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Feedback of laboratory usage and cost data to clinicians: does it alter requesting behaviour?
R Gama1, P G Nightingale, P M Broughton
1Department of Clinical Chemistry, Wolfson Research Laboratories, Queen Elizabeth Medical Centre, Birmingham, UK.
Insights
Providing physicians with laboratory data feedback significantly reduced outpatient test requests and costs. This intervention improved physician awareness of laboratory usage and expenditure without affecting inpatient care.
Area of Science:
- Clinical Chemistry
- Health Services Research
- Medical Economics
Background:
- Physician requesting behavior significantly impacts healthcare costs.
- Monitoring laboratory utilization is crucial for resource management.
- Understanding the effect of data feedback on physician behavior is essential.
Purpose of the Study:
- To evaluate the impact of laboratory data feedback on physician requesting behavior in general medicine.
- To assess changes in clinical chemistry laboratory usage and associated costs.
- To determine the effectiveness of performance monitoring and peer comparison.
Main Methods:
- A 1-year prospective study involving general medicine physicians.
- Monthly feedback of laboratory usage and expenditure data provided to an intervention group.
- A control group receiving no data feedback.
- Comparison of outpatient and inpatient laboratory utilization and costs before and after intervention.
Main Results:
- A significant decrease in outpatient tests (25%), requests (13%), and revenue expenditure (18%) per visit in the intervention group (P<0.01).
- Reductions were most notable in commonly requested, low-cost tests.
- No significant changes were observed in laboratory use or expenditure for inpatients.
- Physicians found the data feedback acceptable and it increased their awareness of usage and costs.
Conclusions:
- Feedback of laboratory data is an effective strategy to modify physician requesting behavior for outpatients.
- This intervention can lead to reduced laboratory workload and healthcare expenditure.
- The findings highlight the potential for data-driven insights to optimize resource utilization in clinical chemistry.
Abstract:
In a 1 year prospective study we evaluated the effect of feedback of laboratory data on the requesting behaviour of physicians in general medicine. Data on within-hours and out-of-hours clinical chemistry laboratory usage and revenue expenditure for inpatients and outpatients, expressed in terms of clinical workload, were supplied monthly to a group of three consultant physicians in general medicine. With these data the physician could monitor his performance over a period of time and compare it with that of his peers. Two consultants in general medicine who received no information served as controls. Over a period of 6 months, there was a 25%, 13% and 18% decrease in tests (P less than 0.01), requests (P less than 0.05) and revenue expenditure (P less than 0.01) per outpatient visit, respectively, in the intervention group of physicians following the introduction of feedback when compared to their baseline period and to the control group. The decrease (P less than 0.01) was in the commonly requested and 'seemingly cheap' tests. There was no significant change in laboratory use and expenditure on inpatients. The feedback of laboratory data was acceptable to the physicians, raised their awareness of laboratory usage and costs and decreased laboratory workload and expenditure.