEI, post EEI, and post cost visibility tool implementation. The primary outcome was antibiotic cost per 1,000 patient days. Secondary outcomes included case mix index (CMI)-adjusted antibiotic cost per 1,000 patient days and utilization of the cost visibility tool.
  
  
  RESULTS
  Initiation of the EEI was associated with a $4,675 decrease in antibiotic cost per 1,000 patient days (P = .003), and costs continued to decrease in the months following EEI (P = .009). After implementation of the cost visibility tool, costs remained stable (P = .844). Despite CMI increasing over time, adjustment for CMI had no impact on the directionality or statistical significance of the results.
  
  
  CONCLUSIONS
  Our study demonstrated a significant and sustained decrease in antibiotic cost per 1,000 patient days when focused medication cost reduction efforts were implemented, but passive cost visibility tool implementation was not associated with additional cost reduction. Antibiotic cost visibility tools may be of most benefit when prior medication cost reduction efforts are lacking or when an active intervention is incorporated.
authors.affiliation: Department of Pharmacy, Fairview Hospital, a Cleveland Clinic Hospital , Cleveland, Ohio.
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Fargo
authors.affiliation: Division of Infectious Diseases, College of Medicine, The Ohio State University Wexner Medical Center , Columbus, Ohio.
authors.forename: Jessica
authors.initials: J
authors.lastname: Johnston
authors.affiliation: Division of Epidemiology, College of Public Health, The Ohio State University , Columbus, Ohio.
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Stevenson
authors.affiliation: Infectious Diseases Department, Kaiser Permanente , Roseville, California.
authors.forename: Meredith
authors.initials: M
authors.lastname: Deutscher
authors.affiliation: Department of Pharmacy, The Ohio State University Wexner Medical Center , Columbus, Ohio .
authors.forename: Erica E
authors.initials: EE
authors.lastname: Reed
keywords: antibiotic; antibiotic cost; cost reduction; cost visibility