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Patient Preferences for Diagnostic Testing in the Emergency Department: A Cross‐sectional Study
Author(s) -
Porath Jonathan D.,
Meka Arjun P.,
Morrow Chelsea,
Iyengar Rahul,
ShtullLeber Eytan,
Fagerlin Angela,
Meurer William J
Publication year - 2018
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13404
Subject(s) - medicine , copayment , emergency department , logistic regression , odds ratio , confidence interval , cross sectional study , odds , emergency medicine , diagnostic test , health care , psychiatry , pathology , health insurance , economics , economic growth
Background Diagnostic 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. Methods We 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. Results Participants 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%, 95% confidence interval [ CI ] = 16% to 28%). Similarly, in the mTBI scenario, 73% of adult participants desired free testing versus 56% when charged a $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. Conclusions In this ED ‐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.