Patient Preferences for Diagnostic Testing in the Emergency Department: A Crossâ sectional Study

BackgroundDiagnostic testing is common during emergency department (ED) visits. Little is understood about patient preferences for such testing. We hypothesized that a patient’s willingness to undergo diagnostic testing is influenced by the potential benefit, risk, and personal cost.MethodsWe conducted a cross sectional survey among ED patients for diagnostic testing in two hypothetical scenarios: chest pain (CP) and mild traumatic brain injury (mTBI). Each scenario defined specific risks, benefits, and costs of testing. The odds of a participant desiring diagnostic testing were calculated using a series of nested multivariable logistic regression models.ResultsParticipants opted for diagnostic testing 68.2% of the time, including 69.7% of CP and 66.7% of all mTBI scenarios. In the CP scenario, 81% of participants desired free testing versus 59% when it was associated with a $100 copay (difference = 22$100 copayment (difference = 17%, 95% CI = 11% to 24%). Benefit and risk had mixed effects across the scenarios. 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.ConclusionsIn this EDâ based study, patient preferences for diagnostic testing differed significantly across levels of risk, benefit, and cost of diagnostic testing. Cost was the strongest and most consistent factor associated with decreased desire for testing.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/144652/1/acem13404.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/144652/2/acem13404_am.pd

The Effect of Financial Incentives on Patient Decisions to Undergo Low-Value Head CT Scans

Background Excessive diagnostic testing and defensive medicine contribute to billions of dollars in avoidable costs in the US annually. Our objective was to determine the influence of financial incentives, accompanied with information regarding test risk and benefit, on patient preference for diagnostic testing. Methods We conducted a cross-sectional survey of patients at the University of Michigan Emergency Department (ED). Each participant was presented with a hypothetical scenario involving an ED visit following minor traumatic brain injury. Participants were given information regarding potential benefit (detecting brain hemorrhage) and risk (developing cancer) of head CT scan, as well as an incentive of 0 or 100 USD to forego testing. We used 0.1% and 1% for test benefit and risk, and values for risk, benefit, and financial incentive varied across participants. Our primary outcome was patient preference to undergo testing. We also collected demographic and numeracy information. Then, we used logistic regression to estimate odds ratios, which were adjusted for multiple potential confounders. Our sample size was designed to find at least 300 events (preference for testing) to allow for inclusion of up to 30 covariates in fully adjusted modules. We had 99% power to detect a 10% absolute difference in testing rate across groups, assuming a 95% significance level. Results We surveyed 913 patients. Increasing test benefit from 0.1% to 1% significantly increased test acceptance (adjusted Odds Ratio [AOR] 1.6; 95% Confidence Interval [CI] 1.2-2.1) and increasing test risk from 0.1% to 1% significantly decreased test acceptance (OR 0.70; 95% CI 0.52-0.93). Finally, a 100 USD incentive to forego low-value testing significantly reduced test acceptance (OR 0.6; 95% CI 0.4-0.8). Conclusions Providing financial incentives to forego testing significantly decreased patient preference for testing, even when accounting for varying test benefit and risk. This work is preliminary, hypothetical, and requires confirmation in larger patient cohorts facing these actual decisions