A Brief Intervention to Improve Cost-effective Resource Use Among Medicine Housestaff

Study Overview
=================
Brief Summary
-----------------
OBJECTIVE: To test a brief intervention designed to improve the cost-effectiveness of care provided by medicine housestaff for hospitalized patients. HYPOTHESIS: A brief intervention in which medicine residents receive itemized bills for recent patients cared for by them, followed by a discussion on approaches to reducing unnecessary inpatient costs, can result in significant cost reductions without adversely affecting patient outcomes.

Detailed Description
-----------------
We designed a brief educational intervention with two primary objectives: 1) to increase awareness among residents about how their decisions impact the costs of inpatient medical care; and 2) to improve the cost-effectiveness of care provided by residents without adversely affecting patient outcomes. We hypothesized that a brief intervention in which residents receive bills for patients they recently cared for, followed by a discussion on approaches to reducing unnecessary inpatient costs, would reduce costs without adversely affecting patient outcomes.

Official Title
-----------------
A Brief Intervention to Improve Cost-effective Resource Use Among Medicine Housestaff

Conditions
-----------------
Graduate Medical Education, Cost-Effectiveness

Intervention / Treatment
-----------------
* Behavioral: Educational Intervention


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Internal Medicine Residents on Inpatient Rotations at Brigham & Women's Hospital Exclusion Criteria: Having a team member who was in either the control group or intervention group in a prior round of this study.
Sexes Eligible for Study
-----------------
All

Study Plan
=================
How is the study designed?
-----------------

Design Details

Allocation: Randomized


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Other: Intervention Group<br>Residents Randomized to Receive Educational Intervention | Behavioral: Educational Intervention<br>* 45-minute teaching session on healthcare costs, in which each resident reviewed an itemized hospital bill for a patient he/she had cared for, followed by an open-ended discussion about reducing unnecessary costs.<br>|
| No Intervention: Control Group<br>Residents randomized not to receive a teaching intervention. | |

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Total Cost | Total hospital cost per admission for 2 weeks following the educational intervention. | 2 weeks following educational intervention | 
| Lab Cost | Total lab cost per admission for 2 weeks following the educational intervention. | 2 weeks following educational intervention | 
| Pharmacy Cost | Total pharmacy cost per admission for 2 weeks following the educational intervention. | 2 weeks following educational intervention | 
| Radiology Cost | Total radiology cost per admission for 2 weeks following the educational intervention. | 2 weeks following educational intervention | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| length of stay |  | 2 weeks after educational intervention | 
| admission to an intensive care unit (ICU) |  | 2 weeks after educational intervention | 
| 30-day readmission |  | within 30 days after end of study period | 
| 30-day mortality |  | within 30 days after end of study period | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
efficiency, cost-awareness, hospitals, graduate medical education