First name
Evan
Last name
Fieldston

Title

Diagnostic Testing During Pediatric Hospitalizations: The Role of Attending In-House Coverage and Daytime Exposure.

Year of Publication

2020

Number of Pages

508-515

Date Published

2020 May - Jun

ISSN Number

1876-2867

Abstract

<p><strong>OBJECTIVE: </strong>Overuse of diagnostic tests is of particular concern for pediatric academic medical centers. Our objective was to measure variation in testing based on proportion of hospitalization during the day versus night and the association between attending in-house coverage on the teaching service and test utilization for hospitalized pediatric patients.</p>

<p><strong>METHODS: </strong>Electronic health record data from 11,567 hospitalizations to a large, Northeastern, academic pediatric hospital were collected between January 2007 and December 2010. The patient-level dataset included orders for laboratory and imaging tests, information about who placed the order, and the timing of the order. Using a cross-sectional effect modification analysis, we estimated the difference in test utilization attributable to attending in-house coverage.</p>

<p><strong>RESULTS: </strong>We found that admission to the teaching service was independently associated with higher utilization of laboratory and imaging tests. However, the number of orders was 0.76 lower (95% confidence interval:-1.31 to -0.21, P = .006) per 10% increase in the proportion in the share of the hospitalization that occurred during daytime hours on the teaching services, which is attributable to direct attending supervision.</p>

<p><strong>CONCLUSIONS: </strong>Direct attending care of hospitalized pediatric patients at night was associated with slightly lower diagnostic test utilization.</p>

DOI

10.1016/j.acap.2019.09.008

Alternate Title

Acad Pediatr

PMID

31648058

Title

Development and Evaluation of High-Value Pediatrics: A High-Value Care Pediatric Resident Curriculum.

Year of Publication

2018

Number of Pages

785-792

Date Published

2018 12

ISSN Number

2154-1663

Abstract

<p>Low-value health care is pervasive in the United States, and clinicians need to be trained to be stewards of health care resources. Despite a mandate by the Accreditation Council for Graduate Medical Education to educate trainee physicians on cost awareness, only 10% of pediatric residency programs have a high-value care (HVC) curriculum. To meet this need, we set out to develop and evaluate the impact of High-Value Pediatrics, an open-access HVC curriculum. High-Value Pediatrics is a 3-part curriculum that includes 4 standardized didactics, monthly interactive morning reports, and an embedded HVC improvement project. Curriculum evaluation through an anonymous, voluntary survey revealed an improvement in the self-reported knowledge of health care costs, charges, reimbursement, and value ( &lt; .05). Qualitative results revealed self-reported behavior changes, and HVC improvement projects resulted in higher-value patient care. The implementation of High-Value Pediatrics is feasible and reveals improved knowledge and attitudes about HVC. HVC improvement projects augmented curricular knowledge gains and revealed behavior changes. It is imperative that formal high-value education be taught to every pediatric trainee to lead the culture change that is necessary to turn the tide against low-value health care. In addition, simultaneous work on faculty education and attention to the hidden curriculum of low-value care is needed for sustained and long-term improvements.</p>

DOI

10.1542/hpeds.2018-0115

Alternate Title

Hosp Pediatr

PMID

30425056

Title

General pediatric attending physicians' and residents' knowledge of inpatient hospital finances.

Year of Publication

2013

Number of Pages

1072-80

Date Published

2013 Jun

ISSN Number

1098-4275

Abstract

<p><strong>BACKGROUND AND OBJECTIVE: </strong>There is evidence suggesting that physicians have a limited foundation of knowledge on health care finances and limited awareness of hospital costs and charges. The objective was to analyze general pediatric attending physicians' and residents' knowledge of costs, charges, and reimbursements for care rendered in the inpatient setting.</p>

<p><strong>METHODS: </strong>An online survey was administered to all general pediatric attending physicians who work on the inpatient service and the entire pediatric residency program at The Children's Hospital of Philadelphia (CHOP) in spring of 2011. Participants' estimates of costs, charges, and reimbursements for several common tests, medications, and services were obtained and analyzed.</p>

<p><strong>RESULTS: </strong>A total of 38 attending physicians and 100 residents participated in the study (84% and 76% response rates, respectively). The majority of both attending physicians (71%) and residents (75%) characterized their understanding as "Minimally knowledgeable" or "Completely unaware". Only 15% of attending physicians' estimates and 11% of residents' estimates were within ±25% of true values across all surveyed costs, charges, and reimbursements. Percent error did not vary by level of experience or self-reported knowledge for attending physicians and residents.</p>

<p><strong>CONCLUSIONS: </strong>Attending physicians and residents demonstrated limited knowledge of costs, charges, and reimbursements as shown by a low accuracy of estimates and a high percent error, compared with the actual values. To meet expectations for competency in systems-based practice and to be effective stewards of medical resources, it appears that pediatricians need further financial education.</p>

DOI

10.1542/peds.2012-1753

Alternate Title

Pediatrics

PMID

23713110

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