Public Release: 

How often are cost considerations documented in clinical notes?

JAMA Network Open

Bottom Line: Treatment in intensive care units (ICUs) is driven by urgency rather than economic considerations. Many clinicians have been trained not to consider financial issues when making treatment decisions but health care costs can be an important concern for patients and their families. To investigate how financial concerns are associated with health care decision making, researchers analyzed clinical notes from more than 46,000 ICU admissions at a large academic medical center. They report nearly 2,000 patients (about 4 percent) had at least one note reflecting financial considerations during the ICU stay. Among the total admissions, 142 (0.3 percent) included notes describing a change in the discharge plan, 142 (0.3 percent) describing a change in the treatment plan, and 303 (0.7 percent) describing a change in medication or previous nonadherence to medication associated with financial considerations. The findings highlight the importance of understanding how financial constraints may alter treatment decisions in ICUs.


Authors: Deborah D. Gordon, M.B.A., Harvard Kennedy School, Cambridge, Massachusetts, and coauthors

To Learn More: The full study is available on the For The Media website.


Editor's Note: The article contains conflict of interest and funding support disclosures. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

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About JAMA Network Open: JAMA Network Open is the new online-only open access general medical journal from the JAMA Network. Every Friday, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

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