By Maya Dewan, MD, MPH
In today’s world, a simple online search yields endless information about the quality and cost of restaurants, retail shops, even pets, but finding information on both the cost and the quality of a particular test is nearly impossible. Our team, which is composed of multiple physicians, including myself, Dr. Bimal Desai, and Dr. Evan Fieldston, as well as undergraduate computer scientist students under Professor Chris Murphy from The University of Pennsylvania, are working to develop a smartphone application to tackle this very problem for pediatric healthcare providers.
First, our application focuses on the quality of a particular diagnostic test. The user selects the likelihood that a patient has a particular disease in the app. Let’s use appendicitis as an example. Hints appear in the app to help the user select the likelihood of the disease based on clinical expectations. Specifically for appendicitis, the application states that “Children with fever > 38°C, nausea or vomiting, and anorexia have an 8-48% chance of having appendicitis”. Based upon the user’s concern for appendicitis they then select the likelihood on a sliding scale from 0 to 1. Next, the user selects the particular diagnostic test they are interested in utilizing for their patient. For appendicitis they can choose from simple blood work or complicated imaging tests. Each test has displayed cost information next to it in a Zagat style $-$$$$. The application then displays the likelihood that the patient has appendicitis if the test is positive and the likelihood that the patient has appendicitis if the test is negative. This allows the user to see that while simple blood work is much cheaper ($), it does very little to affect the users confidence that the patient has or doesn’t have appendicitis. However, an abdominal ultrasound ($$$), while more expensive than laboratory work, significantly increases or decreases the confidence that the patient has appendicitis at a similar quality but lower cost to abdominal CT testing ($$$$).
As we continue to fine tune and update this application, we are working with our adult medicine colleagues to make this application useable for both pediatric and adult providers. We also hope to provide display not just the result for the test the user is interested in, but also comparative tests with higher quality and lower cost.
This application allows the user at their fingertips to understand both the quality of the diagnostic test for the individual patient, as well as, the cost. The application’s use will not only be vital at the bedside of a patient but also during physician teaching where there will be a new emphasize on choosing the best test at the lowest cost for all diagnostic questions. We look forward to a day where healthcare quality and cost is just as available as the information regarding your neighborhood restaurants and we are working to make that happen.
Maya Dewan, MD, MPH is a critical care fellow at The Children’s Hospital of Philadelphia and a contestant in the second annual Teaching Value and Choosing Wisely Challenge.