Intensive CarePRICENCT02476591
Charge Transparency in Critical Care Practice and Its Effects on Overall Cost of Care
An observational study of Intensive Care, run by Vanderbilt University.
Trial summary
To investigate the effects of the availability of daily patient-related charges on ordering patterns of health care ordering providers and cost containment in the Intensive Care Unit (ICU) setting. Read more about this study
- Who is it for?
- Ages 16 years and older
- Conditions the study is for
- Intensive Care
- What is being tested?
- Charge Transparency
- Type of treatment
- Lifestyle or therapy programme
- How many people
- 10,720 participants
- Where
- No sites listed yet
- Study dates
- 2 Nov 2015to 3 Oct 2016
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 16 years and older
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: All patients admitted to the Vanderbilt University Medical Center Cardiovascular, Surgical, Burn, Medical and Neuroscience ICUs will be included
Who may be able to join
- All patients admitted to the Vanderbilt University Medical Center Cardiovascular, Surgical, Burn, Medical and Neuroscience ICUs will be included
Who cannot join
- There are no exclusion criteria
About this study
Official title: Charge Transparency in Critical Care Practice and Its Effects on Overall Cost of Care: Physician Awareness of ICU Charge Environment: The PRICE Study
To investigate the effects of the availability of daily patient-related charges on ordering patterns of health care ordering providers and cost containment in the Intensive Care Unit (ICU) setting.
Read the detailed description
Ordering providers include resident, fellow and attending physicians, as well as mid level providers such as Nurse Practitioners (NP's) and Physician Assistants (PA's). The investigators have developed a dashboard that displays both daily and cumulative charges related to laboratory, pharmacy, radiology, and other services for all patients admitted to Vanderbilt ICU's. Using this dashboard an ICU ordering provider is able to see not only the total daily charges for the previous 24 hours, but also the sum of all charges for that patient's current ICU admission. In addition, a "snapshot" overview tab is available for each patient that displays a day by day trend of the overall charges of the ICU stay for the patient, top 5 most expensive lab/radiology/pharmacy charges, previous 24 hour charges, and the total ICU number of chest x-ray, Complete Blood Count (CBC), Basic Metabolic Panel (BMP), Electrocardiogram (EKG), and Arterial Blood Gas (ABG) charges to the patient. The ordering provider is able to query the database of the dashboard for information regarding individual laboratory and drug charges, as well as view trajectory of total charges for a given patient. This dashboard allows for unprecedented transparency regarding the cost of care for patients in an ICU. Patients are identified in the dashboard by Medical Record Number (MRN), ICU bed, and initials only so as to protect their identity.
AIM 1: To evaluate the effects of introducing charge transparency to ordering providers via a charge dashboard and associated printed synopsis on average charge per patient per day in the Vanderbilt ICUs.
We intend to study the effect of charge transparency to ordering providers on average charge per patient per day by conducting a prospective, self-controlled by unit, multiple cross-over trial. We will divide the study period into four 12-week blocks with two blocks of "charge transparency" and two blocks of "no transparency." Each unit will be assigned to alternating blocks of "transparency" and "no transparency" during the study with each unit on the same schedule so as to prevent cross contamination.
For months during which access is granted, all ordering providers in the study ICU will be granted access to the ICU charge dashboard following a brief orientation. In addition a password protected, unit specific iPad will be provided to each study unit. The iPad will enable point of care access to the patient specific snapshot information, as well as easily incorporate the dashboard information into clinical care.
AIM 2: To evaluate the effects of utilization of a charge dashboard on ordering patterns of providers and cost containment in the Vanderbilt ICUs.
In addition to studying the effect of charge transparency on patient ICU charges, we also intend to study the effect of charge transparency on resource utilization, namely routine laboratory and radiology tests. As surrogate markers for routine laboratory utilization we will measure average number of Comprehensive Blood Count (CBC) and Basic Metabolic Panel (BMP) tests per patient per day, and as surrogate markers for routine radiology utilization we will use average number of chest x-rays per patient per day.
