1. The Perfect Storm Develop a tool that: –Assesses residents current inpatient ordering habits, and what influences them –Assess residents knowledge of health care economics –Can measure the effect of various interventions

2. Medicine Resident Questionnaire of Inpatient Test Ordering Created Domains: –Who influences your ordering? –How do you order? –Knowledge of heath care economics? Held focus groups with residents –Transcribed and reviewed over 100 questions –Developed 48 question survey –Administered to small sample group of residents first, and made revisions Administered to Internal Medicine house staff (5/08) –Excluded ER/Pre-lim Re-administered 2 weeks later to smaller group to evaluate inter-individual reliability (.9) Administered to a sample of Attendings Administered via Survey Monkey to an outside institution to evaluate generalizability

3. Ward Attending Influence -> PGY = 1 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- Attend_Inf~t | 30 2.766667.727932 2 4 Attend_Inf~l | 30 2.033333.7183954 1 3 -------------------------------------------------------------------------------------- -> PGY = 2 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- Attend_Inf~t | 31 3.258065.8932242 2 5 Attend_Inf~l | 31 2.516129.625618 1 3 -------------------------------------------------------------------------------------- -> PGY = 3 Variable | Obs Mean Std. Dev. Min Max -------------+-------------------------------------------------------- Attend_Inf~t | 27 3.444444.8915558 1 4 Attend_Inf~l | 27 3.037037.8077262 2 4 Blood Test Radiographs Blood Test Radiographs Blood Test Radiographs Influence Scale 1 = Most 4 = Least

4. Predicted CBC Charge, by PGY

5. Predicted CT Chest Charge, by PGY

6. Variable Obs Mean Std. Err. Std. Dev. [95% Conf. Interval] BMP 89 182.58 15.54162 146.6193 151.6986 213.47 mean = mean(BMP) t = -13.9893 Ho: mean = 400 degrees of freedom = 88 Ha: mean 400 Pr(T |t|) = 0.0000 Pr(T > t) = 1.0000 ECHO | 89 1207.86 83.34529 786.2779 1042.234 1373.496 mean = mean(ECHO) t = -57.4974 Ho: mean = 6000 degrees of freedom = 88 Ha: mean 6000 Pr(T |t|) = 0.0000 Pr(T > t) = 1.0000 MRI | 89 4179.77 255.4622 2410.025 3672.098 4687.453 mean = mean(MRI) t = -14.9542 Ho: mean = 8000 degrees of freedom = 88 Ha: mean 8000 Pr(T |t|) = 0.0000 Pr(T > t) = 1.0000

7. Knowledge:Interest Mismatch My Knowledge & Understanding of Healthcare Costs is Mean 3.4 (Fair – Poor ) It is important to Know the Costs Of Labs and Imaging Studies Mean 2.1 (Agree)

8. Obtaining Information Variable | Obs Mean Std. Dev. Med School Edu | 89 3.96.79 Resident Edu | 89 3.78.69 Ease of Finding Info | 89 3.87.73 Score 4.0 = Poor

9. Where We Go From Here Continue to improve survey by examining: –Reliability –Validity –Generizability Apply for Funding Evaluate the effect of interventions aimed at altering ordering behavior Principal Investigator: –Jesse Goldman Thank You: –Jesse Goldman –Hana Choe –Tapan Patel –Sridhar Reddy –House staff