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A computer based intervention to reduce unnecessary serologic testing.

D H Solomon1, R H Shmerling, P H Schur

  • 1Robert B. Brigham Multipurpose Arthritis and Musculoskeletal Diseases Center, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA. dhsolomon@bics.bwh.harvard.edu

The Journal of Rheumatology
|December 22, 1999
PubMed
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An interactive computer program significantly reduced unnecessary laboratory test orders for systemic rheumatic diseases by displaying post-test probability estimates. This intervention decreased test orders by 10% without impacting new diagnoses.

Area of Science:

  • Rheumatology
  • Clinical Pathology
  • Health Informatics

Background:

  • Laboratory testing is crucial for diagnosing systemic rheumatic diseases.
  • Uncritical test ordering leads to increased costs and potentially misleading results.
  • House officers in teaching hospitals frequently order tests like antinuclear antibody and rheumatoid factor.

Purpose of the Study:

  • To decrease the number of unnecessary antinuclear antibody, rheumatoid factor, and complement level tests ordered by house officers.
  • To evaluate the effectiveness of a computer-based interactive test ordering program.

Main Methods:

  • A prospective cohort study was conducted using a computer-based order entry system.
  • An interactive program displayed post-test probability estimates during order entry.

Related Experiment Videos

  • A control group received no intervention; test order cancellation rates were compared.

    • Main Results:

    • The intervention group showed a significantly higher cancellation rate (11%) compared to controls (0.4%, p=0.001).
    • Physician pretest probability estimates did not correlate with test order cancellation.
    • Only 1% of all tests resulted in new rheumatic disease diagnoses.

    Conclusions:

    • A computer-based intervention effectively reduced orders for antinuclear antibody and rheumatoid factor tests by 10%.
    • Further reductions in testing are feasible given the low diagnostic yield for new rheumatic diseases.
    • Optimizing laboratory test ordering can improve efficiency and reduce healthcare costs.