- Conditions
- Intensive Care
- Being tested
- Charge Transparency
- Keywords
- Resource utilization, intensive care unit
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Charge TransparencyBehavioural
Providers caring for patients in the "Charge Transparency" cohort will be given access to patient specific charge data on a daily basis via an interactive dashboard which allows for full charge transparency to patients admitted to the Vanderbilt ICUs
| Study group | Role | What they receive |
|---|---|---|
| Charge transparency | Providers with access to charge transparency as displayed via a dashboard with patient specific charge data for a given ICU stay Receives: Behavioral: Charge Transparency | |
| Without charge transparency | Providers without access to patient specific charge data |
What is being measured
The primary outcome is the main question the study is designed to answer.
Average charge per patient per day ($)
Sum hospital charges for each study unit during the 12 week block will be divided by total number of patients admitted to the study unit during that time, and again by 84 days to obtain average charge per patient per day in the ICU during the study period for each cohort.
Measured: 12 week block
Secondary outcomes (3)
Average number of Basic Metabolic Panels per patient per day
Sum total of basic metabolic panels for each study unit during the 12 week block will be divided by total number of patients admitted to the study unit during that time, and again by 84 days to obtain average number of basic metabolic panels per patient per day in the ICU during the study period for each cohort.
Measured: 12 week blocks
Average number of complete blood counts per patient per day
Sum total of complete blood counts for each study unit during the 12 week block will be divided by total number of patients admitted to the study unit during that time, and again by 84 days to obtain average number of complete blood counts per patient per day in the ICU during the study period for each cohort.
Measured: 12 weeks
Average number of chest x-rays per patient per day
Sum total of portable chest x-rays for each study unit during the 12 week block will be divided by total number of patients admitted to the study unit during that time, and again by 84 days to obtain average number of chest x-rays per patient per day in the ICU during the study period for each cohort.
Measured: 12 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted19 Jun 2015 (estimated)
- Study start2 Nov 2015
- Primary completion3 Oct 2016
- Study completion3 Oct 2016
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Intensive CareStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 10,720 participants (actual)
Sponsor and investigators
- Lead sponsor
- Vanderbilt University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Adam Kingeter, Vanderbilt University
- Investigators
- Adam J Kingeter, MD, Principal investigator, Vanderbilt University Medical Center
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02476591
- Sponsor's protocol ID
- 150722
- Acronym
- PRICE
- Status last verified
- May 2017
- First submitted
- 11 Jun 2015
- Last updated
- 9 May 2017
- Results posted
- No
- Data monitoring committee
- No
Study at a glance
From the registry record, last updated by the sponsor on 9 May 2017. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Charge Transparency in Critical Care Practice and Its Effects on Overall Cost of Care: Physician Awareness of ICU Charge Environment: The PRICE Study
- ClinicalTrials.gov ID
- NCT02476591
- Acronym / sponsor ID
- PRICE / 150722
- Conditions
- Intensive Care
- Keywords
- Resource utilization, intensive care unit
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 10,720 participants (actual)
- Lead sponsor
- Vanderbilt UniversityUniversity, hospital or other
- Study start
- 2 Nov 2015 (actual)
- Primary completion
- 3 Oct 2016 (actual)
- Study completion
- 3 Oct 2016 (actual)
- First posted
- 19 Jun 2015 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
To investigate the effects of the availability of daily patient-related charges on ordering patterns of health care ordering providers and cost containment in the Intensive Care Unit (ICU) setting.
