Abstract
BACKGROUND: A lack of cost-conscious medication use is a major contributor to excessive healthcare expenditures in the inpatient setting. Expensive medicines are often utilized when there are comparable alternatives available at a lower cost. Increasing prescriber awareness of medication cost at the time of ordering may help promote cost-conscious use of medications in the hospital. OBJECTIVE: To evaluate the impact of cost messaging on the ordering of 9 expensive medications. DESIGN: Retrospective analysis of an institutional cost-transparency initiative. SETTING: A 1145-bed, tertiary care, academic medical center. PARTICIPANTS: Prescribers who ordered medications through the computerized provider order entry system at the Johns Hopkins Hospital. METHODS: Interrupted time series and segmented regression models were used to examine prescriber ordering before and after implementation of cost messaging for 9 highcost medications. RESULTS: Following the implementation of cost messaging, no significant changes were observed in the number of orders or ordering trends for intravenous (IV) formulations of eculizumab, calcitonin, levetiracetam, linezolid, mycophenolate, ribavirin, and levothyroxine. An immediate and sustained reduction in medication utilization was seen in 2 drugs that underwent a policy change during our study, IV pantoprazole and oral voriconazole. IV pantoprazole became restricted at our facility due to a national shortage (-985 orders per 10,000 patient days; P < 0.001), and oral voriconazole was replaced with an alternative antifungal in oncology order sets (–110 orders per 10,000 patient days; P = 0.001). CONCLUSIONS: Prescriber cost transparency alone did not significantly influence medication utilization at our institution. Active strategies to reduce ordering resulted in dramatic reductions in ordering.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 639-645 |
| Number of pages | 7 |
| Journal | Journal of Hospital Medicine |
| Volume | 12 |
| Issue number | 8 |
| DOIs | |
| State | Published - Aug 1 2017 |
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ASJC Scopus subject areas
- Leadership and Management
- Fundamentals and skills
- Health Policy
- Care Planning
- Assessment and Diagnosis
Cite this
Impact of displaying inpatient pharmaceutical costs at the time of order entry : Lessons from a tertiary care center. / Johnson Conway, Sarah; Brotman, Daniel; Pinto, Brian L.; Merola, David; Feldman, Leonard; Miller, Redonda; Shermock, Kenneth M.
In: Journal of Hospital Medicine, Vol. 12, No. 8, 01.08.2017, p. 639-645.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Impact of displaying inpatient pharmaceutical costs at the time of order entry
T2 - Lessons from a tertiary care center
AU - Johnson Conway, Sarah
AU - Brotman, Daniel
AU - Pinto, Brian L.
AU - Merola, David
AU - Feldman, Leonard
AU - Miller, Redonda
AU - Shermock, Kenneth M
PY - 2017/8/1
Y1 - 2017/8/1
N2 - BACKGROUND: A lack of cost-conscious medication use is a major contributor to excessive healthcare expenditures in the inpatient setting. Expensive medicines are often utilized when there are comparable alternatives available at a lower cost. Increasing prescriber awareness of medication cost at the time of ordering may help promote cost-conscious use of medications in the hospital. OBJECTIVE: To evaluate the impact of cost messaging on the ordering of 9 expensive medications. DESIGN: Retrospective analysis of an institutional cost-transparency initiative. SETTING: A 1145-bed, tertiary care, academic medical center. PARTICIPANTS: Prescribers who ordered medications through the computerized provider order entry system at the Johns Hopkins Hospital. METHODS: Interrupted time series and segmented regression models were used to examine prescriber ordering before and after implementation of cost messaging for 9 highcost medications. RESULTS: Following the implementation of cost messaging, no significant changes were observed in the number of orders or ordering trends for intravenous (IV) formulations of eculizumab, calcitonin, levetiracetam, linezolid, mycophenolate, ribavirin, and levothyroxine. An immediate and sustained reduction in medication utilization was seen in 2 drugs that underwent a policy change during our study, IV pantoprazole and oral voriconazole. IV pantoprazole became restricted at our facility due to a national shortage (-985 orders per 10,000 patient days; P < 0.001), and oral voriconazole was replaced with an alternative antifungal in oncology order sets (–110 orders per 10,000 patient days; P = 0.001). CONCLUSIONS: Prescriber cost transparency alone did not significantly influence medication utilization at our institution. Active strategies to reduce ordering resulted in dramatic reductions in ordering.
AB - BACKGROUND: A lack of cost-conscious medication use is a major contributor to excessive healthcare expenditures in the inpatient setting. Expensive medicines are often utilized when there are comparable alternatives available at a lower cost. Increasing prescriber awareness of medication cost at the time of ordering may help promote cost-conscious use of medications in the hospital. OBJECTIVE: To evaluate the impact of cost messaging on the ordering of 9 expensive medications. DESIGN: Retrospective analysis of an institutional cost-transparency initiative. SETTING: A 1145-bed, tertiary care, academic medical center. PARTICIPANTS: Prescribers who ordered medications through the computerized provider order entry system at the Johns Hopkins Hospital. METHODS: Interrupted time series and segmented regression models were used to examine prescriber ordering before and after implementation of cost messaging for 9 highcost medications. RESULTS: Following the implementation of cost messaging, no significant changes were observed in the number of orders or ordering trends for intravenous (IV) formulations of eculizumab, calcitonin, levetiracetam, linezolid, mycophenolate, ribavirin, and levothyroxine. An immediate and sustained reduction in medication utilization was seen in 2 drugs that underwent a policy change during our study, IV pantoprazole and oral voriconazole. IV pantoprazole became restricted at our facility due to a national shortage (-985 orders per 10,000 patient days; P < 0.001), and oral voriconazole was replaced with an alternative antifungal in oncology order sets (–110 orders per 10,000 patient days; P = 0.001). CONCLUSIONS: Prescriber cost transparency alone did not significantly influence medication utilization at our institution. Active strategies to reduce ordering resulted in dramatic reductions in ordering.
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UR - http://www.scopus.com/inward/citedby.url?scp=85037826403&partnerID=8YFLogxK
U2 - 10.12788/jhm.2779
DO - 10.12788/jhm.2779
M3 - Article
C2 - 28786430
AN - SCOPUS:85037826403
VL - 12
SP - 639
EP - 645
JO - Journal of hospital medicine (Online)
JF - Journal of hospital medicine (Online)
SN - 1553-5606
IS - 8
ER -