P3D189: A Study on the Efficacy of Didactic Modules in Preventing Residents from Ordering Unnecessary Testing

Background: Value-based healthcare is a growing area of interest in the medical community as it becomes increasingly apparent that both medical institutions and patients share a common interest in high-value care that is also cost-conscious. As healthcare costs continue to increase, it is important to address the extent to which physicians commonly order unnecessary diagnostic testing without knowledge of their costs to patients and hospitals. This is especially salient in the field of pediatrics where the cost of healthcare impacts entire family systems. Thus, the purpose of this study was to investigate whether using dedicated educational time to teach residents about value-based care is a worthwhile use of hospital resources.

Methods: We employed a standardized didactic session with 36 emergency medicine and pediatric residents at Nemours Children’s Hospital in Orlando using the common pediatric emergency scenario of a Brief Resolved Unexplained Event (BRUE) in an otherwise healthy 3-month-old infant. This simulated scenario follows a standardized evidence-based treatment algorithm that recommends clinicians order minimal diagnostic testing and discharge patients home on the same day. Residents were first presented with a clinical vignette depicting a BRUE. Next, given a list of commonly ordered interventions, residents chose what labs, procedures, imaging, and medication they would order for their patient. They also chose whether to admit or discharge the patient. All residents then participated in a 20-minute didactic lecture on value-based healthcare. Four to six weeks later, they were contacted via email with a similar BRUE clinical vignette and repeated the exercise of placing orders. One-tailed t-tests were performed to assess whether there was a decrease in the amount and average cost of interventions ordered after didactic training, or an increase in the number of patients who correctly discharged their patients home according to BRUE guidelines.

Results: We determined that there was a statistically significant decrease in the amount of labs (p = 0.006) and procedures (p = 0.031) ordered by residents when they were reassessed following the didactic session. There was also found to be a significant decrease in the average total cost of labs, procedures, and imaging ordered by each resident after the didactic session (p=0.002). There was found to be a significant increase in the proportion of residents who correctly discharged their patients home after receiving the didactic session (p= 0.0005).

Conclusion: These results demonstrate the benefits of using educational resources to teach residents about value-based healthcare to reduce the amount of unnecessary costs associated with ordering excess interventions.