Detailed description
Ordering providers include resident, fellow and attending physicians, as well as mid level providers such as Nurse Practitioners (NP's) and Physician Assistants (PA's). The investigators have developed a dashboard that displays both daily and cumulative charges related to laboratory, pharmacy, radiology, and other services for all patients admitted to Vanderbilt ICU's. Using this dashboard an ICU ordering provider is able to see not only the total daily charges for the previous 24 hours, but also the sum of all charges for that patient's current ICU admission. In addition, a "snapshot" overview tab is available for each patient that displays a day by day trend of the overall charges of the ICU stay for the patient, top 5 most expensive lab/radiology/pharmacy charges, previous 24 hour charges, and the total ICU number of chest x-ray, Complete Blood Count (CBC), Basic Metabolic Panel (BMP), Electrocardiogram (EKG), and Arterial Blood Gas (ABG) charges to the patient. The ordering provider is able to query the database of the dashboard for information regarding individual laboratory and drug charges, as well as view trajectory of total charges for a given patient. This dashboard allows for unprecedented transparency regarding the cost of care for patients in an ICU. Patients are identified in the dashboard by Medical Record Number (MRN), ICU bed, and initials only so as to protect their identity.
AIM 1: To evaluate the effects of introducing charge transparency to ordering providers via a charge dashboard and associated printed synopsis on average charge per patient per day in the Vanderbilt ICUs.
We intend to study the effect of charge transparency to ordering providers on average charge per patient per day by conducting a prospective, self-controlled by unit, multiple cross-over trial. We will divide the study period into four 12-week blocks with two blocks of "charge transparency" and two blocks of "no transparency." Each unit will be assigned to alternating blocks of "transparency" and "no transparency" during the study with each unit on the same schedule so as to prevent cross contamination.
For months during which access is granted, all ordering providers in the study ICU will be granted access to the ICU charge dashboard following a brief orientation. In addition a password protected, unit specific iPad will be provided to each study unit. The iPad will enable point of care access to the patient specific snapshot information, as well as easily incorporate the dashboard information into clinical care.
AIM 2: To evaluate the effects of utilization of a charge dashboard on ordering patterns of providers and cost containment in the Vanderbilt ICUs.
In addition to studying the effect of charge transparency on patient ICU charges, we also intend to study the effect of charge transparency on resource utilization, namely routine laboratory and radiology tests. As surrogate markers for routine laboratory utilization we will measure average number of Comprehensive Blood Count (CBC) and Basic Metabolic Panel (BMP) tests per patient per day, and as surrogate markers for routine radiology utilization we will use average number of chest x-rays per patient per day.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Charge transparency | – | Behavioral: Charge TransparencyProviders with access to charge transparency as displayed via a dashboard with patient specific charge data for a given ICU stay |
| Without charge transparency | – | –Providers without access to patient specific charge data |
Who may qualify
- Ages
- 16 years and older
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- Study population
- All patients admitted to the Vanderbilt University Medical Center Cardiovascular, Surgical, Burn, Medical and Neuroscience ICUs will be included
Key inclusion criteria (1 listed)
- All patients admitted to the Vanderbilt University Medical Center Cardiovascular, Surgical, Burn, Medical and Neuroscience ICUs will be included
Key exclusion criteria (1 listed)
- There are no exclusion criteria
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Charge TransparencyProviders caring for patients in the "Charge Transparency" cohort will be given access to patient specific charge data on a daily basis via an interactive dashboard which allows for full charge transparency to patients admitted to the Vanderbilt ICUs | Behavioural | Charge transparency |
Primary outcome
Average charge per patient per day ($)
Time frame: 12 week block
Sum hospital charges for each study unit during the 12 week block will be divided by total number of patients admitted to the study unit during that time, and again by 84 days to obtain average charge per patient per day in the ICU during the study period for each cohort.
3 secondary outcomes
Average number of Basic Metabolic Panels per patient per day
Time frame: 12 week blocks
Average number of complete blood counts per patient per day
Time frame: 12 weeks
Average number of chest x-rays per patient per day
Time frame: 12 weeks
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 9 May 2017.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Adam J Kingeter, MD principal investigator
Vanderbilt University Medical Center
Questions about this trial
What is this clinical trial studying?
An observational study of Intensive Care, run by Vanderbilt University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 1 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 9 May 2017. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Average charge per patient per day ($) (time frame: 12 week block). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 9 May 2017.