***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE We sought to determine whether information on hospital charges ( prices ) would affect test-ordering and quality of patient care in a pediatric emergency department ( ED ) . DESIGN Prospect i ve , nonblind , controlled trial of price information . SETTING Urban , university-affiliated pediatric ED . METHODS We prospect ively assessed patients 2 months to 10 years of age with a presenting temperature > /=38.5 degrees C or complaint of vomiting , diarrhea , or decreased oral intake . The assessment s were done during three periods : September 1997 through December 1997 ( control ) , January 1998 through March 1998 ( intervention ) , and April 1998 ( washout ) . In the control and washout periods , physicians noted tests ordered on a list attached to each chart . In the intervention period , physicians noted tests ordered on a similar list that included st and ard hospital charges for each test . Records of each visit were review ed to determine clinical and demographic information as well as patient disposition . In the control and intervention periods , families of nonadmitted patients were interviewed by telephone 7 days after the visit . RESULTS When controlled for triage level , vital signs , and admission rates , in a multivariate model , charges for tests in the intervention period were 27 % less than charges in the control period . The greatest decrease was seen among low-acuity , nonadmitted patients ( 43 % ) . In telephone follow-up , patients in the intervention period were slightly more likely to have made an unscheduled follow-up visit to a health care provider ( 24.4 % vs 17.8 % ) , but did not differ on improved condition ( 86.7 % vs 83.4 % ) or family satisfaction ( 93.8 % vs 93.0 % ) . Adjusted charges in the washout period were 15 % lower than in the control period and 15 % higher than in the intervention period . CONCLUSION Providing price information was associated with a significant reduction in charges for tests ordered on pediatric ED patients with acute illness not requiring admission . This decrease was associated with a slightly higher rate of unscheduled follow-up , but no difference in subjective outcomes or family satisfaction Background Prior studies have demonstrated how price transparency lowers the test-ordering rates of trainees in hospitals , and physician-targeted price transparency efforts have been viewed as a promising cost-controlling strategy . Objective To examine the effect of displaying paid-price information on test-ordering rates for common imaging studies and procedures within an accountable care organization ( ACO ) . Design Block r and omized controlled trial for 1 year . SubjectsA total of 1205 fully licensed clinicians ( 728 primary care , 477 specialists ) . InterventionS tarting January 2014 , clinicians in the Control arm received no price display ; those in the intervention arms received Single or Paired Internal/External Median Prices in the test-ordering screen of their electronic health record . Internal prices were the amounts paid by insurers for the ACO ’s services ; external paid prices were the amounts paid by insurers for the same services when delivered by unaffiliated providers . Main Measures Ordering rates ( orders per 100 face-to-face encounters with adult patients ): overall , design ated to be completed internally within the ACO , considered “ inappropriate ” ( e.g. , MRI for simple headache ) , and thought to be “ appropriate ” ( e.g. , screening colonoscopy).Key Results We found no significant difference in overall ordering rates across the Control , Single Median Price , or Paired Internal/External Median Prices study arms . For every 100 encounters , clinicians in the Control arm ordered 15.0 ( SD 31.1 ) tests , those in the Single Median Price arm ordered 15.0 ( SD 16.2 ) tests , and those in the Paired Prices arms ordered 15.7 ( SD 20.5 ) tests ( one-way ANOVA p-value 0.88 ) . There was no difference in ordering rates for tests design ated to be completed internally or considered to be inappropriate or appropriate . Conclusions Displaying paid-price information did not alter how frequently primary care and specialist clinicians ordered imaging studies and procedures within an ACO . Those with a particular interest in removing waste from the health care system may want to consider a variety of context ual factors that can affect physician-targeted price transparency PURPOSE The aim of this study was to determine whether presenting  providers  with cost information at the point of order entry significantly influences  imaging utilization .  