Cost-aware care: Critical core competency

Rajiv Y. Chandawarkar, Shiv Taylor, Peter Abrams, Andrew Duffy, Anthony Voytovich, Walter E. Longo, Robert Kozol

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Hypothesis: Resident core competence can be improved by learning to accurately estimate the costs of postoperative complications. Design: Prospective, institutional review board-approved study. In step 1, residents were provided 3 clinical vignettes detailing specific treatment measures for postsurgical complications and asked to assign total cost estimates for the treatment for each vignette; in step 2 they were given a pocket-sized cost card listing hospital costs, and in step 3, after 2 weeks, they were retested using the same clinical vignettes as in step 1. Setting: University of Connecticut, Farmington, and the Yale University School of Medicine, New Haven. Participants: Fifty-three general surgery residents. Main Outcome Measures: Cost estimates for steps 1 and 3 were compared using the paired t test and analysis of variance to examine whether there is a difference between the baseline cost estimates and the actual cost; whether introduction of the cost card improves performance; and whether responses correlate to postgraduate year level or to the clinical vignette. Results: There was a statistically significant difference between the baseline cost estimates (before introduction of the cost card) and the actual cost of the treatment (P=.03). Introduction of the cost card resulted in a statistically significant improvement between the cost estimates before and after the intervention (P=.002), with a drop in average percentage error by 35% (range, 32%-38%). Level of postgraduate training or type of test vignette (at analysis of variance) did not seem to be a significant factor. Conclusions: There is a lack of awareness among surgical residents of the cost of treatment of postoperative complications. Introduction of a simple educational tool such as a cost card measurably improves their overall understanding of the cost of care and can be easily incorporated into the residency curriculum.

Original languageEnglish
Pages (from-to)222-226
Number of pages5
JournalArchives of Surgery
Volume142
Issue number3
DOIs
StatePublished - Mar 1 2007
Externally publishedYes

Fingerprint

Critical Care
Costs and Cost Analysis
Health Care Costs
Analysis of Variance
Hospital Costs
Research Ethics Committees
Internship and Residency
Curriculum
Mental Competency
Medicine
Outcome Assessment (Health Care)
Learning

ASJC Scopus subject areas

  • Surgery

Cite this

Chandawarkar, R. Y., Taylor, S., Abrams, P., Duffy, A., Voytovich, A., Longo, W. E., & Kozol, R. (2007). Cost-aware care: Critical core competency. Archives of Surgery, 142(3), 222-226. https://doi.org/10.1001/archsurg.142.3.222

Cost-aware care : Critical core competency. / Chandawarkar, Rajiv Y.; Taylor, Shiv; Abrams, Peter; Duffy, Andrew; Voytovich, Anthony; Longo, Walter E.; Kozol, Robert.

In: Archives of Surgery, Vol. 142, No. 3, 01.03.2007, p. 222-226.

Research output: Contribution to journalArticle

Chandawarkar, RY, Taylor, S, Abrams, P, Duffy, A, Voytovich, A, Longo, WE & Kozol, R 2007, 'Cost-aware care: Critical core competency', Archives of Surgery, vol. 142, no. 3, pp. 222-226. https://doi.org/10.1001/archsurg.142.3.222
Chandawarkar RY, Taylor S, Abrams P, Duffy A, Voytovich A, Longo WE et al. Cost-aware care: Critical core competency. Archives of Surgery. 2007 Mar 1;142(3):222-226. https://doi.org/10.1001/archsurg.142.3.222
Chandawarkar, Rajiv Y. ; Taylor, Shiv ; Abrams, Peter ; Duffy, Andrew ; Voytovich, Anthony ; Longo, Walter E. ; Kozol, Robert. / Cost-aware care : Critical core competency. In: Archives of Surgery. 2007 ; Vol. 142, No. 3. pp. 222-226.
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