Background:

Out-of-pocket costs are a serious barrier to care and drive suboptimal medical therapy. Understanding of these costs can lead to care oriented around the limits they generate. Despite this, there is minimal attention paid to these costs in post-graduate education.

Objective:

To define a potential knowledge gap regarding costs experienced by patients by surveying Internal Medicine residents at our large academic institution.

Methods:

We surveyed Internal Medicine residents in spring 2019 about knowledge and practices surrounding patient out-of-pocket costs. Participants answered questions considering their most recent inpatient panel and their clinic patient panel. Familiarity was ranked on a 5-point Likert scale, and for the purposes of presentation, was divided into “Poor” and “Moderate or Better.” Non-parametric analysis was used to test differences between outpatients and inpatients and by year of training.

Results:

Of 159 residents, 109 (67%) responded. Familiarity with patient insurance status was moderate or better in 85%. Reported understanding of costs associated with medications, testing, and clinic visits was less common. Respondents had higher familiarity with out-of-pocket costs for clinic patients compared with inpatients. Knowledge of cost of care was not an often-considered factor in decision making. There was no significant difference in response by year of training.

Conclusion:

Patient out-of-pocket costs are an important dimension of patient care which Internal Medicine Trainees at our institution do not confidently understand or utilize. Improvements in education around this topic may enable more patient-centered care.

中文翻译：

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内科实习生对自付费用的理解和反应

背景：

自付费用是护理和推动次优医疗治疗的严重障碍。了解这些成本可以导致围绕它们产生的限制进行护理。尽管如此，在研究生教育中对这些成本的关注却很少。

客观的：

通过调查我们大型学术机构的内科住院医师，确定有关患者所经历费用的潜在知识差距。

方法：

我们在 2019 年春季对内科住院医师进行了关于患者自付费用的知识和实践的调查。参与者根据他们最近的住院病人小组和他们的诊所病人小组回答了问题。熟悉度采用李克特 5 点量表进行排名，出于演示的目的，分为“差”和“中等或更好”。非参数分析用于测试门诊患者和住院患者之间以及培训年份之间的差异。

结果：

在 159 名居民中，109 人（67%）做出了回应。85% 的患者对保险状况的熟悉程度中等或更好。据报道，对与药物、检测和门诊就诊相关的成本的了解较少。与住院患者相比，受访者对门诊患者的自付费用更为熟悉。对医疗费用的了解并不是决策中经常考虑的因素。不同培训年份的反应没有显着差异。

结论：

患者自付费用是患者护理的一个重要方面，我们机构的内科实习生无法自信地理解或利用它。围绕这一主题的教育改进可能会带来更多以患者为中心的护理。