Cost-Aware Care: Critical Core Competency

Hypothesis Resident core competence can be improved by learning to accurately estimate the costs of postoperative complications. Design Prospective, institutional review board–approved study. In step 1, residents were provided 3 clinical vignettes detailing specific treatment measures for postsurgical complications and asked to assign total cost estimates for the treatment for each vignette; in step 2 they were given a pocket-sized cost card listing hospital costs, and in step 3, after 2 weeks, they were retested using the same clinical vignettes as in step 1. Setting University of Connecticut, Farmington, and the Yale University School of Medicine, New Haven. Participants Fifty-three general surgery residents. Main Outcome Measures Cost estimates for steps 1 and 3 were compared using the paired t test and analysis of variance to examine whether there is a difference between the baseline cost estimates and the actual cost; whether introduction of the cost card improves performance; and whether responses correlate to postgraduate year level or to the clinical vignette. Results There was a statistically significant difference between the baseline cost estimates (before introduction of the cost card) and the actual cost of the treatment ( P  = .03). Introduction of the cost card resulted in a statistically significant improvement between the cost estimates before and after the intervention ( P  = .002), with a drop in average percentage error by 35% (range, 32%-38%). Level of postgraduate training or type of test vignette (at analysis of variance) did not seem to be a significant factor. Conclusions There is a lack of awareness among surgical residents of the cost of treatment of postoperative complications. Introduction of a simple educational tool such as a cost card measurably improves their overall understanding of the cost of care and can be easily incorporated into the residency curriculum.