The impact of peer management on test-ordering behavior

Area of Science:

• Healthcare Management
• Clinical Operations
• Health Economics

Background:

• Hospital laboratory testing is essential but often excessive and costly.
• Previous efforts to curb unnecessary testing have faced implementation challenges.

Purpose of the Study:

• To evaluate the effectiveness of peer management by a resource utilization committee (RUC) in modifying physician test-ordering behavior.
• To improve resource utilization in a large academic medical center.

Main Methods:

• An interrupted time-series study was conducted at an academic medical center utilizing a CPOE system.
• Two interventions were implemented: a daily prompt to discontinue tests beyond 72 hours and unbundling of panel tests with reduced repeat ordering ease.
• Data on test volumes, abnormal chemistry levels, readmissions, ICU transfers, and mortality were analyzed.

Main Results:

• The first intervention reduced metabolic panel component tests by 24% and ECGs by 57%.
• The second intervention further decreased metabolic panel component tests by 51% and portable chest radiographs by 16%.
• Abnormal chemistry levels decreased post-intervention; readmission, ICU transfer, mortality, and length of stay remained unchanged.

Conclusions:

• Peer management effectively reduced provider variability in test ordering and improved resource utilization.
• Hospitals can leverage peer management through CPOE systems to control healthcare costs.
• Limitations include potential influence from concurrent activities and assessment of a limited test set.