Cost-aware care: Critical core competency

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

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


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 (US)
Pages (from-to)222-226
Number of pages5
JournalArchives of Surgery
Issue number3
StatePublished - Mar 1 2007

ASJC Scopus subject areas

  • Surgery


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