Successful use of education and cost-based feedback strategies to reduce physician utilization of low-osmolality contrast agents in the cardiac catheterization laboratory

For the more than 1 million cardiac catheterizations performed in the United States annually, the cost of iodinated contrast agents is an important and potentially adjustable factor in overall cost. Low-osmolality contrast agents decrease the incidence of adverse effects, but are 15 to 20 times more expensive. Most adverse reactions to high-osmolality contrast agents are minor and generally do not prolong hospital stay or result in permanent injury.^1-4 A cost-effective solution would be to reserve low-osmolality agents for high-risk patients who are at greatest risk for contrast-related complications.^5-11 Implementation of strategies to promote cost-effective use of resources is often hampered by the difficulty of modifying physician behavior. Most studies looking at methods to alter physician-ordering behavior have been directed at the overuse of laboratory and radiographic tests. Educational strategies alone have a variable effect on test-ordering patterns of physicians.^12-14 Approaches in which physicians are given individual cost feedback information on practice patterns lead to a more consistent reduction in test utilization.^15,16 In this report, we examine the impact of education and cost feedback strategies to modify physician use of low-osmolality contrast agents for cardiac diagnostic and interventional catheterization procedures.