National cross-sectional study on cost consciousness, cost accuracy, and national medical waste reduction initiative knowledge among pediatric hospitalists in the United States

• Published in: PloS one Vol. 18; no. 4; p. e0284912
• Main Authors: Lee, Benjamin C, Hall, Matt, Agharokh, Ladan, Yu, Andrew G, Parikh, Kavita, Shah, Samir S
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 24.04.2023; Public Library of Science (PLoS)
• Subjects: Accuracy; Biology and Life Sciences; Child; Children; Children's hospitals; Consciousness; Cost estimates; Cross-Sectional Studies; Decision making; Economic aspects; Evaluation; Health aspects; Health care expenditures; Health care policy; Health care reform; Hospital Costs; Hospitalists; Hospitals; Hospitals, Pediatric; Humans; Independent study; Information systems; Knowledge; Laboratories; Management; Medical care, Cost of; Medical economics; Medical imaging; Medical informatics; Medical students; Medical wastes; Medicine; Medicine and Health Sciences; Pediatrics; People and Places; Physicians; Prevention; Refuse and refuse disposal; Research and Analysis Methods; Respiratory diseases; Self report; Social Sciences; United States; Waste management; United States; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0284912

Despite initiatives to reduce waste and spending, there is a gap in physician knowledge regarding the cost of commonly ordered items. We examined the relationship between pediatric hospitalists' knowledge of national medical waste reduction initiatives, self-reported level of cost-consciousness (the degree in which cost affects practice), and cost accuracy (how close an estimate is to its hospital cost) at a national level. This cross-sectional study used a national, online survey sent to hospitalists at 49 children's hospitals to assess their knowledge of national medical waste reduction initiatives, self-reported cost consciousness, and cost estimates for commonly ordered laboratory studies, medications, and imaging studies. Actual unit costs for each hospital were obtained from the Pediatric Health Information System (PHIS). Cost accuracy was calculated as the percent difference between each respondent's estimate and unit costs, using cost-charge ratios (CCR). The hospitalist response rate was 17.7% (327/1850), representing 40 hospitals. Overall, 33.1% of respondents had no knowledge of national medical waste reduction initiatives and 24.3% had no knowledge of local hospital costs. There was no significant relationship between cost accuracy and knowledge of national medical waste reduction initiatives or high self-reported cost consciousness. Hospitalists with the highest self-reported cost consciousness were the least accurate in estimating costs for commonly ordered laboratory studies, medications, or imaging studies. Respondents overestimated the cost of all items with the largest percent difference with medications. Hospitalists practicing over 15 years had the highest cost accuracy. A large proportion of pediatric hospitalists lack knowledge on national waste reduction initiatives. Improving the cost-accuracy of pediatric hospitalists may not reduce health care costs as they overestimated many hospital costs. Median unit cost lists could be a resource for educating medical students and residents about health care costs.