Impact of Cost Display on Ordering Patterns for Hospital Laboratory and Imaging Services.

BACKGROUND: Physicians "purchase" many health care services on behalf of patients yet remain largely unaware of the costs of these services. Electronic health record (EHR) cost displays may facilitate cost-conscious ordering of health services. OBJECTIVE: To determine whether displaying hospital lab and imaging order costs is associated with changes in the number and costs of orders placed. DESIGN: Quasi-experimental study. PARTICIPANTS: All patients with inpatient or observation encounters across a multi-site health system from April 2013 to October 2015. INTERVENTION: Display of order costs, based on Medicare fee schedules, in the EHR for 1032 lab tests and 1329 imaging tests. MAIN MEASURES: Outcomes for both lab and imaging orders were (1) whether an order was placed during a hospital encounter, (2) whether an order was placed on a given patient-day, (3) number of orders placed per patient-day, and (4) cost of orders placed per patient-day. KEY RESULTS: During the lab and imaging study periods, there were 248,214 and 258,267 encounters, respectively. Cost display implementation was associated with a decreased odds of any lab or imaging being ordered during the encounter (lab adjusted odds ratio [AOR] = 0.97, p = .01; imaging AOR = 0.97, p < .001), a decreased odds of any lab or imaging being ordered on a given patient-day (lab AOR = 0.95, p < .001; imaging AOR = 0.97, p < .001), a decreased number of lab or imaging orders on patient-days with orders (lab adjusted count ratio = 0.93, p < .001; imaging adjusted count ratio = 0.98, p < .001), and a decreased cost of lab orders and increased cost of imaging orders on patient-days with orders (lab adjusted cost ratio = 0.93, p < .001; imaging adjusted cost ratio = 1.02, p = .003). Overall, the intervention was associated with an 8.5 and 1.7% reduction in lab and imaging costs per patient-day, respectively. CONCLUSIONS: Displaying costs within EHR ordering screens was associated with decreases in the number and costs of lab and imaging orders.

A Grounded Theory of Effective Reading by Profoundly Deaf Adults.

The purpose of the study was to uncover and describe psycholinguistic and sociocognitive factors facilitating effective reading by signing adults who are profoundly deaf and do not use hearing technology. The sample comprised four groups, each consisting of 15 adults, for a total of 60 participants. The four groups were deaf high-achieving, deaf low-achieving, hearing high-achieving, and hearing low-achieving. Measurements included a language background interview and think-aloud reading discussion. Through the lens of a grounded theory approach, the conditions that facilitate effective reading were uncovered-by coding and categorizing themes, relating the codes and categories, and determining a central theme. It was found that there are similarities and differences in how deaf and hearing people process phonological codes and conceptualize language, and that access to varied instructional strategies and meaningful language experiences is an overarching theme in effective reading.

Selected Factors in Reading Comprehension for Deaf and Hearing Adults: Phonological Skills and Metacognition.

The purpose of the study was to identify factors related to reading comprehension, and to compare similarities and differences in the reading processes of deaf and hearing adults. The sample included four groups, each consisting of 15 adults. The groups were identified as (a) deaf high-achieving readers, (b) deaf low-achieving readers, (c) hearing high-achieving readers, and (d) hearing low-achieving readers. Measurement instruments included a demographic form along with assessments of reading comprehension, phonological skills, and metacognition, the latter of which contained both a making-inferences measure and a think-aloud discussion with a reading strategies checklist. Results indicated that deaf high-achieving readers performed similarly to hearing high-achieving readers, except for phonological skills, and that for all participants, phonological skills and metacognition were related to reading comprehension skills.