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Research Letter |

Hospital Clinicians’ Responsiveness to Assay Cost Feedback: A Prospective Blinded Controlled Intervention Study

Andrew W. Fogarty, DM1; Nigel Sturrock, MD2; Karim Premji, BSc3; Peter Prinsloo, FRCP3
[+] Author Affiliations
1Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, England
2Department of Diabetes and Endocrinology, Queen’s Medical Centre, Nottingham, England
3Department of Clinical Chemistry, City Hospital, Nottingham, England
JAMA Intern Med. 2013;173(17):1654-1655. doi:10.1001/jamainternmed.2013.8211.
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In developed countries, the costs of providing medical care are consistently increasing1 and projected to continue to do so.2 Some components of health care may be regarded as discretional, and this is reflected in the large variation in hospital costs that was not associated with clinical outcomes3 and the conclusions of a systematic review that non–evidence-based variables influence physicians’ test ordering.4 In the United Kingdom, health care is provided by the National Health Service (NHS), with hospital physicians requesting diagnostic tests based on their perception of good clinical practice. The service is free at source, and physicians are not routinely informed of the individual cost of their activities. We tested the hypothesis that hospital clinicians are sensitive to feedback of assay cost in a blinded prospective controlled study.

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Absolute Weekly Number of CRP Assays Requested for NCH and QMC (March 2010–March 2012)

Data points from week 1, 2013, were omitted from the Figure because they were amalgamated with week 53, 2012, creating very high values (QMC = 2829; NCH = 1601). These raw data were included in all statistical analyses. CRP indicates C-reactive protein; NHC, Nottingham City Hospital; and QMC, Queen’s Medical Centre.

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