title: Implementing High-Value Care.
abstract: OBJECTIVE
  Our objectives were to assess physician knowledge of costs of products, tests, and services commonly used by obstetrician/gynecologists (OB/GYNs) and identify those items that could be eliminated without decreasing quality of care by performing a prospective observational pilot study.
  
  
  METHODS
  An anonymous electronic survey was distributed to 70 OB/GYN providers at Greenville Memorial Hospital. Survey items included common laboratory tests, medications, and clinical services. The survey was used to identify items with high cost for which there were less costly but equally efficacious alternatives. As an educational intervention, grand rounds reviewing the survey results, as well as recommendations that would allow for lean healthcare changes, were conducted. Utilization and cost savings were tracked for a 1-year preintervention and a 1-year postintervention.
  
  
  RESULTS
  In total, 50 of 70 providers (71%) completed the survey. Hydrocortisone acetate/pramoxine hydrochloride and dinoprostone vaginal inserts were targeted for intervention. Use of the dinoprostone vaginal insert decreased 50.5% with a savings of $66,500 when comparing the preintervention period with the postintervention period. Use of hydrocortisone acetate/pramoxine hydrochloride decreased 90% with a savings of $92,655. Combined, the decreased use of these products led to a $159,155 cost savings in the 1-year postintervention period.
  
  
  CONCLUSIONS
  OB/GYN providers at our institution had a poor working knowledge of costs. Through the use of a survey and educational intervention, we demonstrated that simple interventions could lead to high-quality, lean healthcare changes.
authors.affiliation: From the Departments of Quality Management and ObGyn, Greenville Health System, Greenville, South Carolina, and the University of South Carolina School of Medicine, Greenville.
authors.forename: Lauren D
authors.initials: LD
authors.lastname: Demosthenes
authors.affiliation: From the Departments of Quality Management and ObGyn, Greenville Health System, Greenville, South Carolina, and the University of South Carolina School of Medicine, Greenville.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Lane
authors.affiliation: From the Departments of Quality Management and ObGyn, Greenville Health System, Greenville, South Carolina, and the University of South Carolina School of Medicine, Greenville.
authors.forename: Dawn W
authors.initials: DW
authors.lastname: Blackhurst
mesh_terms: D000282:Administration, Intravaginal; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000191:economics*; D020070:Cervical Ripening / Q000187:drug effects*; D017046:Cost Savings; D004338:Drug Combinations; D005260:Female; D006176:Gynecology / Q000191:economics* / Q000706:statistics & numerical data; D006306:Health Surveys; D006785:Hospitals, University; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000191:economics; D007745:Labor Onset / Q000187:drug effects*; D008297:Male; D009025:Morpholines / Q000008:administration & dosage / Q000191:economics*; D009774:Obstetrics / Q000191:economics* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011247:Pregnancy; D011446:Prospective Studies; D011787:Quality of Health Care; D013022:South Carolina / Q000453:epidemiology; D011795:Surveys and Questionnaires
chemical_list: D000779:Anesthetics, Local; D004338:Drug Combinations; D009025:Morpholines; C005548:pramoxine; C021650:hydrocortisone acetate; D006854:Hydrocortisone