METHODS Using data from fiscal year 2007 , the 10 most frequently ordered imaging tests were identified . Five of these were r and omly assigned to the active cost display group and 5 to the control group . During a 6-month baseline period from November 10 , 2008 , to May 9 , 2009 , no costs were displayed . During a seasonally matched intervention period from November 10 , 2009 , to May 9 , 2010 , costs were displayed only for tests in the active group . At the conclusion of the study , the radiology information system was queried to determine the number of orders executed for all tests during both periods . The main outcome measure was the mean relative utilization change between the control and intervention periods for the active group vs the control group . An additional measure was the correlation between test cost and utilization change in the active group vs the control group . RESULTS The mean utilization change was + 2.8 ± 4.4 % for the active group and -3.0 ± 5.5 % for the control group , with no significant difference between the two groups ( P = .10 , Student 's t-test ) . There was also no significant difference in the correlation between test cost and utilization change for the active group vs the control group ( P = .25 , Fisher 's z-test ) . On the basis of the observed st and ard deviations , this study had 90 % power to detect an 11.8 % difference in mean relative utilization change between groups . CONCLUSIONS Provider cost transparency alone does not significantly influence inpatient imaging utilization Objectives To determine the impact of systemwide charge display on laboratory utilization . Methods This was a r and omized controlled trial with a baseline period and an intervention period . Tests were r and omized to a control arm or an active arm . The maximum allowable Medicare reimbursement rate was displayed for tests in the active arm during the intervention period . Total volume of tests in the active arm was compared with those in the control arm . Residents were surveyed before and after the intervention to assess charge awareness . Results Charge display had no effect on order behavior . This result held for patient type ( inpatient vs outpatient ) and for insurance category ( commercial , government , self-pay ) . Residents  overestimated the charges of tests both before and after the intervention . Many residents failed to notice the charge display in the computerized order entry system . Conclusions The impact of charge display depends on context . Charge display is not always effective OBJECTIVE To assess the effects on health care re source utilization of a network of microcomputer workstations for writing all inpatient orders . DESIGN R and omized controlled clinical trial . SETTING Inpatient internal medicine service of an urban public hospital . SUBJECTS A total of 5219 internal medicine patients and the 68 teams of house officers , medical students , and faculty internists who cared for them . INTERVENTION Microcomputer workstations , linked to a comprehensive electronic medical record system , for writing all inpatient orders . MAIN OUTCOME MEASURES Total inpatient charges for each admission and charges for specific categories of orders . A time-motion study of selected interns assessed the ordering system 's time consumption . RESULTS Intervention teams generated charges that were $ 887 ( 12.7 % ) lower per admission than did control teams ( P = .02 ) . Significant reductions ( P < .05 ) were demonstrated separately for bed charges , diagnostic test charges , and drug charges . Reductions of similar proportion and statistical significance were found for hospital costs . The mean length of stay was 0.89 day shorter for intervention resident teams ( P = .11 ) . Interns in the intervention group spent an average of 33 minutes longer ( 5.5 minutes per patient ) during a 10-hour observation period writing orders than did interns in the control group ( P < .0001 ) . CONCLUSIONS A network of microcomputer workstations for writing all inpatient orders significantly lowered patient charges and hospital costs . This would amount to savings of more than $ 3 million in charges annually for this hospital 's medicine service and potentially tens of billions of dollars nationwide . However , the system required more physician time than did the paper charts . Research at other sites and system advances to reduce time requirements are warranted BACKGROUND AND OBJECTIVES : Ordering rates for imaging studies and procedures may change if clinicians are shown the prices of those tests while they are ordering . We studied the effect of 2 forms of paid price information , single median price and paired internal/external median prices , on how often pediatric-focused and adult-oriented clinicians ( most frequently general pediatricians and adult specialists caring for pediatric-aged patients , respectively ) order imaging studies and procedures for 0- to 21-year-olds . METHODS : In January 2014 , we r and omized 227 pediatric-focused and 279 adult-oriented clinicians to 1 of 3 study arms : Control ( no price display ) , Single Median Price , or Paired Internal/External Median Prices ( both with price display in the ordering screen of electronic health record ) . We used 1-way analysis of variance and paired t tests to examine how frequently clinicians ( 1 ) placed orders and ( 2 ) design ated tests to be completed internally within an accountable care organization . RESULTS : For pediatric-focused clinicians , there was no significant difference in the rates at which orders were placed or design ated to be completed internally across the study arms . For adult-oriented clinicians caring for children and adolescents , however , those in the Single Price and Paired Price arms placed orders at significantly higher rates than those in the Control group ( Control 3.2 [ SD 4.8 ] , Single Price 6.2 [ SD 6.8 ] , P < .001 and Paired Prices 5.2 [ SD 7.9 ] , P = .04 ) . The rate at which adult-oriented clinicians design ated tests to be completed internally was not significantly different across arms . CONCLUSIONS : The effect of price information on ordering rates appears to depend on whether the clinician is pediatric-focused or adult-oriented We studied the effect of informing physicians of the charges for outpatient diagnostic tests on their ordering of such tests in an academic primary care medical practice . All tests were ordered at microcomputer workstations by 121 physicians . For half ( the intervention group ) , the charge for the test being ordered and the total charge for tests for that patient on that day were displayed on the computer screen . The remaining physicians ( control group ) also used the computers but received no message about charges . The primary outcomes measured were the number of tests ordered and the charges for tests per patient visit . In the 14 weeks before the study , the number of tests ordered and the average charge for tests per patient visit were similar for the intervention and control groups . During the 26-week intervention period , the physicians in the intervention group ordered 14 percent fewer tests per patient visit than did those in the control group ( P less than 0.005 ) , and the charges for tests were 13 percent ( $ 6.68 per visit ) lower ( P less than 0.05 ) . The differences were greater for scheduled visits ( 17 percent fewer tests and 15 percent lower charges for the intervention group ; P less than 0.01 ) than for unscheduled ( urgent ) visits ( 11 percent fewer tests and 10 percent lower charges ; P greater than 0.3 ) . During the 19 weeks after the intervention ended , the number of tests ordered by the physicians in the intervention group was only 7.7 percent lower than the number ordered by the physicians in the control group , and the charges for tests were only 3.5 percent lower ( P greater than 0.3 ) . Three measures of possible adverse outcomes --number of hospitalizations , emergency room visits , and outpatient visits during the study period and the following six months -- were similar for the patients seen by the physicians in both groups . We conclude that displaying the charges for diagnostic tests significantly reduced the number and cost of tests ordered , especially for patients with scheduled visits . The effects of this intervention did not persist after it was discontinued Objectives The aim of this study was to establish whether price list information could reduce laboratory and radiological examination costs in emergency departments ( EDs ) . Material s and methods A prospect i ve survey of adult ( > 16 years old ) admissions was conducted at the ED of a university hospital in Belgium . Nine resident emergency physicians were followed for a span of 6 months , which was divided into 2-month periods : control ( October and November 2011 ) , intervention ( December 2011 to January 2012 ) , and washout ( February and March 2012 ) . Laboratory and radiological costs for each of the daily admissions were calculated during the respective periods and compared . Results A total of 3758 patients were registered : 1093 in period 1 ( control ) , 1329 in period 2 ( intervention ) , and 1336 in period 3 ( washout ) . We observed significant reductions in examination costs : 10.73 % ( P=0.015 ) for laboratory and 33.66 % ( P<0.001 ) for radiological costs in period 2 versus period 1 ; 5.02 % ( P=0.014 ) for laboratory and 40.00 % ( P<0.001 ) for radiological costs in period 3 versus period 1 . In addition , we found that laboratory examination costs increased slightly between periods 2 and 3 ( + 6.4 % ) , whereas costs related to radiologic examinations continued to decrease ( −10.16 % ) ; however , these differences were not statistically significant . Conclusion We conclude that the distribution of price lists at EDs promotes cost awareness , which can result in significant decreases in examination costs Objective Reference tests , also known as send-out tests , are commonly ordered labor 
    Output:
    
Provider price display in electronic health record environment did not consistently influence domains of healthcare quality such as efficiency , effectiveness and patient safety .
Conclusions Published evidence suggests that price display tools aim ed at ordering providers in EHR/CPOE do not influence the efficiency domain of healthcare quality .
Scant published evidence suggests that they do not influence the effectiveness and patient safety domains of healthcare quality .