Accelerating health care costs have led to a variety of cost containment initiatives. The ideal approach, combining effectiveness, durability of effect, low cost and high physician acceptance, has yet to be found. We propose a comprehensive approach that combines normative, prescriptive, educational and administrative interventions into a feedback program for practicing physicians. Using data in existing hospital information systems, we plan to generate and distribute individualized quarterly reports of clinical practice patterns to the medical staff at a medium sized, university affiliated community hospital in upstate New York. These reports will consist of both normative and prescriptive data, showing each physician how he or she compares to the other attending physicians in the same department with regard to the median length of stay and median total charges across all of his or her inpatients, adjusted for case mix and severity. The physicians in the top decile in each category will be required to have all admissions scrutinized by a Utilization Review audit using the Appropriateness Evaluation Protocol, constituting an educational opportunity as well as a sanction. We will study the impact of this program using a randomized, concurrently controlled experimental design. To the extent that our program uses information technology that is already in widespread use, it offers an approach to cost containment which, if shown to be successful, could be rapidly and relatively inexpensively disseminated.
