Cost Matters Most in Patient Preference for ED Diagnostic Testing

by U.S. Medicine

October 28, 2018

ANN ARBOR, MI — Diagnostic testing is often used during emergency department (ED) visits. But, in the rush to diagnosis and treat patients, often not much attention is paid to patient preferences for such testing, according to a recent study.

The article in Academic Emergency Medicine hypothesized that willingness to undergo diagnostic testing is influenced by a balance among the potential benefit to patients, as well as risk, and personal cost.1

A study team led by University of Michigan researchers and including participation from the Salt Lake City, UT, VAMC conducted a cross sectional survey among ED patients for diagnostic testing in two hypothetical scenarios: chest pain (CP) and mild traumatic brain injury (mTBI).

For each scenario, specific risks, benefits, and costs of testing were detailed. Researchers sought to calculate the odds of a participant desiring diagnostic testing.

Results indicated that patients opted for diagnostic testing 68.2% of the time, including 69.7% of CP and 66.7% of all mTBI scenarios.

The study team found that, in the CP scenario, 81% of participants desired free testing vs. 59% when it was associated with a $100 copay (difference = 22%, 95% confidence interval [CI] = 16% to 28%).

Results were similar in the mTBI scenario: 73% of adult participants desired free testing vs. 56% when charged a $100 copayment (difference = 17%, 95% CI = 11% to 24%).

“Benefit and risk had mixed effects across the scenarios,” the researchers noted, adding that, in fully adjusted models, the association between cost and desire for testing persisted in the CP (odds ratio [OR] = 0.33, 95% CI = 0.23 to 0.47) and adult mTBI (OR = 0.47, 95% CI = 0.33 to 0.67) scenarios.

“In this ED-based study, patient preferences for diagnostic testing differed significantly across levels of risk, benefit, and cost of diagnostic testing,” study authors concluded. “Cost was the strongest and most consistent factor associated with decreased desire for testing.”

1. Porath JD, Meka AP, Morrow C, Iyengar R, Shtull-Leber E, Fagerlin A, Meurer WJ. Patient Preferences for Diagnostic Testing in the Emergency Department: A Cross-sectional Study. Acad Emerg Med. 2018 Jun;25(6):627-633. doi: 10.1111/acem.13404. PubMed PMID: 29505177; PubMed Central PMCID: PMC5995656.

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